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A claims expenditure assessment allows legislators Additional detail about the SHADAC data sources
to maintain their 2011 commitment to the provider and key assumptions are as follows:
tax repeal.
Claims for the Fully-Insured Market
Potential Disadvantages • Claims for the fully-insured market are
A claims expenditure assessment is new and would based on net-incurred claims after
require new Department of Revenue processes. reinsurance (excluding pharmaceutical
rebates).
Despite support from federal case law, a claims • Primary Data Source: 2016 National
expenditure assessment may nevertheless be Association of Insurance Commissioners
challenged in court on the question of ERISA (NAIC) Supplemental Health Care Exhibit
preemption. Report Volume I.ii
• We adjusted the 2016 fully-insured claims
expenditure totals to:
o Exclude TRICARE expenditures Claims for MinnesotaCare and Medical
(assumes 1% of the Minnesota Assistance
population is enrolled in • Claims data for MinnesotaCare and Medical
TRICARE).iii,iv,v Assistance are based on DHS forecast data
o Exclude Federal Employee Health for 2020.xii
Benefit Plan expenditures (assumes
the FEHBP per member claims Results (in 000s)
profile is the same as the fully 2016 Actual (Adjusted) and 2020 Projected Claims
insured large group market).vi
Claims 2016 2020
o Adjust the final total claims
expenditure upwards by 6% in order
to account for the inclusion of
Minnesota
standalone dental claims, which are
Commercial
not included in the NAIC data.vii $4,840,000 $5,150,000
Business - Fully
• To project 2016 claims to 2020 for the large
Insured
and small group market, we applied the
National Health Expenditure Trend
Projection growth rate calculated by the
Minnesota
Office of the Actuary in the Centers for
Commercial $8,320,000 $9,980,000
Medicare & Medicaid Services.viii
Business - Self
• To project 2016 claims to 2020 for the
Insured
individual market, claims were adjusted to
reflect the 40% decline in claims between MinnesotaCare n/a $490,000
2016 and 2017ix and the National Health
Expenditure Trend projection was used to Medical Assistance n/a $14,350,000
predict growth between 2017 and 2020.viii
Total Claims n/a $29,980,000
Claims for the Self-Insured Market
• The most significant data gap for
SHADAC’s analysis is related to the self- Based on a total projected claims expenditure of
insured market. $29.9 billion in 2020:
• To estimate the size of this market, we used • In order to raise $501 million in revenue, a
2016 data from the Minnesota Department health care claims assessment rate would
of Health’s Health Economics Program.x,iv need to be: 1.672%
• To estimate 2016 claims expenditures of the • In order to raise $596 million in revenue, a
self-insured market we assumed claims health care claims assessment rate would
experience would be the same as with the need to be: 1.989%
fully-insured market (see above) and that
95% of enrollees in this market were in large
firms.xi
• As with fully-insured claims, we applied
the National Health Expenditure Trend
Projection growth rate to project 2016 claims
December 2018
to 2020.
i Minnesota Department of Management and Budget (MMB). xi Estimate based on SHADAC analysis of the Medical
(2018, February 28). Health Care Access Fund: February 2018 Expenditure Panel Survey - Insurance Component.
Forecast Update. Retrieved from xii Minnesota Department of Human Services, Reports and