Big, geeky technocratic tinkering news out of California last night:
New via @InHealthPolicy: CA to use reserve $ to "cover the $1 premium for abortion coverage required under the ACA." Note: these $1 separate premium payments are not required in statute but rather a burdensome Trump-era regulation. @acog continues to call on @CMSGov to revoke.
— Emily Eckert (@emilyanneck) May 18, 2021
California requires that all plans sold in the ACA individual marketplace have non-Hyde elective/voluntary abortion benefits as a covered benefit. This is considered a “non-essential health benefit.” The ACA has two relevant requirements by law. First, the advanced premium tax credits are only applicable to “essential health benefits.” Secondly, the non-Hyde elective abortion coverage must have a minimum monthly premium of $1 that is put into a dedicated sinking fund so that the money never touches federal funds. The Trump Administration then tried to weaponize administrative burden by requiring two separate payments for individuals who had non-Hyde covered benefits. The first payment was for the essential health benefit and non-abortion related component of non-essential health benefits. This is usually a decent sized check. The second payment was a $1 monthly premium for the abortion related coverage costs.
Under the original ACA subsidy system, a lot of people in California had a $1 plan as their subsidies were big enough to wipe out their obligations to pay for the essential health benefits component of their plan. With the new ARA subsidies, even more people have a $1 plan as their cheapest plan. Now, under this proposal to use state funds to pay for the $1 non-essential health benefit, hundreds of thousands of Californians will now be exposed to a zero premium plan.
Coleman Drake and I found an association between county level presence of a zero premium plan and enrollment among the 151-200% FPL group in a Health Affairs paper from January 2020. We estimated that the presence of a zero premium plan in a county increased enrollment in this subgroup by about 14%.
New work by myself, Coleman, Sih-Ting Cai and Dan Sacks argue that the zero premium effect is not a special price effect (cheaper is better all else equal though) but an administrative burden effect. We looked at zero premium plans in Colorado where there was a tremendous amount of policy driven variation in the prevelance of zero premium plans. We found little differences in enrollment or plan choice among people whose cheapest plan was zero by a little bit and people whose cheapest plan was just over zero by less than the price of a mediocre cup of coffee. Instead what we found was that people who had a zero premium plan were far more likely to start their coverage on January 1st compared to folks who had a nominal premium. Folks who had nominal premiums were more likely to start their coverage in February and March. Colorado’s open enrollment period runs through January, so we think people tried to get coverage, and for folks who had a zero premium plan as their choice, they just had to pick a plan and it started automatically. However, folks who had to pay nominal premiums had to first pick a plan, second make a payment arrangement and then start their coverage. That middle step tripped up a lot of people. McIntyre, Shepard, and Wagner see a similar mechanism in automatic retention in zero-premium plans in Massachusetts.
Zero premium plans get rid of one source of administrative burden and transactional frictions. Given that California, like Colorado, runs their open enrollment through January in non-COVID years, zero might matter less than in other states but it still mattered a lot in Colorado.
Atrios, is that you??
Good, good. Make it spread.
The Hyde amendment needs to die. Although at this point the Repubs are doing their best to kill what is left of Roe… Anyone who thinks that abortion is not already being put out of reach for many people is fooling themselves. Six states are down to one abortion clinic: Kentucky, Mississippi, Missouri, North Dakota, South Dakota and West Virginia. South Dakota (among other states) also has a waiting period between when you go to request an abortion and when you come back to have it performed, 72 hours in the case of South Dakota. Many states have laws to make it harder for abortion clinics to operate or force them to close.
California has always kind of had the attitude that it’s cute that the people in DC think they’re the boss of us, but we’re just going to say yeah, sure and do whatever we want to. Part of it’s just that Western thing, like the Bundys, but liberal.
Like Texas we were our own republic first and are still not sure about letting people 3,000 miles away tell us how to handle our business. Particularly this $1 bullshit. TFG has been hated forever here and Padilla filed more than 100 lawsuits against his petty cruelty when he was our AG.
We have a giant budget surplus Republicans are screaming to be returned via tax cuts, but Jerry Brown insisted on saving for a not-rainy day and the fires and drought that will be upon us more and more.
West of the Rockies
Yes, but wasn’t it nice when TFG visited the people of Pleasure, CA after the Camp Fire (where I lived for 21 years)?
Oh, wait, it’s Paradise, CA–the lazy imbecile couldn’t be arsed to even get the name right.
I am so happy to live in The People’s Republic of California.