Health Affairs September 17, 2019
In October 2017, the Trump administration announced that it would stop reimbursing Affordable Care Act (ACA) Marketplace health insurers for cost-sharing reductions (CSRs), the reduced cost sharing they are required to provide to certain lower-income consumers. President Donald Trump, along with most market
participants and analysts (including myself), predicted that stopping CSR payments would cause chaos in the ACA Marketplaces. At the same time, analysts also predicted that—following the initial disruption—ending CSR payments would ultimately lead to increases in total financial assistance for Marketplace consumers, lower net premiums for many moderate-income people, and higher Marketplace enrollment.
Almost two years later, the ACA Marketplaces have transitioned to the loss of CSR payments more smoothly than most observers expected. Meanwhile, the...
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