Tracking Health Care Reform
Greetings!
As we head into the final months of 2019, the issues surrounding health care are hotter than ever. The Affordable Care Act is facing a federal court decision while Congress and the White House are pushing major changes on the legislative and regulatory fronts. Many of these issues will be addressed at the Society of Actuaries annual meeting next month in Toronto, where I'm scheduled to moderate a panel of state insurance commissioners. Plan to attend Session 131 on Tuesday, October 29, for a candid, informative discussion. -- Dave Dillon
Premiums Show Modest Increases
Insurers Expand into New Markets
Recent reports reflect an Affordable Care Act marketplace that has stabilized and is in relatively good health. In most states consumers will see modest increases next year in premium costs. Read more.
Health Care in Court
Twenty states have challenged the constitutionality of the Affordable Care Act, once again casting doubt on the future of the 10 year-old law. While a federal judicial court in New Orleans is expected to issue a decision this fall, many observers believe the case is ultimately destined for the Supreme Court.
Learn more.
Cost Trends
Here's an excellent report from the Society of Actuaries in collaboration with the Health Care Cost Institute. A data extract that contains commercial health care cost and utilization metrics, it also can be viewed with an interactive tool. See it here .
Consumer-Oriented
Health Reform
The White House and Congress have proposed major changes to make buying medical care and prescription drugs more transparent, including a bi-partisan measure to end surprise medical bills. Read the story.

Delivery Transformation

Providers today are taking on risk as part of the fundamental shift to value-based care. In this article , Joe Wurzburger, health staff fellow at the Society of Actuaries, examines the deepening role of the actuary with Kurt Wrobel, CFO and chief actuary at Geisinger Health Care.
MEDIA COVERAGE
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PODCASTS

Need a recap of the Society of Actuaries Health Meeting in June? Meeting Chair Rick Pawelski talks about the key speakers, takeaways and highlights . Listen.

How do pharmacy rebates impact the healthcare market? This podcasts includes a discussion of proposed changes to improve transparency and what actuaries need to consider when pricing or reserving for health products. Listen.

Leadership interview #1: Society of Actuaries President Jim Glickman talks about his path to becoming and actuary and his broad experience in the profession, which began when he was in high school.

Leadership interview #2: Karen Shelton, Chair of the SOA's Health Section Council, discusses how she became an actuary, her experience as a volunteer, and lessons she has learned along the way.
Listen .

Identifying trends in claims costs is a key element in pricing insurance products in volatile ACA markets. What are the various methods actuaries are using today to more accurately predict utilization?

Successful Medicare Advantage data maintenance involves addressing data quality issues, rectifying adjudication errors, comparing to internal and external benchmarks and making the necessary adjustments to comply with guidelines. How can plans collect, review, and react to their claims experience to optimize financial results and create efficient processes?