Mississippi’s individual health insurance market will be structurally more affordable in 2021 than it has been from 2018-2020. Molina, a Medicaid Managed Care Company, filed their rate request with a very interesting couple of sentences on p.26 of the actuarial memo:
Silver plan premium rates for benefit year 2021 were developed without federal funding for the cost sharing reduction (CSR) program by [REDACTED]. No adjustments were necessary for the Platinum, Gold, Bronze, or Catastrophic plans based on the funding status of the CSR program. The following table illustrates the actuarial values included in the rate filing.
If I am reading this paragraph correctly, Molina is silverloading CSR costs onto only silver plans. Previously, Mississippi had only broad loaded CSR costs onto all plans.
Okay, that is a lot of jargon, so what does it mean.
Cost Sharing Reduction (CSR) subsidies are part of the ACA designed to reduce deductible and other out of pocket costs for people who bought silver plans on the ACA marketplaces and who earned between 100% and 250% Federal Poverty Level. The ACA never explicitly appropriated funding for these subsidies. In October 2017, the Trump Administration stopped paying insurers who were still required to provide the CSR benefits to buyers. Almost all insurers for the 2018 plan year and beyond mitigated the damages of federal non-payment by increasing premiums. Most increased premiums on only silver plans that had the effect of dramatically reducing premiums for subsidized buyers who wanted to buy a not-silver plan. In 2018, five states engaged in what we call “broad loading” where the CSR costs were evenly spread on all metal tiers leading to no discounting of relative premiums for bronze and gold plans. Colorado and Delaware switched to silverloading in 2019.
Now Mississippi is silverloading for 2021 which should reduce premiums for some Molina buyers who want to buy the not-silver products Molina offers.
West Virginia and Indiana are the only states that are not allowing insurers to offer more affordable coverage to their states’ citizens.