Senior Policy Analyst
While drastically cutting the Affordable Care Act’s (ACA) premium tax credits, the House Republican health bill also eliminates the other, lesser-known marketplace subsidies — cost-sharing reductions (CSRs) — that reduce deductibles, co-payments, and other out-of-pocket costs for more than 6 million marketplace enrollees. Our new interactive map shows what’s at stake in the 39 states whose residents enroll through the federal HealthCare.gov platform.
Our map shows, by state, how much help CSRs provide lower-income people with their out-of-pocket health care costs, based on 2016 HealthCare.gov data. The map shows the number of CSR recipients in each state, the average amount of assistance CSR-qualifying residents of a state received, and the total amount of CSR dollars that flowed to each state.
CSRs are available to people who are eligible for premium tax credits, have incomes up to 250 percent of the poverty line (about $60,000 for a family of four), and enroll in a silver-level marketplace plan. They enhance the standard silver plans, so enrollees pay less when they see a doctor, fill a prescription, or go to the hospital. For example, 2015 standard silver plans had an average annual deductible of $2,559, compared to $229 on average for CSR-eligible people with incomes up to 150 percent of the poverty level. Insurers design the CSR plans to fit federal standards, and the federal government reimburses each health insurer that provides CSRs for the estimated costs of reducing the amounts that they’d otherwise charge under the standard silver plan.
More than 5.6 million people, or 59 percent of marketplace enrollees in HealthCare.gov states, received CSRs in 2016. In some states, far higher shares of residents receive CSRs. For example, 73 percent of marketplace enrollees in Mississippi and Alabama receive CSRs, as do 71 percent of marketplace enrollees in Florida and South Carolina. In another four states — Georgia, Louisiana, North Carolina, and Utah — more than 60 percent of marketplace enrollees receive CSRs.
Florida received the largest total dollar amount in 2016; nearly $1.5 billion flowed to marketplace enrollees via CSRs.
The average amount of CSR assistance varies widely among states. For example, Alaskans qualifying for CSRs received an average of $2,456 each in 2016 — by far the largest. Residents of nine other states — Alabama, Florida, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, West Virginia, and Wyoming — received more than $1,200 each on average in 2016. (Those amounts come in addition to the premium tax credits marketplace enrollees may receive if they have incomes up to four times the poverty level.)