Late last week, the Blue Cross and Blue Shield Association released a three page proposal to for an ACA 2.0 bill. This proposal identifies the biggest issues as not enough young people in the pool, idiosyncratic risk and premiums being too high for folks who currently are not eligible for premium subsidies. The pay-for is appropriating Cost Sharing Reduction (CSR) subsidies.
- Younger adults pay a lower percentage of their income (at a given level) for the benchmark plan
- Older adults are held harmless
- All individuals, regardless of income, are eligible for subsidy assistance
- CSRs appropriated
- CSRs expanded
- Full advertising and outreach funded
- Health insurance premium tax suspended
This is an industry proposal. It is a first cousin of the Democrats’ proposed ACA 2.0. The Democrats in HR 5155 were indifferent to the health insurance premium tax but they sought to expand premium tax credit eligibility and upped CSR payments to higher income groups.
These are discussions that are going in the same general direction.
The ACA was the result of several years of stakeholder consensus building. Advocates were involved. Wonks were involved. Hospitals were involved. Physician groups were involved. Insurers were involved. Pharma was involved.
It looks like the insurers are trying to lay markers for where they want to see things in 2021 or 2022. They are looking at a fix and expansion of the current paradigm instead of a complete replacement of the system.
We should look to see what the other major interest groups that can elect to drop $100 million in support or in opposition to major health policy bills. There policy papers will shape the contours of possibility and the trade-offs of ambition.