My piece on a few technical ideas to fix the Exchanges is up at Stat:
The simplest way to do this is for both chambers of Congress to pass a bill that guarantees the funding of Cost Sharing Reduction subsidies…
The BCRA would have allowed a plan to cover 58 percent of expected costs. Former Sen. Mark Begich (D-Alaska) once proposed adding a copper plan, which would cover 50 percent of the expected costs. By lowering health insurance premiums, a copper plan would be more attractive to relatively healthy people, which would increase enrollment and lower average premiums….
A third way to improve the exchanges is to help insurers pay for extremely high claims….
k…..
Yarrow
That’s awesome. I hadn’t heard of STAT before. It looks like it’s a new publication.
Yeah….I wish.
cmorenc
Um…not to hijack your thread David, but are you refereeing high school or club soccer in the Triangle area this fall?
…now back to our regularly scheduled program about ACA Exchange fixes.
Raoul
“In addition, Secretary of Health and Human Services Tom Price and CMS Administrator Seema Verma have asked states to submit reinsurance proposals to CMS.”
I had become so cynical that I had nearly concluded that Price would do literally nothing to help fix insurance. But maybe he has started to realize that the ‘you break it you bought it’ concept starts to apply 200+ days into any admin.
Can’t really blame O-care completely, now, even with the multi-fail repeal effort. Enough people do consume news outside the Fox bubble to know that the chaotic admin Price has strapped himself to has been doing things to sabotage ACA, so price spikes and coverage gaps start to look a lot like his problem.
MomSense
Is re-insurance in this case the same or similar to the risk corridors that Rubio killed?
Raoul
More broadly, David, does a copper plan make much sense? Might it be age-limited so that as folks age, they don’t end up in a situation where they have such crappy insurance that they end up needing go-fund-me/bakesale drives to stay afloat?
What I could see (but I’m not gonna pretend the GOP has one iota of interest in this), would be a bill that authorizes copper 50% AV plans for under-35s, and also opens Medicare as an opt-in for 55+s. 35s-55s have to graduate to a bronze or better, but can bail (at their choice) to Medicare about the time most of us start to get medium-expensive in terms of chronic mid-life ailments, have more heart attacks or cancer, etc.
Maybe this is a terrible idea, since I’m just a duffer tossing out ideas. But that’s what the GOP is, too, and they’d never admit their ideas might be terrible.
David Anderson
@cmorenc: I am doing club soccer this fall but not high school nor college. My schedule is too hectic where I don’t want to put my assignors into the position where they have to take multiple 12 hour notice turnbacks.
Plus I want to spend more time with my family and that is not a euphemism for failing an assessment
David Anderson
@MomSense: different
Maeve
Alaska’s premiums expected to go down over 20% next year due to state program to offset high cost individuals (partly fed funded) and “less utilization” The latter due to more high dedectable plans? Or maybe just fluctuations due to small number statistics? There is only one insurer in the Alaska exchange.
adn.com/alaska-news/health/2017/08/01/premera-expects-a-21-6-percent-decrease-in-individual-market-p…
The reduction is before CSR are taken into account.
Another Scott
@Raoul: I’m no expert, but it seems to me that Copper plans are a horrible idea (except for maybe very, very limited circumstances).
Under-35s are the main group that has kids. Kids are expensive (pre-natal, birth, infancy). It’s essential that we do better in covering pre-natal and infancy because those are the times that have a huge impact on life-long health, etc.
If you restrict Copper plans to males, then you’re again punishing women (because they would be paying the reproductive costs).
We want young adults covered to spread the risk and to spread the funding
over asto be coming from many people as possible. If some/many/most young people can’t afford the premiums, the solution isn’t to make the plans less comprehensive, it’s to increase the subsidies for those who can’t afford it.My $0.02.
Cheers,
Scott.
Raoul
Yeah, I’m not advocating copper plans, but curious how they’d work, since David included them as a possible ‘fix’. Good point about childbearing age and pre- and post- natal care. Hopefully, most families are on employer plans during family growth years and have better than individual market bronze coverage (or are on medicaid, which a lot are!).
Arclite
HMSA is requesting a 27% increase in ACA premiums for next year (all rate increases in HI must be approved by the state). This despite a 27% increase in 2015. The problem is that HMSA took a loss of $48M on ACA plans last year. Still, 27% is hard to swallow.
I wonder if CSR would help alleviate this shortfall, or does that only apply to healthcare.gov plans, not BCBS plans sponsored by HMSA?