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John Cookson

Principal, Consulting Actuary, Milliman

John is a principal with the Philadelphia office of Milliman. He joined the firm in 1973.
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Nov 24, 2015

Impact of the Affordable Care Act (ACA) on Individual versus LG/ASO Trends

When we initiated our forecast on the S&P Healthcare Claims Indices in 2014, we wanted to avoid the effects of the ACA on individual and Small Group claim costs, so we focused on Large Group and Administrative Services Only (ASO) trends.  The individual claim costs continued to show a sharp divergence in trends from the…

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Jun 15, 2015

Impact of the Affordable Care Act (ACA) on Total Business vs Total Business less Individual Market Trends

The chart below shows the history of the S&P Claims Based Indices trends for total business and also total business less individual.  Up until 2014 the total and the total less individual were generally within a half a percent or so on a three month moving average trend basis. However, with the advent of the…

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Jun 15, 2015

Impact of the Affordable Care Act (ACA) on Enrollment

Given the sharp uptick in individual trends in 2014, which have peaked at 45% on a three-month moving basis, our operative scenario is that some of these new enrollees are crowding out care on the LG/ASO lines of business. The reason is that these new enrollees, many of whom have not had insurance and others…

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May 15, 2015

Impact of the Affordable Care Act (ACA) on Individual versus LG/ASO Trends

When we initiated our forecast on the S&P Claims Based Indices late in 2014 we wanted to avoid the effects of the ACA on individual and small group claim costs so we focused our models on the LG/ASO lines of business. Clearly, the 2014 experience on individual shows a sharp divergence in trends from the…

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Feb 20, 2015

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 4

The overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014—increasing up to 3.5% on a 12-month moving average basis as of September[1]. But the winter of 2014 was particularly harsh in much of the country and likely dampened utilization.  Late fall 2014…

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Feb 9, 2015

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 3

The overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014—increasing up to 3.5% on a 12-month moving average basis as of September[1]. But in 2014 the Individual trends reported by S&P are now over 45% based on 3-month moving average trends as…

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Jan 15, 2015

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 2

Although the overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014[1],  the prescription drug trends have been more volatile but modest prior to mid-2013, but have continued to accelerate since then through September 2014.  On a 3-month basis they have climbed to…

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Jan 6, 2015

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 1

The overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014—increasing up to 3.5% on a 12-month moving average basis as of September[1]. Milliman uses the S&P claims based indices to create a Health Cost Index Claims Based Forecast that uses economic factors…

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