Anderson On Health Insurance

Politico has a report on Florida’s law to re-import drugs from Canada:

When Gov. Ron DeSantis ran for president in 2024, he touted his plan for Florida to become the first state in the country to import less expensive prescription drugs from Canada into the U.S.

Yet as his time in office dwindles, that plan has been all but scuttled — leaving one contractor with more than $82 million in taxpayer money and no results to show for it.

The plan is regulatory arbitrage. Florida wanted to take advantage of the fact that Canadian drug buyers do the hard work of saying “NO, Not at that PRICE, sorry aboot that….” without compensating Canadian drug buyers for the new risks that they would take on for Florida.

It is a free rider problem. Canadian drug buyers get the price that they get because they can both credibly threaten to say no, and drug sellers know that their differentiated markets are protected. No one is backing up a semi-trailer to bring Canadian GLP-1s to Florida at a 50% discount. If that was happening, there would either be substantial restrictions on quantity OR no drugs sold at current prices which means a much higher Canadian floor price.

One obstacle Florida and at least eight other states have faced from the beginning is the lack of participation from the Canadian government and the pharmaceutical industry. Despite that, Florida has spent by far the most, and it has made the least amount of progress, said Shabbir J. Safdar, executive director of the Washington-based Partnership for Safe Medicines.

“They spent more than 80 million dollars, and what do they have to show for it?” Safdar said. “It was clear Canada didn’t want anything to do with the program.”

Yeah, Canada gets a vote and they don’t want to wreck their drug supply chain to do Florida, or any other American state, a solid.

NOT SHOCKING

Drug Reimportation means other countries get a votePost + Comments (24)

This seems to be an offer intended to be refused.

News – Moreno makes ACA subsidy offer to Dems

-1 year extension of credits w option to convert to HSA after
– bars “individuals not lawfully present”
– minimum $5 monthly payments on plans
– extends open enrollment to March 31
-penalties on fraud
– CSRs
– Hyde audits
www.semafor.com/article/01/2…

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— Burgess Everett (@burgessev.bsky.social) January 28, 2026 at 2:56 PM

A 1 year extension of ARPA subsidies in exchange for long term hollowing out core affordability and administrative burden reducing measures seems to be a very unbalanced offer.

We can think about the ACA having three periods of affordability.

2014-2017 — Not bad for 100-200% FPL, limited help 200-400% FPL, no help for 400% FPL +
2018-2021 — Common Zero Premium (ZP) Bronze and limited ZP Gold to 200% FPL, more help for 200-400% FPL, no help for 400% FPL + (Silverloading —paper to come soon on the economics of silverloading)
2022-2025 — Lots of help for <200% FPL, including ZP Silver for <150, substantial help 200-400% FPL, and lots of help for over 400% FPL 2026 is currently in 2018-2021 policy environment. Why would Democrats agree to a baseline that brings them back to 2017 where everyone knows there were substantial affordability problems as well as getting rid of the zero premium plans that are quite helpful for enrollment? No deal is a viable option.

An offer intended to be refusedPost + Comments (25)

Just a reminder that Open Enrollment for the ACA for Healthcare.gov and many state based marketplaces ends at 11:59 PM on January 15th

Go sign up.

We have no idea if there will be an extension of subsidies. We have no idea what else is happening so just go sign up.

Sign up for the ACA NOWPost + Comments (11)

The House Republican health insurance bill has items — some are inconsequential (CHOICE/ICHRA accounts), some are esoteric ways to introduce more risk rating to the small group market (ERISA pre-emption for stop-loss insurance as a F-U to California) and some are theoretically supposed to drive down prices.  The word theoretically is doing a lot of lifting.

The bill appropriates funds to pay ACA Cost-Sharing Reduction subsidies. This will reduce the benchmark premiums of Silver plans.  It makes subsidized not-Silver coverage more expensive.  It scores as a coverage loser and money saver:

CBO score for House GOP bill:

-100k fewer people with health coverage
-saves govt $35bn over 10 yrs

(Funding CSRs results in a cut to subsidies, resulting in some losing health coverage, also saving govt money)
https://t.co/HlXFjZqPLP

— Peter Sullivan (@PeterSullivan4) December 16, 2025

As a side note, this policy as it has an anti-abortion rider is surgically designed to dick punch Red states like Texas and Florida while mostly leaving Blue states which may have mandatory non-Hyde abortion riders harmless.

But when your coverage bill leads to a modest drop in net coverage, that is a CHOICE!

Interesting coverage billPost + Comments (7)

The opportunity to buy health insurance on the ACA marketplaces that becomes active on January 1st ends tonight in most states.

If you need health insurance, go online and buy today.

If you need help, drop a line in comments.

 

 

Hurry Up and Buy Health Insurance TodayPost + Comments (33)

Senators Cassidy (R-LA) and Crapo (R-ID) released their health plan proposal for the ACA.

It does not extend premium subsidies but it does provide limited cost-sharing subsidies that are likely to be valuable for healthy and higher income enrollees.

That is the basis of their plan:

 

There is a lot going on here.

1.  Direct payment of HSA funds is great for pretty healthy folks who can afford full priced premiums
2. The decision to fund Cost Sharing Reduction subsidies in 2027 would end the practice of silverloading.
   1. Silverloading inflates Silver premiums
   2. Silverloading is great for enrollees with incomes between 200% to 400% Federal Poverty Level (FPL)  
   3. Silverloading has next to no impact on 100-175% FPLers nor over 400% FPLers
   4. Silverloading and Premium Alignment have juiced the Texas and Florida ACA markets
3. Catastrophic plans have a price advantage on average over Bronze plans for unsubsidized buyers only because risk adjustment does not move Catastrophic funds to cover Silver, Gold and Platinum plan enrollee expenses while Bronze premiums partially cover other enrollees’ expenses
4. Catastrophic plans for everyone worsens both the Metal Level and Catastrophic risk pools
   1. Great for remaining subsidized metal level buyers as higher morbidity is great in generating bigger premium spreads
   2. Really bad for non-subsidized Catastrophic and metal level buyers
5. There is a world where the ACA individual market acts as a well subsidized high cost risk pool — this is not that world.

 

The short version is that this plan does nothing for premium affordablity, and for those who actually need care a $1000 HSA contribution instead of extending the enhanced premium tax credits is still a money loser.  Getting rid of Silverloading increases premiums paid by middle class Americans for Bronze and Gold plans.

There are CHOICES BEING MADE HERE.

Cassidy and Crapo — great for healthy over 400% FPLersPost + Comments (21)