Wednesday, October 07, 2015

What's a "typical" silver plan? Not what Emory researchers say it is

Nothing drives me battier than to see silver-level health plans unenhanced by Cost Sharing Reduction (CSR) subsidies presented as the "average" offering, either of silver plans or of all plans offered in ACA marketplaces. Over 80% of silver plan buyers in ACA marketplaces get CSR. Of those, about 80% have incomes under 201% FPL, which means their plans have an actuarial value of either 94% or 87% --  better than the average employer-sponsored plans.

An Emory University study purporting to show that "in the ACA Marketplaces, "out-of-pocket expenses for medications in a typical silver plan are twice as high as they are in the average employer-sponsored plan" is particularly frustrating because the researchers, led by Kenneth Thorpe, Chair of Emory's health research department, are well aware of how CSR is functioning in the marketplaces. Deep in the text, they acknowledge that 87%* of silver buyers in the marketplaces have CSR attached to their plans -- yet they persist in constructing a "typical" silver plan with AV 70% and very high pharma cost-sharing -- and compare the typical ESI plan exclusively with that construct.

Their rationale: The study considers the likely ill effects on pharma usage if employers drop insurance and dump their employees onto the exchanges. Because over 80% of employees with ESI have incomes over 250% FPL, the authors assert briefly that CSR is irrelevant. They don't address the fact that CBO projections of modest ESI losses assume that those losses will be among lower income workers.

I have a post up on that contrasts patient drug costs in the Emory researchers' "typical" silver plan with those of actual silver plans on the marketplaces available to buyers with incomes under 201% FPL -- again, almost two thirds of silver plan buyers in the marketplaces. Hope you'll take a look.

Now 82% after attrition and a federal audit of those whose income statements on their ACA applications did not match tax data.

UPDATE, 10/8: As originally worded, this summary could be read to imply deliberate obfuscation on the part of the study's authors. That was not my intent, and I regret if I gave that impression. I have have edited accordingly.

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