Terminating Cost-Sharing Reduction Subsidy Payments: The Impact Of Marketplace Zero-Dollar Premium Plans On Enrollment

Drake, Coleman; Anderson, David M.

doi:10.1377/hlthaff.2019.00345

Cited by 29 publications

(26 citation statements)

References 6 publications

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“…We based these calculations, as the marketplaces themselves do, on each enrollee's age, household income, household size, and the marketplace health care plans available to them. 11,25 We then identified enrollees whose default plans met the criteria to be dominated as described above. We applied smart defaults to enrollees in dominated plans under the ARP, assigning them new default health care plans per the smart default algorithm (ie, the plan from the same insurer with the same provider network that has the most generous cost sharing but would not result in a premium increase, after applying premium tax credits).…”

Section: Discussionmentioning

confidence: 99%

“…These $1 premiums would be $0 in most other states; California has a premium floor of $1, resulting from a mandate that its marketplace insurers provide abortion coverage. 11,27 Among affected enrollees with a net premium higher than $1, mean monthly premiums would decrease by We projected that approximately 327 000 enrollees in the 36 states using the HealthCare.gov marketplace, or approximately 4.4% of subsidized enrollees, will be defaulted to dominated health care plans under the current policy. Our projections indicate that approximately 319 000 (97.0%) of these enrollees have incomes below 250% of the FPL, and 230 000 (70.0%) are enrolled in bronze plans (eTable 1 in the Supplement).…”

Section: Discussionmentioning

confidence: 99%

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Estimated Plan Enrollment Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules

2021

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IMPORTANCEThe American Rescue Plan increases premium subsidies for health insurance marketplace enrollees, potentially leading to situations in which enrollees could switch to other health care plans with lower premiums and less cost sharing (ie, deductibles and copayments).Current policy defaults enrollees to their current health care plan if they automatically renew their coverage, which may cause them to stay in health care plans that, because of the American Rescue Plan, are now dominated in that they have higher premiums and cost sharing than other options.OBJECTIVE To estimate the extent to which a smart default policy could reduce US health insurance marketplace enrollees' cost sharing and premiums. DESIGN, SETTING, AND PARTICIPANTSUsing 2018 individual enrollment data and 2021 premium data from California's marketplace and the American Rescue Plan premium tax credit subsidy schedule, this economic analysis estimated the characteristics of enrollees' default health care plans if they defaulted into 2021 health care plans under current and smart default policies. The analysis was conducted from March 20 to April 8, 2021. MAIN OUTCOMES AND MEASURES Characteristics of enrollees' default health care plans under current and smart default policies, including net premiums, plan levels, and cost sharing. RESULTS The analytic sample consisted of 748 087 Covered California enrollees from 2018 (mean [SD] age, 44.80 [13.72] years; 408 410 [54.6%] women). Under current policy with the enhanced subsidies implemented under the American Rescue Plan, 5.8% of sample enrollees would default into dominated health plans. Of these enrollees, 98.0% would have incomes below 250% of the federal poverty level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Estimated Plan Enrollment Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules

2021

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“…14 However, zero-premium marketplace plans, such as the public option proposed by policymakers for nonexpansion states, have been shown to improve marketplace enrollment, especially for low-income adults. 33 Automatic enrollment, another part of this proposal, would likely have similar effects 34 and may promote continuity of coverage 35,36 ; together, these options could significantly improve effectuated enrollment for this population by removing both administrative and financial barriers to coverage. 37 Meanwhile, models that offer coverage to those above the 138% income cutoff in programs more similar to Medicaid, such as the Basic Health Program in New York and Minnesota, may have greater success at covering uninsured populations.…”

Section: Policy Implicationsmentioning

confidence: 99%

Comparison of Income Eligibility for Medicaid vs Marketplace Coverage for Insurance Enrollment Among Low-Income US Adults

et al. 2021

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IMPORTANCEThe Affordable Care Act created 2 new coverage options for uninsured adults:Medicaid expansion, which in most states provides comprehensive coverage without premiums and deductibles; and private marketplace coverage, which requires a premium contribution and costsharing, though with generous federal subsidies at lower incomes. How enrollment rates compare in the marketplace vs Medicaid is an important policy question as states continue to weigh alternative coverage options such as Medicaid buy-in programs, enrolling Medicaid-eligible populations into marketplace plans, or creating a public option.OBJECTIVE To assess the association between income eligibility for Medicaid vs marketplace coverage and insurance enrollment among low-income adults in Colorado. DESIGN, SETTING, AND PARTICIPANTSUsing 2014 and 2015 all-payer claims data from Colorado and detailed income eligibility information, we used a regression discontinuity design to assess the difference in Medicaid and marketplace enrollment just below and just above 138% of the federal poverty level (FPL), the eligibility threshold between the 2 programs. The sample included nonpregnant adults aged 19 to 64 years with incomes between 75% to 400% FPL. We stratified our analysis by age, sex, chronic condition status, and urban vs rural residence. Analysis was conducted from January to October 2020. MAIN OUTCOME AND MEASURESThe main outcome was total enrollment in either Medicaid or marketplace coverage during marketplace's Open Enrollment period. Income-based health insurance eligibility was assessed as a percentage of FPL at the time of initial application for coverage.

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“…The sliver loading strategy was implemented by 43 state insurance commissioners in 2018. 52 Research on silver loading found that it was associated with increases in overall affordability, 52 - 55 increased plan switching behavior, 56 and may have counter-acted some of the enrollment effects of other Trump administration policies. 57 Other work suggests that the decision to expand Medicaid was associated with reductions in Marketplace premiums.…”

Section: Institutional Backgroundmentioning

confidence: 99%

The Affordable Care Act’s Coverage Impacts in the Trump Era

Courtemanche

Fazlul

Marton

et al. 2021

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The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion increased in 2017 (7.0 percentage points) before returning to the 2016 level of coverage gains in 2019 (5.9 percentage points). The net effect of the ACA in expansion states is a combination of these trends, with coverage gains falling from 10.8 percentage points in 2016 to 9.6 percentage points in 2019.

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Terminating Cost-Sharing Reduction Subsidy Payments: The Impact Of Marketplace Zero-Dollar Premium Plans On Enrollment

Cited by 29 publications

References 6 publications

Estimated Plan Enrollment Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules

Estimated Plan Enrollment Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules

Comparison of Income Eligibility for Medicaid vs Marketplace Coverage for Insurance Enrollment Among Low-Income US Adults

The Affordable Care Act’s Coverage Impacts in the Trump Era

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