Charles Gaba ✡️Apr 7
📣 Final 2026 #ACA Open Enrollment Report: Metal Levels, part two Premium Alignment struck Gold after all...but things aren't always what they appear to be... acasignups.net/2026_oep/fin...

Final 2026 Open Enrollment Rep...
Final 2026 Open Enrollment Report: Metal Levels (Part 5B)

On Friday I posted the first half of my analysis of the various metal level enrollment shifts made by ACA exchange enrollees this year, which have special importance for 2026 given three major changes which went into effect starting January 1st: The expiration of the enhanced ACA tax credits, which made net premiums far more expensive for just about all enrollees; The termination of ACA subsidy eligibility entirely for most documented non-U.S. citizens who were previously eligible for them; and The state-based subsidy programs (either new, retooled or beefed up) and/or Premium Alignment pricing policies put into place by some states in an attempt to mitigate the damage caused by the first two bullets above. The main takeaways from the prior post were that: Enrollment in Catastrophic plans did increase by 25% year over year, which sounds significant until you realize that the Trump Regime somehow thought that opening up eligibility to millions more individual market enrollees was somehow going to cause Catastrophic enrollment to skyrocket by an insane 5500%.

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Show threadCharles Gaba ✡️Apr 7
Last week I wrote about ACA enrollment by metal level, noting that while overall, millions of enrollees *did* "buy down" to worse plans to mitigate the massive spike in net premiums, there was what seems to be a surprise as well: ~770K enrollees appeared to *upgrade* from Silver to Gold plans.
Show threadCharles Gaba ✡️Apr 7
The main reason Gold enrollment *increased* ~24% year over year even as millions of others *downgraded* from Silver to Bronze becomes clear when you separate out the states which have implemented #PremiumAlignment pricing from those which didn't: P.A. States: Gold +43% Non-P.A. States: Gold -26%
Show threadCharles Gaba ✡️Apr 7
HOWEVER, there's another important factor to consider as well: Thanks to the way Cost Sharing Reduction (CSR) subsidies are structured, *switching from Silver to Gold isn't always an upgrade in coverage.* In fact, in many cases this is ALSO "buying down."
Show threadCharles Gaba ✡️
Most CSR Silver enrollees have BETTER coverage from an Actuarial Value (AV) standpoint than Gold enrollees: Silver AI/AN CSR: ~99% AV Silver 94 CSR: ~94% AV Silver 87 CSR: ~87% AV Gold: ~80% AV Silver 73 CSR: ~73% AV Silver (standard): ~70% AV
Apr 7 at 1:23pmWeb
Show threadCharles Gaba ✡️Apr 7
Here's what this looks like (I only have CSR breakout data for 30 states; this graph assumes the ratios are similar for the remaining 21)...
Show threadCharles Gaba ✡️Apr 7
...and here's what this looks like visually (again, assuming the CSR breakout for SBM states is similar to that of FFM states). Suddenly that 24% increase in Gold enrollment doesn't look nearly as impressive.
Show threadCharles Gaba ✡️Apr 7
In fact, as @xpostfactoid.bsky.social points out, it's even worse than that; apparently it's not just SOME of the Silver > Gold shift which turns out to have involved "buying down," pretty much *all* of it was. I'll tackle this in a future post.