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Balloon Juice | Plan domination and subset networks
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Balloon Juice | Avoiding Dominated Defaults in the ACA marketplace
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Balloon Juice | Dominated plan choice in the ACA
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At the Health Affairs Blog, Coleman Drake, Petra Rasmussen and I lay out some of our concerns about the ACA choice environment in the first of a two part blog post series.
The passage of the American Rescue Plan had two major changes to the ACA’s subsidy scheme. First, people who earned over 400% FPL were eligible for subsidies if the benchmark silver plan was more than 8.5% of their income.
Secondly, and more importantly, the expected household contribution for lower income buyers who were already subsidy eligible decreased dramatically. Notably, individuals who earned under 150% FPL saw the benchmark premium go from about 4% of income to 0% of income. A massive number of people are now seeing zero premium CSR-94 Silver plans.
In the most recent issue of Health Affairs, Feher and Menashe write about a recent randomized control trial to improve choice quality on the Covered California individual health insurance marketplace. Covered California had, in 2019, roughly 20,000 households earning under 200% Federal Poverty Level (FPL) who were qualified for Cost Sharing Reduction (CSR) subsidies for either the 94% or 87% actuarial value silver variants. However these households bought either gold or platinum plans. Gold or platinum plans will offer worse cost sharing at the same or higher net premiums on the same network/insurer as the silver variant. This is a very similar analytical set-up that Petra Rasmussen and I are using as we looked at households earning over 200% FPL in 2018 while Feher and Menashe look at under 200% FPL in 2019 to identify households in dominated plans.