In This Issue

Mechanisms to compensate insurance plans covering disproportionate numbers of chronically mentally ill patients in the planned health insurance exchanges are generally adequate, according to an analysis of past claims data (figure). After implementation of the Affordable Care Act (ACA) in 2014, report Barry et al. (p. 704), financial solvency will be largely ensured through “risk adjustment” by a pool of contributions from all plans in the state. The ACA also designates two temporary measures: commercial reinsurance purchased by each plan for costs above a certain threshold and “risk corridors” of payments flowing from the federal government to plans with higher than expected costs, in conjunction with payments coming in from plans with lower costs. In their editorial, Garfield and Druss (p. 675) note that some plans may still be underpaid despite these provisions, and they describe the ramifications of “adverse selection,” incentives for mentally ill patients to choose particular health insurance plans.