Timothy Stoltzfus Jost, Washington and Lee University
jostt@wlu.edu
- The ACA will expand coverage through:
- Medicaid expansions (up to 138% of the poverty level)
- Tax credits (up to 400% of the poverty level)
- The Minimum Coverage Requirement (individual mandate)
- The Minimum coverage requirement will increase coverage by expanding Medicaid and premium tax credit enrollment and encouraging employer coverage and enrollment
- The ACA recognizes five categories of coverage, each of which is regulated differently under the law:
- Grandfathered plans
- Self insured plans
- Large group plans
- Small group plans
- Individual policies
- Individual and small group plans will need to cover the essential benefits package, and enrollees will be protected from some industry practices (annual and lifetime limits, rescissions, etc), but plans are likely to have high cost sharing.
- The prohibition on health status underwriting and the limitation of age-based underwriting will raise premiums for some enrollees, reduce them for others.
- High cost sharing may reduce costs, but is also likely to have adverse effects on the utilization of necessary and preventive care.
- Premium tax credit overpayments are likely to be common, and, under recent legislation, repayment demands may be substantial and cause serious hardships.
- Enforcement of insurance regulatory requirements will largely be left to the states. Insurers are likely to continue to be creative in pursuing risk selection.
