If the government eliminates funding for cost-sharing reduction (CSR) payments, the worst-case scenario would be that the number of uninsured Americans increases by 9.4 million in 2018, and average premiums rise nearly 37%, according to the Urban Institute.
That scenario would be triggered by insurers exiting the Affordable Care Act marketplaces in response to the loss of CSR funding and other policy uncertainties and changes. Researchers also modeled two other scenarios.
In one case, insurers have enough time before the start of the plan year to incorporate their anticipated CSR costs into a surcharge on silver marketplace premiums. That would result in them being willing to stay in the marketplaces but increase silver premiums by 23% in 2018.
The final scenario assumes that the federal government does not reimburse insurers for CSRs and lawmakers alter the ACA so that insurers are no longer required to pay CSRs to eligible enrollees. In that case, 4 million more people would be uninsured, and individual market premiums would rise by about 12%. (Issue brief)
Deductibles on the rise for employer-sponsored health plans
While premium growth in employer-sponsored health plans has slowed in recent years, it has been offset by climbing deductibles, according to a new analysis funded by the Robert Wood Johnson Foundation.
In their analysis of the Medical Expenditure Panel Survey Insurance Component, researchers at the University of Minnesota’s State Health Access Data Assistance Center found that between 2015 and 2016, premiums for single coverage grew 2%, while deductibles grew by 10% (from $1,541 to $1,696).
Overall, the number of individuals in high-deductible, employer-sponsored plans grew by more than 2.2 million people in 2016, for a total of 24.8 million. The analysis defines high-deductible plans as those with deductibles greater than $1,300 for an individual and $2,600 for a family—benchmarks also used by the IRS. (Fact sheet) (PDF)
Uninsured rate increases for three demographic groups
Though the uninsured rate of 14% among 19- to 64-year-old adults was statistically unchanged from 2016 to 2017, uninsured rates increased “significantly” in three specific groups, according to new research from The Commonwealth Fund.
Those groups include: 35- to 49-year-olds, adults with incomes of 400% of the federal poverty level or more (or about $48,000 for an individual) and adults living in states that had not expanded Medicaid.
The study also notes that half of uninsured adults are likely eligible for Affordable Care Act marketplace subsidies or the Medicaid expansion in their state, and that 4 in 10 uninsured adults are unaware of the marketplaces. (Study)
ACA exchange plans increase out-of-pocket charges for specialty drugs
Among silver plans, the most commonly purchased ACA exchange plan, the average coinsurance rate increased by 16% for high-priced specialty drugs in 2017, according to HealthPocket. That 16% increase produces anywhere from $226 to $1,763 more in monthly out-of-pocket costs among the top five specialty drugs.
Entry-level bronze plans saw their coinsurance fees rise 5%, while gold plan coinsurance fees increased 13%.
Platinum plans were the only category of marketplace plan in which specialty drug cost-sharing decreased in 2017 compared to 2016. However, only 1% of marketplace consumers enrolled in platinum plans for 2017. (Analysis)