Here’s the deal with the Obamacare ‘bailout’

January 27

Explain the Obamacare 'bailout' to me as simply as possible.

The Obamacare "bailout" is a term that Republicans recently began using to describe three programs in the health-care law -- two temporary and one permanent --  that make it less financially risky for health insurance plans to sell on the new exchanges. Sometimes its also used to refer to one specific program in the health-care law known as 'risk corridors.'

What are risk corridors? Are they as boring as they sound?

Risk corridors limit both the amount of money that a health insurance plan can make -- and how much it can lose -- during the first three years it sells on the health insurance exchanges. Risk corridors tend to exist in the bowels of actuarial science rather than in New York Post op-eds but, since they're having a moment in the sun, we'll stop here to explain this very technical program in two paragraphs.

Some background is helpful here: Typically, insurance companies rely on their past experience to set prices; how many people got sick in 2013 can be a good proxy for estimating how many people will get sick in 2014. But when insurance companies went onto the exchanges, none of them had ever sold in the Obamacare marketplaces. They didn't have a 2013 to rely on, which made setting premiums a vexing task.

One way insurance companies could mitigate their risk was by setting premiums pretty high -- if you charge each person $800 per month, for example, to sign-up for your plan, you will probably cover the cost of claims. But the Obama administration was worried that such high prices would scare away consumers and enter the risk corridors, a program that reimburses insurance plans for claims that cost significantly more than premiums that new subscribers paid in.

What counts as "significantly" more? 

The risk corridor program kicks in when health insurers show that the claims their subscribers submit outpace premiums they paid in by more than 3 percent. So, if we take the World's Tiniest Insurance Company and say it received $100 in premiums (it is, after all, very tiny) but paid out $110 in claims, it would get help from other insurance plans paying for that $10 above and beyond the $100 paid in premiums -- but the government will not foot the whole bill.

For claim costs that are 3 to 8 percent higher than the amount paid in premiums, the federal government will reimburse half that amount. For costs that exceed 8 percent, insurers will be reimbursed 80 percent. So, if we stick with World's Tiniest Insurance Company example, this means the government would reimburse it $4.10: $2.50 for 50 percent of the 3 to 8 percent cost above the premium, which in this case was $5, and another $1.60 for 80 percent of remaining 2 percent, $2 in this example, in additional costs.

Could you put this in a chart?

We can't--but the American Academy of Actuaries can! This chart shows how the risk corridor program kicks in at different levels of claims paid out.

bailout

Where does the money to pay insurance companies come from?

Other insurance companies. All non-grandfathered plans are required to pay into a pot of money that's used to fund the risk corridor program. This means there's potential for insurers to lose money through the risk corridor program, which is what you see represented on the left side of the above chart. If an insurance company finds that their premiums way more than cover claims paid out - the technical definition of "way more" here is defined as claims cost at least 3 percent less  than premiums - then that health plan has to fork over some of that money into the risk corridor pool.

And this just goes on forever, each year?

No -- the health-care law's risk corridors are a temporary program that expires in 2016. By then, insurance plans should have enough experience with who is in their plans and the level of claims they submit in order to accurately price their insurance products.

So is this a bailout?

No, and you can read a great explanation of why here from Mike Konzcal.

More generally, risk corridors are a pretty common feature of insurance design. They're still used in Medicare Part D, the program where private insurers sell prescription drug plans to seniors. "Any conservative plan for universal coverage will have to use similar methods risk adjustment," Yevginey Feyman writes for Forbes.  "The point here is simple - if you want insurers to participate more broadly in the individual market, you'll need to offer a carrot to offset the unavailable uncertainties."

Or, as MIT economist Jon Gruber put it to Sahil Kapur, "This is yet another feature of Obamacare that's designed to minimize any disruption caused to insurance markets.  "The risk corridor is pretty wide, so you have to make a lot of money or lose a lots of money for it to kick in."

It's worth noting too that the risk corridors don't offer full protection. Insurance plans that screw up their pricing are still paying a portion of the costs of the claims that outpace premiums. And if their losses are in that zero to 3 percent range above premiums paid in, they're not getting any help at all. The risk corridors are a buffer for health plans, but they aren't full protection against financial loss.

You mentioned earlier there were three programs. What are the other two?

Are you ready to get wonky? Hope so! The two other programs are called risk adjustment and reinsurance.  In the risk adjustment program, Health and Human Services collects funds from plans who have healthier enrollees and redistributes them to plans that have sicker enrollees. Unlike risk corridors, this is a permanent part of the health-care law. In the temporary reinsurance program (which, like risk corridors, runs through 2016), Health and Human Services has $10 billion in federal funding to help insurers pay the cost of especially expensive enrollees.

More specifically, the reinsurance program helps health plans pay for subscribers who run up at least $60,000 in claims. There is a cap on reinsurance payments, too: Above $250,000, the health plan would once again be responsible for covering its subscribers' costs.

More charts please!

Okay! Here's a great one from Kaiser Family Foundation that puts all three of these programs onto one page, comparing their main features.


What's the precedent for these types of programs, or do they just exist because the health-care law is going so badly?

There is indeed precedent: Medicare Part D has existed for nearly a decade and still uses these type of policies to make the market for selling drugs to seniors a friendly one for insurers to enter. The risk corridors were part of the Affordable Care Act well before the health-care law roll out went so poorly.

Will Republicans repeal the risk corridors?

Sen. Marco Rubio (R-Fla.) has introduced legislation that would repeal the risk corridor program, although its unlikely that the Democratic-controlled chamber will bring up the legislation for a vote. Like many other parts of the health-care law, its possible that the Republican-run House could pass this type of legislation but it would fail in the Senate and near-certainly be vetoed by the President.

In early February, the Congressional Budget Office put another kink in the Republicans' repeal plan: It estimated that the risk corridors will actually save the federal government $8 billion, because insurance companies will pay more money into the program than they take out of it. More specifically, the CBO projects that the federal government will collect $16 billion from health insurers who have premiums outpace claims--but only distribute $8 billion to the plans who don't have enough premiums to cover medical costs. That leaves over $8 billion in savings for the federal government.

And insurance companies are okay with that? They're essentially handing $8 billion over to the federal government.

Health plans are, in fact, supporters of the risk corridors, which they essentially see as limiting the risk of entering a new insurance market. Yes, they might end up paying for that limited risk. But it also makes it much easier to test out the exchanges, and reduces the possibility of catastrophic losses in the early years.

This is the part where there's an animal video, right?

You guys know me too well. Here's Bao Bao the baby panda.

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