Entries by David Anderson

Pennsylvania’s 2018 Exchange market

Pennsylvania released their 2018 ACA rates on Monday afternoon. Their data is here (XLSM file) and the press release is here. They are explicitly Silver Switching the entire state to accommodate the CSR cut-off. Because cost-sharing reductions are only available on silver plans, rate increases necessitated by the non-payment of these cost-reductions will be limited […]

Misunderstanding the No CSR World

I want to highlight a story that I think has a fundamental mis-analysis of the individual health insurance policy world where there are no more Cost Sharing Reduction subsidies being paid. Now the piece that has me scratching my head is from the Washington Examiner and a story about Senator Johnson (R-WI) willingness to appropriate […]

Plan Types aren’t everything

There are four basic plan design types. They are based on two elements. Is there a Primary Care Provider (PCP) gatekeeper requirement? Is there an out of network benefit for non-emergency changes? That is it. There is nothing inherent to a Preferred Provider Organization (PPO) that makes it immediately superior to an Health Management Organization […]

Sunday morning CSR Status report

Good morning, I have a status report on CSR responses that I need to write before I get coffee for myself and my wife. There will be lawyers This was the only prediction I was certain on Friday morning. From CNBC: The attorneys general for New York, California, and more than a dozen other states moved Friday to […]

CSR thoughts this morning

Okay, I’m trying to process and think through the next week on Cost Sharing Reduction news. Here is what I am expecting: Lawyers and lots of them doing lawyer things in a lot of court rooms Well capitalized insurers in states that planned ahead for no CSR to practice their Scrooge McDuck dives They’re double […]

CSR and exit clauses

This is the statement from the acting Secretary of Health and Human Services.  The last word is critical:  “Immediately”   Immediate termination is critical because the contracts insurers signed for 2017 and 2018 each had exit clauses.   The 2018 contract language looks like this: Pretty sure is the official insurer agreement language, via CMS https://t.co/iX5t1EROym […]