Charles Gaba ✡️HEY TEXAS ACA ENROLLEES: Here's an article about #SilverLoading & #PremiumAlignment which puts them in pretty easy-to-understand terms:
www.houstonchronicle.com/politics/tex...
Why a little-known state law m...
Why a little-known state law m...
I should note that if #SilverLoading *is* ended, the 14 states with #PremiumAlignment policies in place will still have more affordable Gold & Bronze plans, it just won't be nearly as dramatic.
Silver Loading/Switching make up the bulk of Premium Alignment but not all of it.
It's also worth giving a shout-out to states like CA, CO, NJ and others who are taking action to mitigate the damage.
In some cases this is via state-based subsidies; in others it's via leveraging the remaining subsidy formula to the hilt via #PremiumAlignment.
acasignups.net/25/10/14/sil...
Silver Linings Playbook: Some ...
Silver Linings Playbook: Some ...
Silver Linings Playbook: Some states are taking action to mitigate the upcoming tax credit tsunami (Update: Add MA to the list!)
As anyone not under a rock for the past few months knows by now, the improved federal Affordable Care Act tax credits which were put into place by President Biden and Congressional Democrats starting in 2021 are currently scheduled to expire at the end of December, just 2 1/2 months from now. If this happens, the consequences for ~24 million Americans will be devastating, with average health insurance premiums more than doubling and millions being priced completely out of the insurance market altogether. On top of this, the Trump Regime has also made administrative regulatory changes to how the ACA is structured resulting in the remaining tax credit formula becoming even less generous yet, while also eliminating eligibility for either financial assistance or even ACA enrollment whatsoever to many other Americans. Congressional Republicans could still potentially agree to extend the tax credit upgrade, but that's extremely unlikely at this point, and even if they do, some of the other executive actions taken by the Centers for Medicare & Medicaid Services (CMS) under Trump, RFK Jr. and Dr. Oz would still negatively impact a lot of people.
📣 ALSO IMPORTANT: There are 7 *other* states which haven't embraced #PremiumAlignment but which *do* have their own state-based subsidy programs or other programs in place to help lower-income enrollees, including...
📣 IMPORTANT: #PremiumAlignment is NOT A SUBSTITUTE FOR THE EXPIRING ENHANCED TAX CREDITS.
Even in states which have embraced it, it doesn't help *all* enrollees, and even among those it helps it doesn't necessarily cancel out all of the damage.
It does, however, help a lot for a lot of people.
Next up: #ARKANSAS, which some of you may recall I got a bit obsessed with tracking a couple of months ago.
Arkansas is one of the states NEWLY implementing #PremiumAlignment for 2026, *directly* in response to the enhanced tax credits expiring.
This results in an odd-looking pricing pattern...
First up: #ALASKA (also the income exception...the Federal Poverty Level is 25% higher in AK, so I put the income 25% higher as well)
AK has had #PremiumAlignment for years, so Bronze, Silver & Gold are all going up...but Gold still cost an avg. of 28% LESS than Silver after subsidies are applied.
With that in mind, here's the 14 states which DO have #PremiumAlignment policy in place...some of which may surprise you!
CAVEATS:
--They assume a 50-yr old single adult
--They assume an annual income of $50K/yr (w/one exception)
--They assume the enrollee lives in the capital city of that state
Before I dig in, here's what you'd *normally* expect #ACA plan pricing to look like, using my home state of #MICHIGAN, which (unfortuantely) has NOT instituted #PremiumAlignment yet:
For both years, Bronze plans cost the least, Silver costs more and Gold costs the most. Seems obvious, right?
Last week I explained how wonky stuff like #SilverLoading and #PremiumAlignment have been used by some states to significantly *reduce* the price of GOLD and BRONZE plans while simultaneously boosting the amount of federal subsidies which can be used to buy them.
acasignups.net/25/11/06/pre...
Premium Alignment, or how a do...
Premium Alignment, or how a do...
Premium Alignment, or how a dozen states are quietly providing ACA enrollees w/better options even in the face of expiring tax credits
I've written multiple times in the past about "Silver Loading," the ACA health insurance policy pricing strategy in which insurance carriers load the extra cost of their Cost Sharing Reduction financial burden (the portion of deductibles, co-pays & coinsurance which they're required to cover themselves for low-income enrollees who select Silver plans) onto the gross premium of those same Silver plans. It gets a bit wonky, but the bottom line is that Silver Loading results in the gross price of Silver ACA plans increasing significantly even if the price of Bronze, Gold & Platinum plans only go up modestly. From the carriers perspective, how the CSR load is allocated doesn't matter much as long as they aren't left stuck with the bill...but pricing the plans in this fashion has major implications for the enrollees themselves. This is because the formula for the ACA's advance premium tax credit subsides (APTC) is based on the gross price of Silver plans: If the price of Silver plans increases, so do the subsidies for those eligible..but you can use APTC to enroll in non-Silver plans if you wish. This in turn means that if Silver plans go up by, say, 30% while Bronze & Gold only go up by 10%, the net premium you pay for a Bronze or Gold plan will be significantly lower.