Funding CSR and getting something back

Axios’s Caitlyn Owen’s reported recently that Senator Murray (D-WA) is still trying to get Alexander-Murray passed with modifications. I’ve been on-board with three of the four segments. I have not thought that Cost Sharing Reduction (CSR) subsidies should be appropriated as Silver Loading combined with either Silver Switch or state 1332 waivers could improve the lived experience of most buyers while protecting non-subsidized buyers.

However, Sen. Murray is proposing to use the pragmatic baseline of increased federal costs for non-appropriation of CSR to fund other health priorities. Interesting is my first response!

Senate Democrats, led by Sen. Patty Murray, are pushing to increase the Affordable Care Act’s subsidies as part of a stabilization bill being renegotiated with Sen. Lamar Alexander….

What we’re hearing: The initial Alexander-Murray bill would have restored federal funding for the ACA’s cost-sharing subsidies. Democrats now want to not only restore that funding, but to expand it — and to bolster the separate subsidy that helps people pay their premiums.

Now that is a big deal.  Silver-loading would disappear but the money that otherwise would have been spent on Silver Loading would instead be used to increase the income cap for premium tax credit eligibility and also increase the size and scope of CSR eligibility.

If premium tax credits are adjusted so that everyone is guaranteed at to spend no more than 10% of their income on the Benchmark Silver, that is a liberal policy win.

If premium tax credits are adjusted so the individual contribution grows at a slower rate for people who make more than 200% FPL, that is a liberal policy win.

If CSR is expanded so everyone who makes between 200% to 300% Federal Poverty Line can buy a CSR Silver with 80% AV, that is a major liberal policy win.

If the family glitch is debugged, that is a win.

There are a lot of IFs that could produce significant liberal policy wins by making the law work better.  And if those are the trade-offs being made, I am all for it as those are liberal policy goals that can be efficienctly and effectively cover people in a far less convoluted and kludgy manner.

Last August I noted the dynamic would change.  If Senator Murray is able to get the changes to CSR and APTC that she wants, it will be a clear illustration of the changed reality on the ground. 
 

Democrats have no reason to trade CSR funding for policies that they don’t prefer.  Inaction gives them an incredible policy victory.  Conservatives are the ones who need to make concessions to fully fund CSR.

The Congressional Budget Office projects that most states will allow insurers over the long run to load the cost of their obligated but not reimbursed CSR obligations to only their Silver plans.  This will have an incredible change in the dynamics of the market….

Liberals will have achieved an incredible policy victory in the states that force insurers to load the cost of CSR onto only Silver plans….

Since it is an incredible policy victory that will be cemented into place by inaction, giving it up for short term funding of a secondary set of subsidies would be counterproductive.






6 replies
  1. 1
    d58826 says:

    Well I got my first paycheck with the tax cut included. It’s 98 dollars more. And contrary to GOP talking points I still hate the GOP and Der Fuhrer.

    ReplyReply
  2. 2
    Another Scott says:

    We all know that there are sensible tweaks to the PPACA that can be made. If Murray-Alexander can move the ball forward overall, and the balance is strongly in favor of increasing the numbers substantially better off while those worse off are mostly corner cases that can be addressed later, then I’m all for it.

    Incremental progress is the only way long-lasting work gets done.

    I just hope that Murray and her team are smart enough to catch all the jiggery-pokery to make things worse that too many of the Teabaggers want to throw in the mix.

    Thanks for continuing to keep us in the loop on policy efforts like these, and the implications.

    Cheers,
    Scott.

    ReplyReply
  3. 3
    Another Scott says:

    @Another Scott: The FWYWP Dungeon? Really? I don’t see it.

    Help?

    Thanks.

    Cheers,
    Scott.

    ReplyReply
  4. 4
    Fake Irishman says:

    I appreciate Sen. Murray’s attempt to move the goalposts here in a productive fashion. Even if this doesn’t pass now, it could become a nifty part of a Democratic health reform in a future Congress: imagine pairing this up with a version of Brian Schatz’s Medicaid buy-in legislation or some form of Bennet-Kaine’s Medicare X.

    Better yet, extending premiums subsidies to the upper middle class and CSRs to the middle class would likely function similarly to an individual mandate: by lowering prices, it gives people an additional incentive to buy insurance, which would help stabilize rates.

    ReplyReply
  5. 5
    Marcelo says:

    Fixing the family glitch would save me so much goddamn money. It would be HUGE.

    ReplyReply
  6. 6
    Mike S says:

    Thanks for keeping us informed about the ACA issues. I really appreciate it. Without you I would have to rely on the totally clueless MSM. (actually I think they are negatively clued!) And I agree with the above. Fixing the family glitch would be a big help.

    ReplyReply

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