Pennsylvania is one of the exemplary states using Healthcare.gov on implementing the Gold Gap/Silver Load scheme in action. There was a slight shift from Silver to Gold in the strongest CSR, a decent size shift from Silver to Gold in the middle CSR tier and massive shifts from Silver to Gold in the weakest CSR tier. County level pricing dynamics will drive the rationality of choice significantly but the general story was people switched out of Silver to either Bronze or Gold with most of the migration going to Gold as it was frequently cheaper than the least expensive silver in the state.
Nominal actuarial value went down slightly for people earning under 200% FPL as 87% an 94% Silver CSR plans were replaced with 80% AV Gold plans. This may not be a bad choice if the people who replaced their plans are generally healthy folks who either anticipated very few if any medical expenses or people with low incomes but some assets who were willing to trade off lower premiums for slightly more risk. For people earning between 200-400% FPL, nominal average actuarial value increased. It increased by almost 2 full points for folks qualifying for light CSR at 200-250% FPL as they traded 73% Sivlers for 80% Golds and it increased by over 2 full points for folks earning between 300% to 400% FPL as 80% Golds replaced 70% Silvers.
Pennsylvania executed the Silver Load/Gold Gap strategy well and it created new facts on the ground as we talked about last August:
Liberals will have achieved an incredible policy victory in the states that force insurers to load the cost of CSR onto only Silver plans. In these states, the benchmark plans will be sufficient to buy 90% actuarial value coverage. That is better than Medicare. 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.
Silver loading has created new facts on the ground in Pennsylvania and elsewhere.