Participation: Is It a Good Thing or a Bad Thing?

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One of the central tenets of underwriting medical plans is to avoid adverse selection at all cost. Adverse selection results when a plan is designed or priced in such a way that it only adequately incentivizes sicker employees to enroll; failing to attract good risk to offset the bad. For this reason, most insurers historically… [Read More]

Is Disaster Brewing in New York’s Small Group Market?

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The United Hospital Fund (UHF) just issued a comprehensive study of patterns in the New York State small group market and they don’t look good. From 2007 to 2016 enrollment shrank by 600,000 members, to 1.1 million. Rates were 35% higher than the national average. This, despite New York being one of the very few states to increase… [Read More]

Extreme Healthcare Chaos

Stethoscope with American Flag Reflection on Wooden Table.

Turmoil by executive order again… On Thursday, President Trump threw two more giant logs on the raging healthcare marketplace fire by ordering the discontinuance of federal funding for cost-sharing subsides for low income Americans and by directing the Secretary of Labor to provide guidance on liberalizing association healthcare plan rules. Cost-sharing subsidies made healthcare affordable… [Read More]

A Look Back at Private Exchanges

A Look Back at Private Exchanges

It’s been about 5 years since we posted our thoughts about the likely adoption of private exchanges. At the time, consultants and Wall Street analysts were touting these exchanges as the greatest innovation in employer benefits since 401(k)s. Many suggested that by 2018 more than 20%, and perhaps as many as 50%, of employers would… [Read More]

Wikileaks Gives an Inside View of Clinton’s Healthcare Thinking


Wikileaks recently exposed a Clinton campaign memorandum on the shortcomings in the Affordable Care Act. Well at least they understand that there are shortcomings. These include: Penalties that are insufficient to draw in young, healthy Americans Disappointing enrollment at less than half of the Obama administration’s projections primarily due to the lack of affordability for people earning… [Read More]

Private Exchanges: Despite the Hoopla, They’re Not for Everyone


There’s a buzz about the advent of private exchanges: An employer provides employees a fixed dollar amount with which they can purchase a variety of medical and ancillary insurance products. Employees buy as much or as little coverage as their needs and risk appetites determine, and the employer’s cost is fixed. The intent is to… [Read More]