United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1994-09-22 monographic deposited born digital GA 1.13:HEHS-94-173 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-94-173 P0b002ee1803952f2 f:he94173 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-94-173 machine generated eng fdlp REPORT GAOREPORTS-HEHS-94-173 HEHS-94-173 Medicare programs Medical economic analysis Health maintenance organizations Risk management National policies Health services administration Health insurance Health care cost control Health insurance cost control Insurance regulation Federal Employees Health Benefits Program Clinton Health Care Plan National Health Care Reform Initiative Health Security Act Letter Report HEHS As part of the debate over health care reform, some have proposed prohibiting insurers from denying coverage or charging different premiums to persons on the basis of their health status. Under such a "community rating" system, an insurer would have to charge each potential beneficiary the same premium for a given insurance plan. However, community rating could create financial incentives for insurers to attract only healthy clients because these people would, on average, pay more in premiums than they generate in claims. Insurers' profits would depend more on the plan's ability to attract health beneficiaries and would be less responsive to efforts to deliver high-quality service at the lowest price. Risk adjustment can mitigate the undesirable effects of community rating on insurers' incentives. This report describes how the federal government's previous experience with risk adjustment is relevant to implementing risk adjustment under health care reform and identifies features of health care reform that could affect the ability to adequately adjust risk. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-94-173/html/GAOREPORTS-HEHS-94-173.htm GAO/HEHS-94-173 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-94-173 Letter Report GAO/HEHS-94-173; Health Care Reform: Considerations for Risk Adjustment Under Community Rating; Medicare programs Medical economic analysis Health maintenance organizations Risk management National policies Health services administration Health insurance Health care cost control Health insurance cost control Insurance regulation Federal Employees Health Benefits Program Clinton Health Care Plan National Health Care Reform Initiative Health Security Act