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As individual markets fail, employers should expect more enrollees in 2018

The individual market was already hurting, and now the federal government is cutting off millions in subsidies that help insurers offer plans to individuals at more affordable rates.

Open Enrollment season will soon be upon us, and this year could look quite a bit different for many employers. Why? People who currently have individual policies are weighing their options, and employer plans are looking better and better. The individual insurance market is in serious jeopardy of implosion as a result of Trump’s recent executive order on health  care (and other underlying drivers) removing much of the financial backstops committed to under PPACA. As a result, employer health plans may be absorbing many of the people who otherwise would have purchased an individual plan in 2018.

So what exactly is happening? The individual market was already hurting, and now the federal government is cutting off millions in subsidies that help insurers offer plans to individuals at more affordable rates. The rare exchanges/insured plans that weren’t suffering before the executive order will likely enter a downward spiral soon.

It’s a familiar story we’ve seen before: Insurance carriers losses worsen, premiums rise sharply, and the healthy/young people so desperately needed to balance the risk will opt for a skinny plan or go uninsured altogether—thus the problem continues. The moral of this story is that employers need to prepare. They hold a disproportionate percentage of the risk – and must use all tools available to manage this risk. Here are a few key areas on which to focus your energy in the coming year:

  • Pressure test budgets
  • Look at your Rx management strategy
  • Review current contributions/employee costs to make sure your plan can sustain the additional risk.

Last but definitely not least in today’s climate, consider the supply side of care. With more than 90% of hospital beds and physicians currently participating in national networks, employers are beginning to ask: “Is this a network, or a 3rd party retail financing mechanism?” High performance, smaller networks and other innovative products offer employers more tools to mitigate risk. These will become even more important in the year ahead.

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