Senators Alexander and Corker (R-TN) have a proposal to tweak the ACA. I can’t figure out what the actual problem is that they are trying to fix.
Alexander/Corker intro ACA fix: waive mandate penalty for people w/ no options and let them use the subsidy on a plan outside the exchanges. pic.twitter.com/nxrFZFJjOi
— Sahil Kapur (@sahilkapur) March 29, 2017
Right now if there is no on-exchange plan in a county, a hardship exemption can be triggered by the Secretary of Health and Human Services to waive the mandate. That was the most likely scenario that would have occurred in Pimal County, Arizona last August when it looked like there were to be no carriers in that county. Blue Cross/Blue Shield stepped in at the last minute.
Taking the subsidy to go buy insurance off-exchange means the subsidy would either apply to an Off-Exchange QHP or to a mini-med or to a health sharing ministry. As a short term fix, I get this. But there is a major problem here.
“If you like it, you can keep it”
That is the problem. The politics of the situation will grandfather individuals who bought a non-QHP during a no-choice year will keep that policy and the attendant subsidy. Mini-meds and HSM both underwrite and limit benefit choices. They weaken the long run risk pool as healthy people will stay in them and sick people will migrate back to the QHP non-underwritten pool as quickly as possible.
I don’t see what problem Alexander-Corker are trying to solve other getting a good headline back in Tennessee as there are sixteen counties with no plans committed to for 2018 yet.