Adrianna McIntyre at Vox raises a good mechanical point about the next Exchange open enrollment period. People will be changing plans in order to minimize their out of pocket premiums. She explains the mechanism:
The federal subsidies used to offset the cost of insurance are based on income, but they’re also pegged to the second-cheapest silver plan on each state exchange, which is called the “benchmark plan.” When people choose something cheaper than the benchmark plan (the cheapest silver plan, or one of the bronze plans), they will spend less money out of their own pocket on the insurance premium. If a person chooses a plan that’s more expensive than the benchmark plan, he’s responsible for the extra cost…
But annual changes to insurance premiums aren’t uniform across plans. That means the “benchmark plan” can change from year to year — with financial consequences for those with subsidies. These consequences will be most acutely felt by low-income enrollees.
My first response looking at the world as it is instead of as I and many others here wish it to be, is so what. People in private insurance have to routinely consider switching plans every year to minimize their premium and expected out of pocket expenses. I know that I have held the same exact plan configuration (benefits, deductibles, co-pays, network) at the same exact per paycheck cost for one dyad in my working life. It happens in the private market, it happens in the public-private partnership of CHIP market, it happens for Medicare and Medicare Advantage, it happens basically everywhere except Medicaid fee for service.
However there are a few important policy and technical points to draw out.