The Impact of Silver Loading in ACA Health Insurance Marketplaces
ACA健康保险市场中的银级加载效应
Abstract
In 2017, the federal government ended payments for cost-sharing reduction (CSR) subsidies for the Health Insurance Marketplaces created by the Affordable Care Act. Rather than uniformly increase Marketplace plans’ premiums to offset the loss of these payments, over 40 states responded by silver loading—only increasing the premiums of silver plans to which CSR subsidies apply and premium tax credits are tied. Silver loading was intended to increase the affordability of Marketplace coverage by increasing premium tax credits and thereby enrollment, though the literature lacks causal estimates. Furthermore, Congress is considering reinstating CSR subsidy funding, effectively undoing silver loading. We use panel data on 2015-2021 Marketplace health plan premiums and enrollment in 12 states from the Centers for Medicare and Medicaid Services to estimate silver loading’s effects using contiguous county-pair models. We find that silver loading functioned as intended, lowering the cost of Marketplace coverage and increasing enrollment by 8-14% among subsidized Marketplace enrollees with incomes between 250% and 400% of the poverty level. We project that Congress ending silver loading would decrease Marketplace enrollment by at least 330,000 enrollees in 2027.
中文摘要
2017年，联邦政府终止了对《平价医疗法案》所创建的健康保险市场的成本分担削减（CSR）补贴支付。超过40个州没有统一提高市场计划保费以抵消这些支付损失，而是通过银级加载来应对——仅提高适用CSR补贴且保费税收抵免与之挂钩的银级计划的保费。银级加载旨在通过增加保费税收抵免从而提高参保人数，来增强市场覆盖的可负担性，尽管文献缺乏因果估计。此外，国会正在考虑恢复CSR补贴资金，这实际上将撤销银级加载。我们使用来自医疗保险和医疗补助服务中心的2015—2021年12个州市场健康计划保费和参保的面板数据，采用相邻县对模型估计银级加载的效应。我们发现银级加载按预期发挥作用，降低了市场覆盖的成本，并使收入在贫困线250%至400%之间的受补贴市场参保者参保人数增加8—14%。我们预测，国会终止银级加载将在2027年使市场参保人数至少减少330,000人。