Over the weekend, I wrote in the New York Times** why I think CSR funding may not come back:
Mr. Trump’s decision to end cost-sharing-reduction subsidies, known as C.S.R.s, and perhaps to derail a bipartisan bill by Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, that would restore C.S.R. funding through 2019 may actually lead to better coverage for more people paying lower monthly premiums.
That’s because insurers and state regulators prepared a workaround in anticipation of Mr. Trump’s move — and at least for 2018, most consumers could benefit from it.
This is the Silver Load and Gold Gap ideas that we’ve been talking about here at Balloon Juice for six months now. The basic thrust is that in normal situations, the price line runs Bronze-Silver-Gold-Platinum, but without CSR, the price line in most states will run Bronze-Gold-Silver-Platinum. And since premium tax credits are based on the relative price of Silver plans, this makes Gold and Bronze plans comparatively much cheaper in 2018 than they were in 2017 for subsidized buyers.
There is one major downside to this mechanical argument.
It is confusing and complex.
Over the past couple of weeks, I’ve been talking to reporters, Balloon Juice community members, and other interesting people via e-mail. The common response is always — “How does this affect me?”
This is hard to work through as our normal heuristics are being broken.
I think there are three sets of responses. First, if you buy individual insurance, actively shop on the Exchanges this year even if it is to confirm that you qualify for nothing. Weird things will happen, so see if the weirdness works in your favor.
Secondly, we have mechanical and decision support responses. We’ll review some of the ideas in this post.
Finally, tomorrow, I’ll start writing out cheat sheets depending on how your state decided to handle no CSR costs.
States need to be active in their outreach and they need to provide tools to help people figure out the weirdness. Pennsylvania is partnering with Checkbook.org
The Pennsylvania Insurance Department is partnering with Consumers’ Checkbook again this year to create a shopping tool that allows consumers to compare both on-exchange and off-exchange plans available in Pennsylvania. Consumers can enter their income to see what subsidies may be available to them and estimate the monthly premium and total annual cost of plans in their area. If consumers find a plan they would like to buy, the plan comparison tool will take them to either Healthcare.gov or the company’s website to make a purchase. Consumers can visit https://pa.checkbookhealth.org to use the plan comparison tool.
Open enrollment for 2018 health insurance runs from November 1 until December 15 – a change from previous years. Consumers must sign up by December 15 in order to have coverage effective January 1. The open enrollment period may be the only time consumers can enroll for 2018, and those who do not purchase a plan may be subject to a penalty as well as being uninsured for the year. On-exchange plans can be purchased at Healthcare.gov. Consumers who need assistance enrolling may visit localhelp.healthcare.gov to find free resources in their area.
Andrew Sprung at Xpostfactoid is looking at
Metal level choices: Imperial 92222 (Region 13)
Monthly premiums for 40 year-old with $25,000 income (207% FPL)
States and potentially Healthcare.gov need plan tools to show how to avoid bad choices in this situation. If we are to assume that the insurer, plan type (HMO vs. PPO etc) and network are the same for a $1 premium plan, Bronze and Silver are dominated by Gold. Gold offers the same or better for the chooser attributes than Bronze and Silver. Dominated plan choices are bad. Decision support tools that either show only non-dominated plans or highlights the best choice by placing it at the top of the screen will help out.
Insurers need to be getting in front of the confusion as well. It is in their interest as placing people in zero or low dollar plans means that they won’t lose healthy members with few claims due to the non-payment of premiums. It improves their bottom line. This can mean paid advertising, it can mean funding navigator groups, it can mean social media campaigns and earned media campaigns. They need to get in front of this.
No matter what, this is going to be confusing, but there are steps that can, are and should be taken to reduce some of the confusion.
** My wife said I have one pretentious sentence and this was it.