A group of actuaries is urging House leaders to think carefully before they try to change the current Affordable Care Act system.

Shari Westerfield, the vice president of the Health Practice Council at the Washington-based American Academy of Actuaries, has written to House Speaker Paul Ryan, R-Wis., and to Rep. Nancy Pelosi, D-Calif., the minority leader, to say that simply repealing the ACA, or canceling major provisions without making other adjustments, could make problems in the individual major medical insurance market worse.

"Repealing major provisions of the ACA would raise immediate concerns that individual market enrollment would decline, causing the risk pools to deteriorate and premiums to become less affordable," Westerfield writes in the letter. "Even if the effective date of a repeal is delayed, the threat of a deterioration of the risk pool could lead additional insurers to reconsider their participation in the individual market."

If, for example, Congress wants to repeal most of the ACA but keep some popular provisions, such as provisions that prohibit insurers from considering individual health status when deciding whether to offer people coverage, and when deciding how to price the coverage, Congress needs to provide strong mechanisms to encourage healthy people to keep signing up for coverage, Westerfield writes.

Otherwise, Westerfield writes, insurers may attract too few healthy enrollees to compensate for the cost of covering the enrollees with high health costs.

She writes that eliminating ACA provisions that encourage enrollment, or getting rid of major ACA programs and subsidies that insurers have already included in 2017 premium assumptions, could also destabilize the individual health market and lead to insurer withdrawals from the market.

Instant Insights /

Wrong ACA moves may tank individual market, actuaries warn

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