Health Affairs December 6, 2022
Access to health insurance with affordable premiums is only one aspect of access to health care. Consumers may face barriers to care if a plan’s cost-sharing requirements (e.g., deductibles and coinsurance) are unaffordable. Provisions in the Affordable Care Act (ACA) increase health insurance affordability by providing income-based premium subsidies and cost sharing reductions (CSRs) to eligible enrollees. The CSRs are provided through silver plan variants with reduced cost-sharing requirements relative to standard silver plans, and currently are paid for out of plan premiums. Some approaches to accounting for the cost of CSRs prioritize affordability of subsidized exchange coverage over actuarial principles—artificially increasing the cost of unsubsidized silver coverage on the exchange and eroding the actuarial soundness of premium rates.
The...