[20181003]IF10994_私人健康保险市场的风险调整.pdf

https:/crsreports.congress.gov Updated October 3, 2018Risk Adjustment in the Private Health Insurance MarketSection 1343 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) established a permanent risk adjustment program that is designed to assess charges to private health plans in a state that have relatively healthier enrollees and to use collected charges to make payments to private health plans in the same state that have relatively sicker enrollees. The risk adjustment program aims to reduce the incentives insurers may have to avoid enrolling individuals who are at risk of high health care costs. All non-grandfathered, individual (non-group) market and small-group market health plans, both inside and outside of the exchanges, participate in this program. This In Focus briefly describes risks the ACAs risk adjustment program is expected to mitigate and provides an overview of the program. More information about the risk adjustment program is available in CRS Report R45334, The Patient Protection and Affordable Care Acts (ACAs) Risk Adjustment Program: Frequently Asked Questions. Risk Mitigation Individuals differ in their risk in the health insura