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Profitability on ACA Public Exchanges: In the Eye of the Storm or the Heart of the “Churn”?

Healthcare Spotlight 4
June 10, 2016
by ,
Summary

Participating in the public health insurance exchanges established by the Affordable Care Act (ACA) has been a tremendous financial strain for most health plans. Approximately three-quarters of exchange plans lost money in 2015.

There has been much discussion about how public exchanges are everything health plans had feared, and then some. In response to these challenges and losses, many have increased premiums, dropped PPO plans, and reduced sales commissions for brokers. Some are pulling out of selected exchange markets altogether.

In this Executive Insights Healthcare Spotlight, we examine how a few profitable exchange plans may yield some insights — and raise key questions — as to how sustainable exchange plans will evolve. What are the lessons for a more sustainable exchange future?

http://cdn.lek.com/sites/default/files/LEK_HS_Profitability_ACA_Public_Exchanges.pdf