I was asked by Professor Richman to talk to a bunch of law students this evening about healthcare. They are part of a colloquium where some of the leading minds on health policy and law are flown in and talk. A few weeks ago, it was Nick Bagley, next week, Tim Jost is supposed to be here, and then Mark Hall is scheduled for November. And then me.
I’ll be speaking about the entire Cost Sharing Reduction (CSR) saga. This is something that I’ve been hammering on here at Balloon Juice for the past two years, and it is a natural extension of the thought process that goes into my Silver-Loading arguments and analysis that I’ve been bird-dogging for almost four years now. However this is the first time I’ve presented in this format, so I want to go over some of my major points:
Readings:
Joint Letter on Silver Loading options Anderson, Norris, Gaba, Sprung (October 2016)
Section E Legal Limits and the Implementation of the Affordable Care Act Nicholas Bagley (January 2016)
“Implications of CMS Mandating a Broad Load of CSR Costs” Anderson, Norris, Gaba, Sprung (May 2018)
“Mining the Silver Lode” Sprung, Anderson (September 2018)
Major points to make:
- IANAL
- No working majority in Congress to touch coverage expansion elements of the ACA since 3/23/10
- Both Obama and Trump campaigned aggressively on reforming what they saw as an unfair and unjust healthcare system
- Mechanics matter
- States have tremendous flexibility with their insurance markets
- Mixed choice states are fascinating for anyone who wants to study natural experiments
- State Insurance Commissioners knowledge and involvement in decision making varies widely
- Last successful vote in Congress matters
- If law is to be used as a lever, understanding the entire structure is needed so things don’t go OOPS
- Legal follow-up on Silver loading, mitigation and implied contracts will be a big deal
- IANAL
And my rough timeline is below the fold:
susanna
Wow. Your extensive and needed studies are impressive, needed and appreciated. And good to know there are formats for getting this information more broadly out to the public.