American Academy of Actuaries to work with regulatory authorities to enhance quality of care

American Academy of ActuariesMar 26 2010

With the enactment of health care reform legislation yesterday, the American Academy of Actuaries said the successful implementation of this and forthcoming reconciliation legislation will require coordinated efforts to ensure that the regulatory development process accomplishes the intended goals of reform. The actuaries plan to work with regulatory authorities as they begin implementing reform legislation to meet its goals of increasing the availability and affordability of coverage, enhancing the quality of care, and addressing health spending growth.

"Health care reform legislation has been passed, but many of the details regarding implementation need to be worked out at both the federal and state levels," said Cori Uccello, the senior health fellow for the American Academy of Actuaries. "Actuarial expertise will be essential in the development of new regulations if the insurance market is to successfully implement health care reform."

In the near term the actuaries will focus on the reform provisions that take effect most immediately, including the new medical loss ratio requirements that will apply to insurers in the individual and group markets. To calculate loss ratios, the value of benefits received by policyholders is divided by the premiums paid. But Uccello said that, "There are countless technical issues regarding how to define benefits and premiums that will need to be worked out."

The actuaries will also focus on forthcoming regulations regarding market reforms that will become effective in 2014. Uccello said that actuaries will work with regulators to structure health insurance exchanges and implement the individual health insurance coverage mandate to successfully reduce adverse selection.