Risk variation and fallback insurers in universal coverage insurance plans

This paper argues that optimal treatment of health expenditure risk variation over one's lifetime requires partial offsetting of experience-related premium fluctuations. It argues that government should provide protection against the risk of serious chronic illness by offering risk-related tax credits that offset some (though not all) of the changes in premiums due to such illnesses. The performance of a fallback insurer, present in most market-based health reform proposals, is shown to depend on whether or not it is permitted to risk rate. Forbidding any risk rating is likely to cause adverse selection problems, whereas permitting the fallback insurer to risk rate should help it to perform its proper role and avoid being subject to dumping of high risks.