Just saw an interesting paper on healthcare innovation waivers/Wyden waivers/Sec 1332 waivers with the following few paragraphs catching my attention:
Using 1332 waiver authority, states could address one or all of these problems by (1) making coverage more appealingtothe remaining uninsured, (2) increasing affordability for lower- and middle-income enrollees, and (3) minimizing the potential for enrollment in suboptimal plans. To accomplish this, a state could allocate a greater proportion of its tax credits to people more in need, reducing the amount available to those earning closer to four times the povertyline,the cutoff for APTC eligibility. They could also usethat offset to enhance the power of CSRs for income levels where it is weakest. To direct shoppers toward optimal plans, states could make the bronze tier unavailable below 201 percent or 250 percent FPL. Or they could go the other way, attaching CSRs to metal levels other than silver. Exchanges could offer more actuarial levels by calculating the subsidy formula, using the total cost of a policy instead of the premium only (Mayhew 2015). [my emphasis] However, behavioral research shows that more choice is not always better (Frakt 2013). Moreover, actuarial level, metal tier, and cost-sharing reductions do not interact intuitively. An exchange could scrap the metal system, where, confusingly, a silver plan is markedly more valuable than a gold plan for somebody near the poverty line and where a gold plan appears more inherently desirable than a silver plan in general (Ubel, Comerford, and Johnson 2015).
Actually it is a really good overview of the 1332 waiver process and option space….
Punchy
Textbook humble brag.
RSA
Nice!
David Koch
have you written anything on the Cadillac tax?
How many union members will be effected by it (5%, 10%)?
Do you agree with Vox that scrapping it to pander to unions is a bad policy?
Richard Mayhew
@Punchy: fuck no, just a straight up brag, nothing humble about it :)
NCSteve
Dude. People near 400% FPL need more help, a lot more. Not less. Both politically and in terms of real life need, putting the subsidy phaseout here instead finding the money to do that at some higher arbitrary point, like 500 or 600, was a major fuckup. It was a fuckup perpetrated in the utterly futile hope of getting a Republican to vote for it, as is most everything else that’s wrong with the ACA that isn’t John Roberts’ fault.
At 400% FPL, a family is in a financial situation that is remarkably parallel to that of a family at 200%. Every dollar earned has multiple creditors’ hands on it before it comes through the door, every day is a struggle, often a losing one, not to fall further behind, every day is lived under a pall of fear that some unexpected four digit expense will fall out of the sky. At 400% FPL, you have the same despair that you can ever make your kids’ lives better than it is right now as all of those earning less. You have more and better stuff, but with the gigantic difference of food security, the stress and fear is the same. And the menace of that slippery slide down to 200 or 100 or worse is always there, longer but much steeper.
Telling those people they had to tighten up their belts and come up with several thousand dollars to buy unsubsidized insurance was a moral error and a major self-inflicted political clusterfuck. And ensuring that demographic specifically would be, at best, ambivalent about the ACA was a major gain of the multi-month tease the so-called “moderate” Republicans did. It was a perfect demonstration of how utterly disconnected our millionaire Congress members are from the lives of the “ordinary Americans” they profess to treasure. And preventing the Democrats from addressing that problem is, whether intentionally or otherwise, a political major benefit the Republicans have scored from their Massive Resistance” campaign.
Face
But who among Frakt, Ubel, Comerford, or Johnson has banged the center back?
Richard Mayhew
@David Koch: I’ve not written a lot about it:
https://balloon-juice.com/2014/03/26/cadillac-mechanics/ (mechanics post) is about the most I’ve written.
And yes, I agree with Vox, removing Cadillac without replacing it with something that makes high cost plans less attractive (there are a few options) is a really dumb idea but politically it is a very tempting idea as the costs are dispersed (higher medical price inflation) and benefits very concentrated on groups that both parties hear and listen to.
Richard Mayhew
@Face: I did not either, I just heard about it and received a 12 pack of Dog Fish Head because someone banged the center back
Gin & Tonic
@Richard Mayhew: At least if you weren’t getting some action, you got good beer out of it.
ruemara
It was English, but I couldn’t understand it. Of what I could grab the jist of, I support anything that helps people in my situation, since i fit the “too poor for this, but too rich for help” thing.
benw
@Face: Johnson, of course.
@Richard Mayhew: “12 pack of Dog Fish Head” What, you’re too good for a case of Bud? Commie.
Richard mayhew
@benw: either a 12 of something good, or a pony keg of bud. I need to keep my in season weight down , so quality over quantity
BobS
Mr. Mayhew, I’m sorry to bother you with a question unrelated to your post but… an old friend of mine (and his wife) get their health insurance through his employer — as I understand it, the cost is charged to his gross income and he pays somewhat more to have both he and his wife covered than if it were just him. However, because his wife is offered (and declines) coverage by her employer, his employer charges him an additional fee. Apparently this policy was begun soon after implementation of the ACA and consequently he blames ObamaCare for the extra $120/month he’s being charged after already paying for spousal coverage. Is this in fact a stipulation of the ACA, or is his employer just taking advantage of the timing to gouge him for a few dollars more? Thanks in advance for your answer.
Richard Mayhew
@BobS: Good question
It is not ACA related at all except by coincidental timing. Employers have been trying to reduce their covered head count as much as they can because insurance is expensive and they want to reduce their costs.
His employer’s logic is that they need to offer spousal coverage as a general benefit of employment, but they really don’t want to cover spouses who are coverable elsewhere. That is why they are two tiering it — first tier is 2X (X for employer only coverage) for stay at home spouses or spouses working as free lancers or working at shitty jobs, and then 2X+$120 for spouses who work at companies that offer less good insurance. The goal is to get the spouse who works at a company with less good insurance to stay there as the better/richer benefit at the offering employer is not $120/month better.
My wife’s company does this. Thankfully my company does not so I have the entire family on my coverage, but if Mayhew Insurance added $75/.$100 surcharge, my wife will go to her employer coverage.
BobS
@Richard Mayhew: Thanks again — I’ll let him know to direct whatever ire he may have toward his employer instead of at Obama and the Democrats.
Richard Mayhew
@BobS: Good chance that I am turning this comment exchange into a post for next week as it is a good question.