Issues in Merging the Individual and Small-Group Markets在合并的个人和小团体的市场问题.pptVIP

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Issues in Merging the Individual and Small-Group Markets在合并的个人和小团体的市场问题.ppt

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Issues in Merging the Individual and Small-Group Markets在合并的个人和小团体的市场问题

Issues in Merging the Individual and Small-Group Markets Elliot K. Wicks, Ph.D. Health Management AssociatesJanuary 2007 Only 5% of Population Has Individual Coverage, 14 Million Why merge? Poor individual market performance For high-risk people, premiums too high or even denied coverage Due to insurer risk rating/medical underwriting Coverage sometimes “skimpy” High deductibles, less comprehensive than typical Very few insurers participate — risky, not much revenue compared to other markets Result: many individuals don’t buy coverage What expectations from merger? Spread risk/costs over more people, bring down costs in individual market, because . . . Small-group rating rules limit insurer latitude Can’t deny coverage Allow less rate variation based on risk Thus merger expected to reduce premiums for higher-risk people now in individual market Why poor performance in individual market? Strong danger of adverse selection against the whole market: Attract too many high-risk people, because . . . People can partially predict need for medical care Tend to enter market when expect to incur expense Violates the insurance principle: high-risk and low-risk people contribute premium to avoid large, unpredictable loss/medical claim. Premiums would rise, low-risk people would stay out: spiral of adverse selection Due to voluntary nature of buying insurance coverage People wait to buy individual coverage until they need it, because Cost is high relative to often skimpy benefits Many are lower income (no employer coverage), just out of work, maybe poor health, just entering labor force No employer subsidy No tax subsidy, unlike employer coverage So to lower-risk people, may seem not a good value The Voluntary Market Dilemma Either allow risk-rating and denial of coverage, with resultant hardship for high-risk people, or Have adverse selection against the market, with consequent likely market failure The Individual Market Problems Potential for adverse selection against the ma