Come for the politics, stay for the snark.

A thin legal pretext to veneer over their personal religious and political desires.

It’s all just conspiracy shit beamed down from the mothership.

Beware of advice from anyone for whom Democrats are “they” and not “we.”

Stop using mental illness to avoid talking about armed white supremacy.

JFC, are there no editors left at that goddamn rag?

But frankly mr. cole, I’ll be happier when you get back to telling us to go fuck ourselves.

The real work of an opposition party is to oppose.

If you voted for Trump, you don’t get to speak about ethics, morals, or rule of law.

If rights aren’t universal, they are privilege, not rights.

Relentless negativity is not a sign that you are more realistic.

When they say they are pro-life, they do not mean yours.

Too little, too late, ftfnyt. fuck all the way off.

Sometimes the world just tells you your cat is here.

Let me file that under fuck it.

I really should read my own blog.

Anyone who bans teaching American history has no right to shape America’s future.

People are complicated. Love is not.

Republicans: slavery is when you own me. freedom is when I own you.

Jack Smith: “Why did you start campaigning in the middle of my investigation?!”

Hot air and ill-informed banter

fuckem (in honor of the late great efgoldman)

The truth is, these are not very bright guys, and things got out of hand.

We do not need to pander to people who do not like what we stand for.

Republicans don’t lie to be believed, they lie to be repeated.

You are here: Home / Anderson On Health Insurance / The ACA individual market for the next four years

The ACA individual market for the next four years

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I recently was on a panel to discuss the future of the individual market over the next four years of the Trump Administration.  I want to write up my notes and some of my thoughts from my portion of the talk.

I think that the changes of the Trump Administration from the Biden Administration are in the realm of normal, thermostatic politics where one party comes in and pushes in one direction and then the other party pushes back once they have the ability to do so.  The proposed program integrity rule that is out for comments (due early April) is an attempt to make the ACA a much smaller market.  But I don’t think this is an existential threat (that is Medicaid)

The ACA under the Biden Administration was primarily focused on taking care of the needs of the subsidized population.  The Trump Administration has made it clear that their priority is the non-subsidized population.  I think that there is a chance of a limited subsidy extension for individuals over 400% FPL so instead of going from 8.5% of income for a benchmark plan to unlimited exposure on 1/1/26, there might be an extension for either 10% or 12% or something like that cap.

In order to drive down gross premiums, lower value plans will be offered.  The de minimas variation will be increased so a Gold plan now will have an allowable minimal value of 76% AV instead of 78% AV, and so on.  The calculation that drives maximum allowable out of pocket limits will be tweaked to inflate that total cap.  Essential Health Benefits will be squeezed.  I will be surprised if there is not a proposal for a Copper Plan. 

I anticipate a lot more state autonomy and action.  I anticipate a few Section 1332 reinsurance waivers as the math unlikely maths well, or at least I’ll be writing those comments letters on the goddamn regular.  I anticipate a lot more Section 1332s that go along the Georgia Access Model proposal from 2020 where federal subsidy funds were designated to pay premiums for underwritten coverage that can take health history/pre-existing conditions into account to set premiums and exclude people.    I think there will be a lot more Premium Alignment policies like what Texas, Virginia, New Mexico and Pennsylvania are doing [my manuscript on this is going out the door on Friday at the latest… it improves affordability for a lot of subsidized and non-subsidized buyers].  I think a lot of Blue States will take a look at their current reinsurance programs and redirect them to more cost-effective targeted subsidies.

I think Individual Contribution Health Reimbursement Accounts (ICHRA) (ie defined contribution employer health insurance) will become more important and act as a political and policy stabilizer as these concepts don’t work without a viable guaranteed issue individual market.

I have several under-developped thoughts on Section 1331 (Basic Health Programs) and Section 1333 (interstate compacts).  I think BHPs are intriguing and have something on them just accepted this week, and 1333 won’t do much.  I think there are options for states to adjust to large Medicaid cuts through chunks of the ACA.

 

These are my rough thoughts as I presented them earlier this week.

Reader Interactions

7Comments

  1. 1.

    PBK

    David, I’ve been wanting to ask you a question if you have time.  Maine republicans are champing at the bit to make changes to MaineCare (Medicaid).  One of their proposals is to not allow any new enrollees until current enrollment drops by 10%.  Is this even legal?
    As always, thank you for your posts.

  4. 4.

    am

    My first read of this is that it is pretty encouraging news?

    You’re busy, I’ll understand if you can’t, but could you describe what the experience ICHRA would likely be like to an employee? Also, what’s interesting about BHPs?

    “math unlikely maths well” is an exceptionally good turn of phrase.

  5. 5.

    am

    My first read of this is that it is pretty encouraging news?

    I should make it clear I have astonishingly low expectations.

  6. 6.

    Matt

    I think Individual Contribution Health Reimbursement Accounts (ICHRA) (ie defined contribution employer health insurance) will become more important and act as a political and policy stabilizer

    I work at a smallish company where we’re switching to ICHRA this year (effective date 4/1).

    I’m going to be paying twice as much monthly for a substantially-inferior plan compared to what we had from Anthem previously, and my employer is also paying more.

    Plan-shopping was the worst “buying a thing” experience I’ve ever had; a blizzard of plans that have identical “summary PDFs” but vastly different prices even from the same company, piss-poor visibility into if my doctors are “in-network”, and plenty of other hassles besides.

    The whole thing seems clearly set up to get people to either buy too much insurance or too little. It feels like I’m placing a bet on a casino game I barely understand, while the operators of the casino take the other side.

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