Monday, November 24, 2014

Can the ACA exchanges steer customers away from bad choices?

An important feature on Healthcare.gov -- improved for the new open season, I believe -- could steer significant numbers of users toward plans best suited to their needs -- and perhaps point a way towards solving the "auto-renewal" problem, whereby existing plan holders may face steep price hikes if they fail to comparison -shop.

The feature in question is addressed to those buyers who are eligible for Cost Sharing Reduction subsidies, which lower plan deductibles and out-of-pockets costs for lower-income buyers -- but only if they buy silver-level plans, which will cost them significantly more per month in premiums than bronze-level plans.

Lower income buyers who choose bronze plans, which have lower premiums, can forfeit thousands of dollars' worth of CSR benefits. Fortunately, the vast majority of CSR-eligible buyers do seem to have found their way to silver, notwithstanding premiums that can be tens of dollars per month higher for individuals and over $100 per month more for families.

Dave Chandra, a Senior Policy Analyst at the Center on Budget and Policy Priorities and a Certified Application Counselor, tells me that this year, if an applicant who qualifies for CSR takes steps toward buying a bronze plan (or, less probably, gold or platinum), a prominent pop-up message will warn her that she is eligible for CSR and will forfeit it if she proceeds. Here it is:

Friday, November 21, 2014

Why go for the bronze?

I've devoted a lot of posts to worrying about who bought high deductible bronze plans but shouldn't have, especially those who were eligible for Cost Sharing Reduction subsidies if they bought silver (Fortunately, most CSR-eligible buyers did choose silver.) This evening I have a post up on healthinsurance.org digging into who should buy bronze -- that is, for whom is a plan with, say, a $5,000 deductible at least a rational choice.

One key: in  some states and counties, some bronze plans provide substantial benefits that kick in before the deductible is reached -- say, $20 primary doctor visits or $10 generic drug copays. Another: for the unsubsidized, premiums climb steeply with age, while deductibles and copays remain the same regardless of age. For the rest, I hope you'll take a look.

Thursday, November 20, 2014

The ACA and the white working class

When Bill Gardner this morning pointed out, as many have, that Americans approve of the core components of the ACA but disapprove of the law, I expected the corollary to be "slander works," or"it's really hard to communicate how these moving parts fit together," or some combination of the two.

Instead, I was confronted with this chart from a paper by Henry Aaron and Gary Burtless:

Tuesday, November 18, 2014

Gruber clips inspire powerful condensed defenses of the ACA

On occasion, I've made my case against opinion writers' "paragraph briefs," which make an omnibus case for something by packing disparate and often dubious assertions in comma-separated series.

An often more powerful variant, though still subject to slipping in slugs and ringers, is the link-packed paragraph brief.  These cite an array of evidence in a way that dares the reader not to take the cited authorities on faith -- each of them, maybe a half-dozen, are a click away. Of course, most of us do take most of them on faith most of the time. But the cards are on the table.

The Gruber brouhaha has driven a lot of progressive policy wonks to retrospection -- reviewing the legislative and political history of the ACA while chewing over Gruber's assertions that the process was deceptive and his apparent early impression that federal subsidies to states that built their own exchanges might not be immediately forthcoming.  That process has given rise to what's struck me as two particularly powerful paragraph briefs.

First, Ezra Klein delivers a short legislative history that rebuts the preposterous Halbig/King contention that the ACA's drafters intended to make premium subsidies available only to buyers in state-run exchanges:

Monday, November 17, 2014

Fleshing out a (real) ACA hardship story in the WSJ

It's inevitable that reporters' vignettes about ACA shoppers will often lack context or essential details. Print space is limited, readers' attention is limited,  reporters' time is limited, and protagonists' grasp of their own experience may even be limited.

Still, the back stories are often worth probing (3210). Here's one from today's Wall Street Journal, with Louise Radnofsky, Stephanie Armour, and Anna Wilde Mathews reporting on the first day of Open Season II. There's no inaccuracy, but the rate-shock subplot in this brief account does leave a question mark:

Sunday, November 16, 2014

The Times wrestles with ACA re-enrollment; I call some fouls

To a point, New York Times healthcare writers (see byline below) did a good job explaining the complexities of the renewal decision facing many buyers of health plans on the ACA exchanges for 2014. But I have three beefs with the front-page presentation.

The first is in the headline (not the reporters' responsibility). The lead that follows clarifies the problem -- but for many, of course, the headline shapes perception:
Cost of Coverage Under Affordable Care Act to Increase in 2015
By ROBERT PEAR, REED ABELSON and AGUSTIN ARMENDARIZ NOV. 14, 2014


WASHINGTON — The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent — unless they switch plans.
Unless they switch plans is the key. For the 85% of buyer who qualify for federal subsidies, their costs will not go up at all if they buy the benchmark second-cheapest Silver-level plan, or a cheaper plan -- except insofar as their income rises. Their share of the premium is a fixed percentage of their income. In fact, if their income is flat they may qualify for higher Cost Sharing Reduction (CSR) benefits, since the formula for determining those benefits is adjusted yearly for inflation.

Saturday, November 15, 2014

Getting the word to the uninsured: Can Healthcare.gov show the subsidy, pronto?

More than half of the uninsured don't know that the government will help fund their insurance, according to the Kaiser Family Foundation. More than half of the subsidy-eligible who shopped but didn't buy on healthcare.gov didn't recognize that they were eligible for subsidies, according to McKinsey and Company.

A functioning shop-around feature, in which a user punches in location, household members and income and gets price quotes with subsidies included, could be a major weapon against that widespread ignorance. When Healthcare.gov launched, or failed to launch, last fall, it didn't have one. In December a shoparound was up and functioning -- but many folks never saw it; the home page didn't particularly steer you to it.

This year is different. The shoparound showing quotes for 2015 was up before Open Season launched, and you couldn't miss it (good news: now that Open Season has kicked off, that's still true). How effective is it?

I have an article up on Healthinsurance.org that explores its strengths and weaknesses, with expert health. In brief, the good news: you can't miss the shoparound when you visit hc.gov, and if you try it, you can get price quotes in under a minute.  And the bad: the guidance toward silver plans for those eligible for Cost Sharing Reduction subsidies, which are available only with silver, is still weak, and the information about CSR subsidies is incomplete. More generally, the level of decision support is not up to that of select states, like Idaho, the only state to exit Healthcare.gov and launch its own exchange this year.