Small Business Exchanges & Risk Adjustment at Online Marketplaces

This discussion is about two aspects of the new healthcare sector that is arising in America—the Reforms and Exchanges like the Shop Exchange.

Small Businesses have Reason to Cheer with Shop Exchanges

Small businesses are among one of the most targeted segments at the healthcare exchanges that are due to surface in October 2013. Exchanges are likely to engage thousands of small business employers; typically, those with less than 50 employees. Exchanges are due to provide an even playing field for smaller businesses who have traditionally suffered because of their larger counterparts and have usually been underinsured as the payers have been reluctant to offer them the same level of service as that offered to the bigger employers. Federal regulations will ensure that this kind of inequality is removed. The shop exchange framework will further offer tax credits for smaller businesses as long as they are honest in providing details about their employee strength, annual earnings and the kind of coverage they want to purchase. SHOP Exchanges will also offer options as to how smaller employers can provide coverage opportunities to their employees and have access to an easier system of employee benefit management.

Risk Adjustment under ACA Norms

Federal rules have placed emphasis on how the payers handle their risk pool. Risk adjustment should be done in such a manner that a payer cannot manipulate into signing upon only the low-risk individuals. Those with pre-existing conditions or job-related health hazards too need to be covered as well as those with a genetic disposition towards developing a medical condition. The idea is to spread the risk pool across the payers in such a manner that all people, irrespective of the amount of risk they pose, have access to healthcare enrollment. Health plans have to take upon a minimum pool of high-risk individuals and depending upon the kind of health claims they settle, they will get contributions from the state and federal governments for offsetting the resulting costs of higher coverage. Considering these changes, insurers are now asked to present diagnostic, prescription, demographic and other relevant data that defines their risk pool. This is applicable to the small group market and individual market, in and outside the exchanges.