Insurance premiums are in large part a function of risk-adjusted expected outlays, with the addition of administrative costs and profit added on. Factors that affect risk-adjusted outlays include such common features of insurance as co-pays, deductibles, out of pocket maximums, and the underlying benefits that are covered, as well as the available provider network and, of course, the underlying illness of the insureds.
The Affordable Care Act isolated ~ 11 million individuals with high medical costs in a high-risk insurance pool (the Individual Market), creating high premiums and a no-win situation for the relative handful of healthy individuals who need to buy insurance in the Individual Market and are not eligible for a government subsidy. At the same time, it left more than 150 million insured Americans with little or no exposure to the premium costs of the Individual Market. That is the key to this presentation - without quantifying all the elements of the cost of insurance, you cannot possibly understand the conflict surrounding the ACA or compare premiums.
We will also address the issues of severability in legislation that is the core issue before the Supreme Court, subsidies, and the peculiar method of risk-sharing in the ACA Marketplace, among other topics.
Learning Objective:
- Identify the Four Horsemen of the health insurance apocalypse
- Identify the different types of plans including Large and Small Group Markets, Individual/Obamacare Marketplace, Self-insured Market, and Adverse Selection.
- List and define the "Precious Metals" of Obamacare
- Identify the subsidies in the Obamacare Marketplace
- Recall the peculiarities of risk-sharing in the Obamacare Marketplace
- Recognize a fair way to share the actuarial risk of the Individual Market
Mark Dietrich
Mark O. Dietrich
CPA
[email protected]
(508) 877-1999
Mark O. Dietrich is a summa cum laude, Beta Gamma Sigma graduate of Boston University, where he also earned an MBA with high honors. He holds a Master in Taxation degree from Bentley College as well.
A prolific writer, Mark is Editor and Contributing Author to the Business Valuation Resources/American Health Lawyers’ Association Guide to Healthcare Finance and Valuation 4th Edition, Editor and Principal Author of Business Valuation Resources Guide to Physician Practice Valuation 3rd Edition; and co-editor and contributing author to the Business Valuation Resources/ American Health Lawyers’ Association Guide to Valuing Physician Compensation and Healthcare Service Arrangements 2nd Edition and co-author with Gregory Anderson, CPA/ABV, of The Financial Professional’s Guide to Healthcare Reform. Mark is also the author of the Medical Practice Valuation Guidebook and co-author of Thomsen-PPC’s Guide to Healthcare Consulting along with more than 100 articles on valuation, taxation, managed care, and the healthcare regulatory environment.
Mark’s career experience includes serving as partner-in-charge of the annual audit of an 80-physician tax-exempt faculty group practice affiliated with a major teaching hospital, representation of tax-exempt and taxable entities in Internal Revenue Service field audits, participation in the development of a 250-physician network and negotiation of managed care and Medicare Advantage contracts, and more than 450 valuation and litigation support engagements in the healthcare industry. Mark has an in-depth knowledge of the healthcare payment and regulatory environment, including such arcane matters as physician billing codes and the impact of local market provider payment rates on fair market value compensation.
A regular speaker at state and national conferences on healthcare reform, valuation, and other topics, Mark also lectured in the United Kingdom in 2009, 2011, 2012, and 2014 on Managed Care, Healthcare Valuation, and on Valuation of Medical Practices to Her Majesty’s Revenue and Customs. He served as Chairperson of the American Institute of CPA’s (AICPA) National Healthcare Industry Conference for 2012 and 2013, chaired the AICPA Virtual Conference on the Affordable Care Act in January 2014 and the National Healthcare Industry Conference Affordable Care Act section in 2014. AICPA acknowledged his career achievements at the 2016 National Healthcare Industry Conference.
About Our Presenter
Mark Dietrich is one of the appraisal profession’s most prolific and accomplished authors (with four books published in 2012 and one each in 2016 and 2017) and lecturers. If you are interested in purchasing one of his books, visit the Publications page. Specific categories of services can be found by visiting our Services page. Mark is also available as a widely recognized and accomplished speaker on the impact of the COVID-19 Pandemic, healthcare valuation, healthcare Reform and buy-sell agreements.
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