NOTE: THE FULL VERSION OF THIS DIARY CAN BE FOUND OVER AT ACASIGNUPS.NET, INCLUDING THE FULL METHODOLOGY, ETC.
Since the day Donald Trump took office, I've repeatedly sounded the alarm about the impact that he, in collusion with a fully GOP-controlled Congress, would have on individual market premiums for millions of people...especially for those earning more than 400% of the Federal Poverty Line (around $48,000/year for a single adult or $98,000/year for a family of four).
This was so blatantly obvious to anyone paying attention that GOP lobbyists didn't even try to pretend otherwise; the only thing they worried about was who would take the blame for their actions:
...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.
“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”
Sure enough, as 2017 dragged out, Donald Trump and Congressional Republicans threw every type of sabotage they could think of at the ACA. Most of the official legislation ended up failing (aside from repealing the individual mandate, though that doesn't formally kick in until 2019), and some of Trump's regulatory sabotage efforts either fell flat or blew up in his face. Even so, a toll was definitely taken...and as I expected, it was those in the middle class who ended up taking it right in the face.
The most obvious example of sabotage working was also, ironically, the one which failed most spectacularly: The elimination of Cost Sharing Reduction reimbursement payments to the carriers.
Due to the complicated way in which the CSR and Advance Premium Tax Credit (APTC) formulas interact with each other, most (but not all) carriers, working together with the state insurance regulators and state-based ACA exchanges, whipped up a clever pricing workaround called "Silver Loading" (or a more elaborate version called "Silver Switcharoo" in about 20 states) which not only cancelled out the negative pricing impact for subsidized ACA exchange enrollees, but even managed to lower the price they're actually paying each month.
HOWEVER, not all of the CSR damage could be mitigated. While Silver Loading/Switching made it possible in theory for unsubsidized ACA enrollees to avoid the CSR hit, in practice it was hit & miss, with some carriers/states being more successful at making the strategy work than others. Some states offered Silver Switching but didn't explain how it worked. Some only offered Silver Loading. Some didn't offer either. And while I and other healthcare wonks/activists did our best to get the word out, our success was limited as well, as many enrollees ended up being simply confused and bewildered by all the changes.
As I've said many times, Trump doesn't have to kill CSR payments, he just has to leave the carriers NOT KNOWING whether he'll kill them. https://t.co/DfmRbzuRwZ
— Charles Gaba (@charles_gaba) April 26, 2017
In addition, while the CSR cut-off was the most obvious and easiest-to-quantify cause of rate increases this year, there were other sabotage factors which contributed to them. The fate of the Individual Mandate was bopped around all year. Within hours of taking office Trump issued an Executive Order which the IRS originally took to mean "don't enforce the mandate penalty at all" only to do a complete 180 later in the year and decide to enforce after all. Various versions of the Repeal/Replace bills thrown at the wall by Congressional Republicans included repealing the mandate and even making the repeal retroactive to prior years. Some House Republicans even introduced a bill to legally prohibit the IRS from enforcing the mandate penalty.
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In this sense, even the failed sabotage measures "succeeded" to some degree because the health insurance market is in a very real sense based on risk and uncertainty. The more uncertainty an insurance carrier has about what the landscape is gonna be the following year, the more they're likely to jack up their prices to cover themselves to prepare for a worst-case scenario.
I spent most of the summer and fall painstakingly tracking practically every rate filing by every carrier in every state, and by October I concluded that nationally, the average unsubsidized ACA-compliant individual market premium was going to shoot up by around 30% in 2018, with a good 60% of that (around 18 points) being due specifically to the various sabotage efforts laid out above. Most of that was due to the CSR cut-off, with a smaller amount being caused by carrier concerns about mandate enforcement and the other oddball policy changes.
Sure enough, when the dust settled and the actual 2018 Open Enrollment Data came in, I turned out to be pretty damned close to the mark: The average increase was 28% nationally, and I was within +/- 5 points in half the states and within 10 points in 13 more. That ~28% average varied greatly from state to state (as well as carrier to carrier and especially from plan to plan, given the nature of Silver Loading).
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Finally, I've put it all together into a single spreadsheet: How many people are paying the Trump Tax and how much they're each paying on average. As you can see, it ranges from nominal amounts in the single digits per month in Vermont and North Dakota (neither of these states allowed their carriers to load CSR costs at all) to as much as $132/month per enrollee in Mississippi.
Unfortunately, while I have estimates of the number of unsubsidized enrollees in all 50 states + DC, I was unable to include estimates of the percent or dollar amount increase caused by sabotage efforts in DC or New York due to being too uncertain of their average starting (2017) premiums.
Once again, I need to stress that while I'm pretty confident about most of my conclusions, there are a few states where I could be off base on either the dollar amounts or the number of people impacted due to the insane amount of variables involved.
All of those caveats aside, to the best of my ability, here's what I've come up with: 6.5 million middle-class people getting collectively hosed for $6.3 billion over the course of 2018 for absolutely no reason other than Donald Trump not liking Obamacare.
Are you among them?
I’ll keep analyzing/educating people about healthcare data & helping fight Republican efforts to sabotage healthcare coverage, but I need help to do so! If you find my work at ACA Signups of value, please consider supporting it on a recurring basis via Patreon or one-time via GoFundMe, thank you!