Health Watch 2014: Implications Of ACA Subsidies

Question 1

Stakeholder concerns of ACA subsidies

Answer 1

1. Issuers
   1.1 there is no much data for pricing
   1.2 review enrollment, pharmacy claims, and the market premium
   2 employees
   2.1 some way drop EE coverage or dependent coverage
   2.2 understanding the subsidies helps employers understand the net costs
2. Labor unions
   3.1 unions argue that their benefits are generally richer than exchange plans
   3.2 understanding net premium by age and income helps model member benefits
3. States
   4.1 approved lower rates lower revenues for issuers and Outlays for the federal government
   4.2 The lowest Bronze on the plan has premium inversions
   4.3 The rate review process benefits higher income individuals but actually increases net rates on lower income individuals ( as both the subsidy and the gross premium reduce)
   4.4 State are considering a basic health plan BHP for enrollees below 200% FPL. considered the income biased enrollment that will occur
4. Federal government
   5.1 the subsidy amount depends on how many subsidy-eligible individuals enroll, who enrolled, the marketplace goes premiums, ACA awareness, unemployment rates

Question 2

Describe the ACA premium and cost sharing subsidies

Answer 2

1. Premium subsidies
   
   1. 1 subsidies lower the purchasers cost to a more affordable rate
   2. 2 must have an income between 100 and 400 percent FPL, purchase a plan in an individual exchange, and not be eligible for other coverage
   3. 3affordability is determined based on a graded scale as a percentage of income
   4. 4 affordability does not consider accumulated savings nor that older people budget a higher percentage of spending for Healthcare Services
   5. 5 The benchmark plan is the second lowest priced silver plan in the geographic region
   6. 6 if the individual select a more expensive or lower cost plan, they carry over the subsidy to the selected plan
   7. 7 primarily benefit older people, as premiums for younger are more likely to be affordable
2. Cost sharing subsidies
   
   2. 1 available for individuals below 250% of the FPL who select a silver plan
   3. 2 benefits are adjusted to the AV from 70% to 73% (200 to 250 percent FPL) 87% (150 to 200 percent FPL) or 94% (100 to 150 percent FPL)
   4. 3 Premium remains at the 70% level and the government reimburses insurers for enrich design