Resolves the row ws11-scorecard.md flagged as untested.
One Washington reinsurance design has suggestive adverse evidence
Line-edit applied 2026-08-10 (queued at deviations #19, missed by the #23 pass, caught on Phase 1 verification): the §4 digest published on site/elder-care/sources/index.html still headlines this finding as "Reinsurance was actually tried by a state, and it failed." Red-team #8 softened that to "suggestive negative evidence from one unread secondary-sourced state study," and this file's own closing section says "not 'tested and rejected'." The public digest is corrected on the same branch.
Washington State's 2015 legislature-mandated feasibility study (Milliman, via DSHS/ALTSA) modeled a public-private reinsurance option (state reimburses private insurers for catastrophic claims) alongside a public payroll-funded benefit. Secondary accounts report that Milliman found this design had "little potential to generate savings"; the original study has not yet been read in this record. That is suggestive adverse evidence for this state-subsidized, voluntary-market reinsurance design, not a definitive verdict on reinsurance generally. The public-benefit option became WA Cares.
The connection to the CLASS adverse-selection diagnosis is the researcher's inference: shifting catastrophic-tail risk between insurer and state does not, by itself, change who chooses to enroll. It is a plausible mechanism account, not a finding Milliman established.
Academic modeling (Braun & Kopecky, Cleveland Fed) points toward a different lever: tying private LTC insurance to Medicaid asset-test offsets (dollar-for-dollar spend-down protection for buyers), which changes enrollment incentives directly rather than pooling risk after the fact — conceptually closer to WA Cares' mandatory logic than to reinsurance. (Lower confidence: based on an abstract summary, not a direct read of the paper.)
No named federal reinsurance-for-LTC bill or Academy-of-Actuaries-endorsed reinsurance mechanism was found. The Bipartisan Policy Center proposal leans on auto-enrollment with opt-out, not reinsurance. That is consistent with an enrollment-mechanics concern, but it is equally compatible with political or fiscal cost differences: reinsurance requires up-front public spending, while auto-enrollment does not. It is not evidence that the mechanism question has been settled.
Hybrid life/LTC combo products aren't a mass-market fix
Dominant new-sales channel since ~2014 (guaranteed premiums, joint-life designs), but multiple sources converge: these are pitched at buyers with 500K–5M net worth who can fund permanent life insurance premiums up front. No source characterizes them as solving adverse selection — they sidestep it by selling into an already wealthy, self-selected pool, which is a different thing from a market fix.
Effect on the protocol and the scorecard
Update ws11-scorecard.md's private-LTC-insurance-reform row, previously marked untested: CC remains 2; IQ/WS remain 1; CR is 1 only as a cautious reading of one indirectly reported state study; AA remains 2. The result is real but scope-limited negative evidence, not “tested and rejected.” It applies to Washington's design; a federal risk-corridor, subsidy, or mandate variant remains untested.
Sources
Milliman feasibility study for Washington State (via secondary reporting — Spokane Journal of Business, AARP, Economic Opportunity Institute; original PDF not directly retrieved); Bipartisan Policy Center, "Bipartisan Solutions to Improve the Availability of Long-Term Care" (2021/2022); American Academy of Actuaries, "The State of Long-Term Care Insurance—2025"; Braun & Kopecky (Cleveland Fed working paper, "Reforming the US Long-Term Care Insurance Market" — abstract-level only); EY and industry hybrid-product trackers.
Confidence tier
Medium. The WA/Milliman finding and BPC/Academy characterizations are corroborated across independent source types (state government study, think tank, actuarial professional body, trade press), but the Milliman PDF itself wasn't directly read — this rests on secondary reporting of a primary study, not the primary document. The academic-modeling claim (Braun & Kopecky) is lower confidence, abstract-only.