Over at the the Health Affairs Blog, I, along with Charles Gaba, Louise Norris and Andrew Sprung look into the implications of a possible requirement that CSR costs be broadly loaded into the individual market plans instead of the dominant Silver Load choice that almost all states have adapted.
If broad loading is required, there will be significant changes in the lived experience of the ACA for subsidized buyers in most states. In this case, all ACA-compliant plans offered on and off exchange would include some CSR load. Between six and seven million nonsubsidized enrollees will be paying for actuarial value they do not receive. Premium hikes to pay for CSRs will be loaded on top of premium hikes stemming from repeal of the individual mandate penalty, estimated at 10 percent per year by the CBO. Some nonsubsidized silver buyers would be better off, while all other nonsubsidized buyers and some subsidized buyers would be worse off….
Assuming the proportion of enrollees benefiting from silver loading is roughly the same in the state-based Marketplaces as on HealthCare.gov, there may be approximately 1.8 million nationally (16 percent of 11,750,000 enrolled and 19 percent of 9.8 million subsidized) who are disadvantaged if silver loading stops.
Go read it!