Help me tell ACA stories

Greetings, dear readers: I would like to tell stories about people's experiences with lesser-known ACA benefits -- or shortcomings. Writeups may appear elsewhere -- healthinsurance.org or other publications -- or here.  These are the categories I have in mind:

1) Donut hole: I'd like to speak to Medicare enrollees who have benefitted (or not so much) from the ACA's gradual closing of the "donut hole" in prescription drug coverage.

2) Lifetime coverage caps: pre ACA, in 2009, 59% of people insured through employers were subject to lifetime caps on coverage -- typically $2 million by 2009, but often $1 million. The ACA banned lifetime and annual caps.  In a recent post, I  dug up a 2007 study finding that 20,000-25,000 people would hit lifetime caps by 2009.and forecasting that 300,000 would max out by 2019 if the caps were not raised. I'd like to speak to anyone who ever hit the caps, or was saved from the caps by the ACA, or is worried about hitting the caps (because of an expensive chronic condition) post-ACA.

Five under-reported facts about the ACA

It just popped into my head to consolidate a few facts about the ACA that I think I know and that seem to be pretty widely unrecognized. I just delved into the first one today, and I've flogged many or most of them several times, but here goes:

1. Silver plans are usually more than silver: 85% of silver plans sold on ACA exchanges are enhanced by Cost Sharing Reduction subsidies that raise the actuarial value from a baseline of 70% to 73%, 88%, or 94%, depending on the buyer's income. Two thirds of silver plan buyers have the stronger forms of CSR -- AV 87% or 94%.  On the other hand...

2. Half of those buying plans in the individual market are off-exchange, and many of those are doubtless buying silver plans with AV 70% (the metal levels are in use in ACA-compliant plans sold off exchange).

3. Most of those buying off-exchange are paying more than they would have pre-ACA, but perhaps 20-50% of them have a pre-existing condition or have a family member with one. Many of those buyers are paying less than they would have pre-ACA, and some would not have been able to buy or afford insurance at all.

4  ACA coverage rules are not the main reason that the law raised the price of unsubsidized individual market insurance.  Republicans have made the ACA's mandatory Essential Health Benefits their favorite whipping boy, but the real price driver is guaranteed issue -- the prohibition against basing the price of a plan (or eligibility) on the would-be buyer's medical history. And most Republicans profess (rather vaguely) to support that.

Is the ACA reducing underinsurance?

About 16 percent of the U.S. population has no health insurance. Reducing that percentage by more than half is a primary purpose of the Affordable Care Act. As subsidized coverage in a reformed individual market has become available for the first time in 2014, news coverage has understandably focused mainly on how many previously uninsured people are gaining coverage.

But the ACA also rewrote the rules governing what kinds of coverage health insurance policies had to offer. The revamp was designed to address a problem nearly as pressing as reducing the ranks of the uninsured: tens of millions of Americans were also underinsured, or unreliably insured.  Coverage was subject to annual or lifetime caps and to arbitrary rescission.  Essential benefits such as hospitalization, mental healthcare, rehabilitative care and childbirth were excluded from many policies.

Many ACA provisions designed to end underinsurance have been in effect for some time  -- the ban on lifetime coverage limits has been in place since September 23, 2010, as has mandatory free coverage for a long list of preventive services, including birth control  I would like to examine the extent to which serious uninderinsurance has already been reduced.  What follows is a kind of scope-of-question outline -- a few questions, a few premises, a few observations.