Lewis & Ellis Inc.

Health Care Reform & Policy

Health Care reform has been in the news for some time. The Affordable Care Act (ACA) has far reaching effects for issuers of both private and public health insurance industry. The ACA is significantly impacting the actions of states, employers, health insurers, health care providers, and insurance consumers.

Health benefit exchanges

L&E is uniquely positioned to help states successfully design and analyze the impact of a Health Benefit Exchange. Known for our technical acuity and comprehensive knowledge of the healthcare industry, L&E offers independent analysis to help states cost-effectively manage their populations without compromise.

L&E has assisted multiple state insurance and Medicaid departments in making difficult, data-driven decisions regarding the development of an Exchange. To assist these agencies prepare for healthcare reform, L&E has developed actuarial and economic models that can be tuned to their needs.

These simulation models states understand and indentify the enrollment and premium shifts that will occur as a result of the implementation of Exchanges and other healthcare reforms. These models answer all reform questions using a number of different variables, including population by income, current health status, insurance coverage, state-level cost variation, and the cost variation across all insurance markets.

L&E’s expert consulting partnered with its robust modeling tools provides the states with unmatched analytic expertise.

Effective rate review programs

The passage of the ACA has brought an unprecedented level of scrutiny and transparency to health insurance rate increases. The Act ensures that any proposed rate increase by individual or small group market insurers at or above 10 percent will be scrutinized to make sure it is justified. States with effective rate review systems must conduct the reviews, but if a State lacks the resources or authority to conduct the required rate reviews, the Department of Health & Human Services (HHS) will conduct them. 

L&E has assisted multiple states develop rate review programs to ensure that they meet the requirements of an effective rate review program. Services provided to states include:

The right health care services

L&E works with state and other governmental agencies, national associations, and employers to measure the impact of federal reform implementation and to develop and analyze the coverage and cost impact of alternative health care reform initiatives.

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Testimonials

“We are extremely pleased with their work to date and would highly recommend their professional actuarial services for your needs.”

-- Oklahoma Department of Insurance