Tuesday, June 9, 2015

GAO Report: Patient Protection & Affordable Care Act

The General Accounting Office (GAO) has released a report, Patient Protection and Affordable Care Act: Despite Some Delays, CMS Has Made Progress Implementing Programs to Limit Health Insurer Risk, which evaluates the three programs mandated under the Affordable Care Act (ACA) to mitigate the risks issuers of health insurance faced starting in 2014.

Each of these three programs—risk adjustment, reinsurance, and risk corridors—was intended to account for a different source of issuer risk, such as enrollee health status or high-cost medical claims. CMS considered a range of market characteristics—including demographics and the availability of data—in making decisions about how to design each of the programs. CMS's design decisions also reflected the temporary status of the reinsurance and risk corridors programs, which are set to expire after 3 years. While CMS considered similar Medicare risk mitigation programs during the design process, key differences in the markets served by Medicare and the ACA programs resulted in different approaches to their design.

GAO was asked to provide information on the design and development of these three programs and issuer perspectives on them. Subsequently this report, describes: (1) the factors that guided CMS's design of these programs, (2) the data collection systems CMS developed for these programs, (3) CMS's plans to monitor and evaluate the programs, and (4) issuer experiences with the programs. GAO reviewed regulations, guidance, and documentation about design and implementation activities and interviewed CMS officials. 

To obtain a copy of the full GAO report go to http://www.gao.gov/products/GAO-15-447.

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