Mastodawn

In any event, CSR funding being eliminated in October 2017 led to #SilverLoading as an unintended consequence, and Silver Loading is a MAJOR part of the "Premium Alignment" pricing policies which over a dozen states now have in place: acasignups.net/25/11/12/the...

There Will Be Graphs: A deeper...

There Will Be Graphs: A deeper dive into how 14 states are dramatically mitigating the expiring tax credits

IMPORTANT: Premium Alignment is NOT a substitute for making the enhanced ACA tax credits permanent. It does little to help the lowest-income folks who are still better off with Silver plans thanks to robust CSR assistance, and the benefits of it will be mediocre for those over 400% FPL if the enhanced tax credits expire. Even for those it benefits the most (primarily those who earn between 200 - 400% FPL), it's a complement to the upgraded subsidies, not a replacement for them. HOWEVER, it's still hugely helpful to those who know how to take advantage of it, and particularly in the states newly implementing it, it should relieve a huge portion of the pain being caused by the enhanced APTC expiring next month. Last week I posted a deep dive into how a bunch of states are taking action to at least partially cancel out the impact of the impending end of the enhanced federal Advance Premium Tax Credits (APTC) which have been in place since early 2021. I discussed wonky health insurance policy pricing terminology like "Silver Loading" and "Premium Alignment" and included a few examples to demonstrate how some states have set up their pricing policies in such a way as to maximize the impact of the tax credit formula which we're scheduled to convert over to starting on January 1st.

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Charles Gaba ✡️Dec 30

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...

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Charles Gaba ✡️Dec 16

IMPORTANT: The ~300,000 that the CBO projects to lose coverage due to #SilverLoading ending would be ON TOP OF the ~4M or so the CBO projects to lose coverage due to the enhanced tax credits expiring. I've updated the headline at the link to try & make this more clear.

Charles Gaba ✡️Dec 16

IMPORTANT: The ~300,000 that the CBO projects to lose coverage due to #SilverLoading ending would be ON TOP OF the ~4M or so the CBO projects to lose coverage due to the enhanced tax credits expiring.

RE: https://bsky.app/profile/did:plc:kd4cyu4rpkgjbym3gckhrivz/post/3ma4wzdjqds2e

Charles Gaba Dec 16

🚨 House GOP Bill: No #ACA tax credit extension after all; CBO projects 300K to lose coverage due to end of #SilverLoading in mostly red states:

https://acasignups.net/25/12/16/house-gop-bill-no-tax-credit-extension-after-all-cbo-projects-300k-lose-coverage-due-end

House GOP bill: No tax credit extension after all; CBO projects 300K to lose coverage due to end of Silver Loading in mostly red states

Welp. In a development which should surprise absolutely no one, GOP House Speaker Mike Johnson has announced that the bipartisan "Fitzpatrick Bill" which would include a 2-year extension of the enhanced ACA tax credits (albeit with significant caveats) won't be included in their healthcare bill vote this week after all. Via Politico: Speaker Mike Johnson confirmed Tuesday he will not allow a House vote this week to extend expiring Obamacare subsidies — a reversal from last week when a GOP leadership aide said the process “would allow” for an amendment vote. “In the end, there was not an agreement,” Johnson told reporters, noting the divides in his conference over the subsidies. Meanwhile, the main House GOP bill (which doesn't include any tax credit extension) will move forward anyway...and the Congressional Budget Office has published their official ten year score of the budgetary & insurance coverage impact of the bill: H.R. 6703 would establish new rules for association health plans, modify requirements for individual and group health coverage, require contracts between plan sponsors and pharmacy benefit managers (PBMs) to meet certain standards, and appropriate funding for reductions in cost sharing.

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Charles Gaba ✡️Dec 16

🚨 House GOP Bill: No #ACA tax credit extension after all; CBO projects 300K to lose coverage due to end of #SilverLoading in mostly red states: acasignups.net/25/12/16/hou...

House GOP bill: No tax credit ...

House GOP bill: No tax credit extension after all; CBO projects 300K to lose coverage due to end of Silver Loading in mostly red states

Welp. In a development which should surprise absolutely no one, GOP House Speaker Mike Johnson has announced that the bipartisan "Fitzpatrick Bill" which would include a 2-year extension of the enhanced ACA tax credits (albeit with significant caveats) won't be included in their healthcare bill vote this week after all. Via Politico: Speaker Mike Johnson confirmed Tuesday he will not allow a House vote this week to extend expiring Obamacare subsidies — a reversal from last week when a GOP leadership aide said the process “would allow” for an amendment vote. “In the end, there was not an agreement,” Johnson told reporters, noting the divides in his conference over the subsidies. Meanwhile, the main House GOP bill (which doesn't include any tax credit extension) will move forward anyway...and the Congressional Budget Office has published their official ten year score of the budgetary & insurance coverage impact of the bill: H.R. 6703 would establish new rules for association health plans, modify requirements for individual and group health coverage, require contracts between plan sponsors and pharmacy benefit managers (PBMs) to meet certain standards, and appropriate funding for reductions in cost sharing.

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Charles Gaba ✡️Dec 13

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.

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Charles Gaba ✡️Dec 13

This means that #SilverLoading would be ended in red states (and some purple/blue ones) but would continue in the following states: CA, CO, IL, ME, MD, MA, MN, NJ, NY, OR, VT, WA.

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Charles Gaba ✡️Dec 13

You can read my explainer of #SilverLoading here. Short version: It made *full-price* Silver plans more expensive but also made BRONZE and GOLD plans far *less* expensive in most states...to the point that some people can get them for $0/mo. acasignups.net/24/01/05/my-...

My Simplified #SilverLoading E...

My Simplified #SilverLoading Explainer

I've written in-depth explainers before of how Silver Loading came into existence and how it works as part of longer blog posts, but I also wanted to have a simpler, standalone version, so here it is. First, a quick backstory: The ACA includes two types of financial subsidies for individual market enrollees through the ACA exchanges (HealthCare.Gov, CoveredCA.com, etc). One program is called Advance Premium Tax Credits (APTC), which reduces monthly premiums for low- and moderate-income. APTCs are the subsidies which have been substantially beefed up by the American Rescue Plan (the additional subsidies will be available starting in April in most states, soon thereafter in most other states). The other type of subsidies are called Cost Sharing Reductions (CSR), which reduce deductibles, co-pays and other out-of-pocket expenses for low-income enrollees. The way the CSR program works is a bit unusual. Unlike premiums, which are a set, known dollar amount for every enrollee each month, the CSR program involves deductibles & co-pays, which can vary greatly from month to month. Therefore, instead of subsidizing the enrollees directly, the insurance carriers are contractually required to cover the given portion of the enrollee's deductibles, co-pays etc.

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Charles Gaba ✡️Dec 13

Trump & the GOP thought ending these payments would severely damage the ACA; instead they actually ended up unintentionally *strengthening* it thanks to a clever pricing reaction by insurance carriers & state regulators called #SilverLoading which turned lemons into lemonade.