ACA Risk Pool Fragility Simulator | Health Insurance Economics

Policy Levers

Subsidy Architecture

State Reinsurance Buffer 0%

Individual Mandate Penalty $0/yr

Underlying Medical Inflation 6.5%

Actuarial Presets

Actuarial Simulation Progress

Year: 2026 (Cycle 0)

Risk Pool Mix (Synthetic 10,000 Lives) H: 5,800 | M: 3,000 | C: 1,200

58%

30%

12%

● Healthy (Low Claims: $1.2k) ● Moderate ($5.4k) ● Chronic ($24k)

Premium vs Loss Ratio Spiral Trajectory ■ Benchmark Premium | ◆ Loss Ratio

Actuarial Event Audit

Initialized representative 2026 exchange risk pool (10,000 enrollees).

Market Telemetry

Silver Benchmark $485 +0.0% drift

Medical Loss Ratio 84.2% Target: 85.0%

Active Insurers 4 Competitive

Healthy Cohort Loss 0.0% 5,800 retained

Adverse Selection Risk Gauge

MODERATE Index: 1.42

Federal Outlay Est. / Enrollee $3,920 Annual taxpayer subsidy support

Actuarial Mechanism: When subsidies lapse or net premiums rise, healthy individuals drop coverage first. The remaining sicker pool inflates average claim costs, compelling insurers to re-rate premiums upwards or exit entirely.