I don't know why it's taken me so long to notice, but something I've always wanted to know about ACA enrollment has been hiding in plain sight since July.
The question is what percentage of marketplace enrollees at different income levels who are eligible for Cost Sharing Reduction (CSR) subsidies do in fact access the benefit by selecting silver plans, the only metal level at which CSR is available. This is important, because out-of-pocket expenses for lower income enrollees -- which means most enrollees -- are basically only manageable in CSR-enhanced plans.
CSR raises the actuarial value of a silver plan from a baseline of 70% to 94% for those with incomes up to 150% FPL; to 87% for those in the 150-200% FPL range, and to just 73% for those between 200% and 250% FPL. Conversely, the percentage of income required to buy a silver plan rises with income -- disproportionately, to judge from takeup, which is higher at lower income levels. Those who opt for a lower premium by buying bronze plans are leaving a valuable benefit on the table and letting themselves in for deductibles generally north of $6,000.
Every year since the launch of the ACA marketplace for 2014, HHS has published ever-more specific enrollment data (for HealthCare.gov states in particular). But CSR takeup at different levels has had to be extrapolated from various not-quite-complete hints, including data published by states that run their own marketplaces.
That was the case, that is, until this past July, when a CMS data brief appeared with a CSR Rosetta Stone wrapped in the middle. And I'm going to take a little credit for that, as well as drawing conclusions.
The question is what percentage of marketplace enrollees at different income levels who are eligible for Cost Sharing Reduction (CSR) subsidies do in fact access the benefit by selecting silver plans, the only metal level at which CSR is available. This is important, because out-of-pocket expenses for lower income enrollees -- which means most enrollees -- are basically only manageable in CSR-enhanced plans.
CSR raises the actuarial value of a silver plan from a baseline of 70% to 94% for those with incomes up to 150% FPL; to 87% for those in the 150-200% FPL range, and to just 73% for those between 200% and 250% FPL. Conversely, the percentage of income required to buy a silver plan rises with income -- disproportionately, to judge from takeup, which is higher at lower income levels. Those who opt for a lower premium by buying bronze plans are leaving a valuable benefit on the table and letting themselves in for deductibles generally north of $6,000.
Every year since the launch of the ACA marketplace for 2014, HHS has published ever-more specific enrollment data (for HealthCare.gov states in particular). But CSR takeup at different levels has had to be extrapolated from various not-quite-complete hints, including data published by states that run their own marketplaces.
That was the case, that is, until this past July, when a CMS data brief appeared with a CSR Rosetta Stone wrapped in the middle. And I'm going to take a little credit for that, as well as drawing conclusions.
