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You are here: Home / Anderson On Health Insurance / CSRs are dead

CSRs are dead

by David Anderson|  March 22, 20186:35 am| 12 Comments

This post is in: Anderson On Health Insurance

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The 2,200 page omnibus spending bill came out last night.

Cost Sharing Reduction subsidies are not in the bill.

I want to indulge in a little bit of unseemly bragging as this was the logical end result of terminating CSR after insurers had enough time to load the cost of CSR into the Silver premiums.

From May 2017:

This is a time limited threat. It is obviously a time limited threat for insurers have been stating that they are usually filing with the assumption that CSR will be paid for 2018, they reserve the right to refile under a variety of assumptions and attribution methods if CSR goes for 2018….Well capitalized insurers could survive longer and jack up their rates for 2018 with state support.

The CSR threat loses its ability to blow up the market by sometime in the fall.

From last August:

model of leverage is wrong.

Democrats have no reason to trade CSR funding for policies that they don’t prefer. Inaction gives them an incredible policy victory. Conservatives are the ones who need to make concessions to fully fun…
That is an incredible improvement over the ACA as plans will become more affordable to many more people as premiums and deductibles will decrease and the risk pool will get healthier as the value proposition gets better.

Since it is an incredible policy victory that will be cemented into place by inaction, giving it up for short term funding of a secondary set of subsidies would be counterproductive. …

And once the CSR funding was terminated last October, we looked at the new Best Alternative To No Agreement (BATNA) for CSR:

No agreement involving CSR is an acceptable outcome for Democrats. They could agree to outreach funding, catastrophic plans, waiver modifications and employer mandate changes and still be better off with that agreement than no agreement. Re-funding CSR is not a critical component of Democratic policy or political objectives over the long run.

The Democratic BATNA of doing nothing to CSR is an acceptable alternative. And since one party has an acceptable outcome of no deal, they have the leverage to restrict the changes in the deal.

And there was no deal on CSR.

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Reader Interactions

12Comments

  1. 1.

    Planetjanet

    March 22, 2018 at 7:00 am

    And Democrats will not get credit for it. Too hard to explain to those who do not have access to your insights.

  2. 2.

    Cermet

    March 22, 2018 at 7:03 am

    My question is – will the orange fart cloud sign this? Since he is all gas and no spine, likely he will but if anyone can screw the pooch, that asswipe can and will.

  3. 3.

    rikyrah

    March 22, 2018 at 7:04 am

    Thanks Mayhew

  4. 4.

    Baud

    March 22, 2018 at 7:17 am

    @Cermet:

    Sanders said yesterday they were on board. Who knows though?

  5. 5.

    Ken

    March 22, 2018 at 7:44 am

    On bottom of the first page of this 2000+ page bill, they give Louise Slaughter’s daughter a full year salary. Like someone just stuck it in there. But it’s well deserved.

  6. 6.

    kindness

    March 22, 2018 at 8:48 am

    The bill would have passed had it not contained Susan Collins poison pill abortion provisions. That is the only reason Democrats voted against it. I’m glad they did.

  7. 7.

    Dupe1970

    March 22, 2018 at 9:03 am

    It’s almost like Dems study and understand policy and policy impact/implications and Repubs listen to Fox News.

  8. 8.

    MomSense

    March 22, 2018 at 9:20 am

    I really don’t know why losing CSR is a good thing. I guess it may be for many but I think it is making it impossible for us in Maine to get a decent health insurance plan.

  9. 9.

    Fair Economist

    March 22, 2018 at 10:31 am

    Well, since you’ve been accurate on your predictions, you’ll never get a job as a TV pundit or NYT opinion writer unless you learn to be wrong first.

  10. 10.

    David Anderson

    March 22, 2018 at 10:44 am

    @Fair Economist: No I’ve been wrong to very wrong on things, just on CSR I made a $200 billion dolllar bet and it is paying off

  11. 11.

    David Anderson

    March 22, 2018 at 10:46 am

    @MomSense: I’ll lay out the mechanics again tonight. The short version is that for people who earn between 100% and 200% FPL ($12,140-24,280 for a single individual) they will see no change to their coverage. People earning between 200% FPL and 400% in most states will see Bronze and Gold plans get comparatively a lot cheaper while people earning over 400% FPL need to do a little bit of running around to “only” pay the regular premium.

  12. 12.

    ProfDamatu

    March 22, 2018 at 1:18 pm

    @MomSense: I think Maine is a Silver Switch/Switcheroo state, so it should work the way Mayhew describes in #11. However, it might be that there’s a lack of competition or just a really small pool in Maine, leading to more expensive plans that might also have worse cost-sharing. I know it’s worked that way in much of Virginia, where, for example, Charlottesville has the highest average premiums across the board in the nation…with only one insurer, and the plans are all…not great (it’s similar with slightly lower numbers in many of the other one-insurer counties/cities). Granted, that insurer didn’t Silver load, but I can’t imagine that the lack of competition is helping matters.

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