House Bill Would Make Significant Progress on Health Care Affordability and Coverage
End Notes
[1] By expanding financial assistance, providing funding for reinsurance, and increasing funding for outreach (which disproportionately increases enrollment among healthier people, lowering premiums), the bill would reduce premiums for the 13.4 million consumers purchasing ACA-compliant individual market coverage. (See Ashley Semanskee, Larry Levitt, and Cynthia Cox, “Data Note: Changes in Enrollment in the Individual Health Insurance Market,” Kaiser Family Foundation, July 31, 2018, https://www.kff.org/health-reform/issue-brief/data-note-changes-in-enrollment-in-the-individual-health-insurance-market/.) In addition, as explained below, the bill would reduce premiums for some people with employer coverage by allowing them to instead purchase individual market coverage with financial assistance.
[2] Aviva Aron-Dine and Matt Broaddus, “Improving ACA Subsidies for Low- and Moderate-Income Consumers Is Key to Increasing Coverage,” Center on Budget and Policy Priorities, March 21, 2019, https://www.cbpp.org/research/health/improving-aca-subsidies-for-low-and-moderate-income-consumers-is-key-to-increasing.
[3] Examples assume consumers face the national average marketplace benchmark premium. The family of four is composed of two 40-year-old parents, a 5-year-old, and a 10-year-old. The benchmark plan is the second-lowest-cost silver tier plan offered where the consumer lives.
[4] Calculations are based on the national average cost of the benchmark plan and the lowest-cost gold plan, available at https://www.kff.org/health-reform/state-indicator/average-marketplace-premiums-by-metal-tier/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Data on average deductibles by metal level are from https://www.kff.org/health-reform/fact-sheet/cost-sharing-for-plans-offered-in-the-federal-marketplace-for-2019/.
[5] For example, premium tax credits would phase out at an income of about $215,000 for a family of four facing the national average benchmark premium, because $1,529 per month (the national average benchmark premium) is less than 8.5 percent of income for those with incomes above $215,000. Notably, subsidies for middle-income individual market consumers would be similar to the tax benefits the federal government already provides to middle-income people with employer plans, for whom tax subsidies cover about 40 percent of (combined employer and employee) premiums, on average. See Aviva Aron-Dine, “Making Health Insurance More Affordable for Middle-Income Individual Market Consumers,” Center on Budget and Policy Priorities, March 21, 2019, https://www.cbpp.org/research/health/making-health-insurance-more-affordable-for-middle-income-individual-market.
[6] This change, in combination with the bill’s changes to financial assistance, means that almost all consumers would be guaranteed an option to purchase coverage for less than 10 percent of income. Exceptions are people in the coverage gap in states that have not expanded Medicaid, undocumented immigrants, and certain special cases (for example, a couple in which one person is paying Medicare premiums while the other is purchasing marketplace coverage).
[7] Estimates of the bill’s impact on coverage are not available; however, RAND researchers estimated that a similarly structured but much less generous set of tax credit improvements would cause about 2.5 million people to gain coverage. Gains from this proposal would be substantially larger. Jodi Liu and Christine Eibner, “Expanding Enrollment Without the Individual Mandate: Options to Bring More People Into the Individual Market,” Commonwealth Fund, August 2018, https://www.commonwealthfund.org/sites/default/files/2018-08/Liu_expanding_enrollment_without_mandate.pdf.
[8] Joshua Peck, “Trump’s ad cuts will cost a minimum of 1.1 million Obamacare enrollments,” Get America Covered, October 23, 2017, https://medium.com/get-america-covered/trumps-ad-cuts-will-cost-a-minimum-of-1-1-million-obamacare-enrollments-9334f35c1626; and Peter V. Lee et al., “Marketing Matters: Lessons from California to Promote Stability and Lower Costs in National and State Individual Insurance Markets,” Covered California, September, 2017, http://hbex.coveredca.com/data-research/library/CoveredCA_Marketing_Matters_9-17.pdf.
[9] Sarah Lueck, “Key Flaws of Short-Term Health Plans Pose Risks to Consumers,” Center on Budget and Policy Priorities, September 20, 2018, https://www.cbpp.org/research/health/key-flaws-of-short-term-health-plans-pose-risks-to-consumers.
[10] Sarah Lueck, “Association Health Plan Expansion Likely to Hurt Consumers, State Insurance Markets,” Center on Budget and Policy Priorities, March 7, 2019, https://www.cbpp.org/research/health/association-health-plan-expansion-likely-to-hurt-consumers-state-insurance-markets.
[11] Sarah Lueck, “Commentary: Trump Administration Rules on Health Waivers Weaken Pre-Existing Condition Protections,” Center on Budget and Policy Priorities, November 2, 2018, https://www.cbpp.org/health/commentary-trump-administration-rules-on-health-waivers-weaken-pre-existing-condition.
[12] Sarah Lueck, Tara Straw, and Shelby Gonzales, “Health Care Rule Changes Will Harm Consumers,” Center on Budget and Policy Priorities, April 12, 2018, https://www.cbpp.org/research/health/health-care-rule-changes-will-harm-consumers.
[13] While recent estimates are not available, in 2013 the Congressional Budget Office estimated that a public option would save $158 billion over ten years.