1. Unveiling Invisible Risk Pools
Mark A. Hall
Wake Forest University
Brookings Institution, with Nick Bagley

2. Industry-Funded Reinsurance Pools For The Small Group Market
State
Year Enacted
Enrollment mid-2006
Alaska
1993
Repealed
Connecticut
1990
>3,000
Idaho
~ 120
Massachusetts
1991
Missouri
1992
Nebraska
1994 20
New Hampshire
2005
>600
North Dakota
Vermont
Never Implemented
Wyoming
~ 30

4. Anthem Projections in Maine, 2012

6. 2 Birds, One Stone?
Does Risk Adjust + Retro Reins = Prospec. Reins?

7. Maine Health Assessment Form
Medical Conditions and Treatment.
A. Have you or any person to be covered been diagnosed or received treatment in the last two (2) years for any of the following conditions?
Cancer – Brain and Nervous System D Yes D No
Cancer – Breast D Yes D No
Cancer – Colon/Rectum D Yes D No
Cancer – Esophagus D Yes D No
Cancer – Lung, Bronchi, Pleura D Yes D No
Cancer – Multiple Myeloma D Yes D No
Cancer – Myeloid Leukemia D Yes D No
Cancer – Ovary D Yes D No
Cancer – Pancreas D Yes D No
Cancer – Urinary Bladder D Yes D No
Celiac Disease D Yes D No
Cerebral Palsy D Yes D No
Chronic Kidney Disease D Yes D No
Chronic Seizure Disorders D Yes D No
Cirrhosis of the Liver D Yes D No
Coagulation Defect (Hemophilia) D Yes D No
Coronary Artery Disease D Yes D No
Coronary Occlusion D Yes D No
Crohn’s Disease (Inflammatory bowel disease) D Yes D No
Cystic Fibrosis D Yes D No
Friedreich's Ataxia D Yes D No
Heart Disease Requiring Open Heart Surgery D Yes D No
Hepatitis D Yes D No
Hodgkin's Disease (Lymphoma) D Yes D No
Huntington's Chorea or Huntington’s Disease D Yes D No
Hypertension D Yes D No
Insulin Dependent Diabetes D Yes D No
Lupus D Yes D No
Myasthenia Gravis D Yes D No
Myotonia D Yes D No
Parkinson's Disease D Yes D No
Polycystic Kidney Disease D Yes D No
Psychotic Disorders D Yes D No
Quadriplegia/Paraplegia D Yes D No
Scleroderma D Yes D No
Stroke D Yes D No
Syringomyelia D Yes D No
Thrombosis D Yes D No
Ventricular Septal Defect D Yes D No
Wilson's Disease D Yes D No

8. Subsidy Efficiency
$10-$15 billion required to reduce uninsured by ~ 1 million
That equals $10,000 - $15,000 per newly insured

9. Bifurcated Risk Pools ACA transitional “grand-mothered” plans 2015
ACA Compliant
Noncompliant
Difference
Premiums
$355
$231
54%
Claims
$350
$190
84%
MLR
99%
82%
17 points

10. Premiums for Selected HIPPA Nongroup Plans in 3 States GAO 1998
Premium as a percentage of Carrier standard rate A 140 B 150 C 185 D 200 E 200 F 225 G 300 H 300 I