It’s the risk pool, stupid


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Last week, the Supreme Court dismissed a third court challenge to the constitutionality of the Affordable Care Act (ACA) and the Biden administration wasted no time in celebrating, deploying a litany of offers regulatory changes to the law. The main one of them is a year-round nomination for households at or below 150 percent of the Federal Poverty Line (FPL). This proposal raises questions about the stability of the health insurance market.

Under the ACA, individuals and families can normally purchase coverage through exchanges during an open enrollment period occurring at the end of the year. Anyone can also purchase coverage during special enrollment periods that are triggered when a household experiences certain life events such as the birth of a child or loss of insurance coverage. Beyond these opportunities, however, if you want to sign up for coverage, you’re out of luck. The reason for these limited windows is to prevent freeloading where people wait to buy insurance coverage until they get sick, and potentially abandon it again once they have received treatment. . Since the ACA requires insurers to sell insurance to anyone who wishes to purchase it, regardless of their medical condition, a limited enrollment period is required to ensure that enough healthy people buy in the risk pool.

Since the start of his tenure, however, President Biden has worked to undermine this valuable part of the market. Days after taking office, Biden announced a Special Enrollment Period (SEP) that was supposed to allow people who lost their insurance due to unemployment during the pandemic to purchase subsidized coverage, but MS was open to everyone. . Then, in March, the administration decided to extend the SEP until August 15, or six full months. At the time, I wrote that Biden’s SEP was relatively useless because people who had lost coverage were already eligible to sign up for ACA Exchange coverage, and we had just concluded an open enrollment period. But, “If market-wide SAEs were to evolve into a continuous open enrollment period, there would be real risks to the health insurance market. There we are, registration open year round, although limited to a subset of consumers for the time being.

Open enrollment would be optional for states that operate their own exchanges, but would be implemented in the majority of states that use the federal exchange. The administration argues that there is a need to make enrollment open year round for these people, in part to ensure that anyone who loses Medicaid coverage when states start checking eligibility again will be able to enroll. to Exchange coverage, but of course the loss of people insurance coverage to be purchased during the plan year. The Centers for Medicare and Medicaid Services (CMS) argue in the proposed rule that the risk to market stability is minimal because once enrolled, such people would have little incentive to drop coverage as they will in most cases pay nothing for that. However, there is still the risk that people will wait to enroll until they have medical bills, and CMS predicts that the policy will directly result in an increase in health insurance premiums of between 0.5 and 2. %. The proposed rule also notes that federal spending on insurance subsidies will increase by $ 250 billion to $ 1 billion per year.

Whether the administration’s relatively optimistic projections are correct is somewhat irrelevant. More interesting is the question, why cap this permanent open registration at 150% of the FPL? Why not 250 percent, the point at which eligibility for cost-sharing reduction payments gradually disappears? Why not higher? The ACA has removed most of the options available to insurers to keep costs down, and in the absence of an individual mandate, limits on when people can enroll are crucial in controlling insurance premiums. The Biden administration, however, seems indifferent. After all, the federal government can just put the bill on the national credit card.

Examining the Charts: Shortages of Healthcare Workers

Jake Griffin, Healthcare Policy Intern

The United States is projected face significant health worker shortages in the years to come. Several factors have been identified as contributing to this shortage. As the population continues to age, chronic diseases will become more common and require more health care for longer periods. Additionally, almost a third of nurses will retire over the next 10 to 15 years and will need to be replaced. The graph below shows that the gap between vacancies and hirings in the healthcare industry has widened over the years, suggesting that healthcare organizations are struggling to find jobs. workers to fill job vacancies. By 2025, the largest shortages of health workers should not be doctors or nursing assistants, but home helpers (446,000) and registered nurses (500,000), both being a result an elderly population in need of care and a limited number of new nurses. Licensed practical nurses are not predicted to experience the same levels of shortage as home health aides, who perform similar functions, due to a slightly higher salary resulting in less job turnover. Unfortunately, there is no easy solution. Healthcare workers need comprehensive training and specific skills, so it is difficult to quickly increase the pool of available workers. Strategies to grow the health care workforce will need to be creatively designed if they are to be successful in meeting demand.

Sources: Mercier and AMN

Monitoring of COVID-19 cases and vaccinations

Jake Griffin, Healthcare Policy Intern

To track immunization progress, the Weekly Review will compile the most relevant statistics for the week, with the seven-day period ending on Wednesday of each week.

Weekend: New cases of COVID-19:
7 day average
Newly fully vaccinated:
7-day average
Daily deaths:
7-day average
30-June-21 12,514 246443 206
23-June-21 11,472 394,539 233
16-June-21 11 610 613 357 285
9-June-21 15,975 717 985 350
2-June-21 14 969 513 079 383
26-May-21 22,273 809,533 455
19-May-21 27 917 1,051,361 523
12-May-21 34,780 1 261 937 562
5-May-21 45 321 1,455,650 592
28-Apr-21 52,139 1 490 998 620
21-Apr-21 60 939 1,511,760 637
14-Apr-21 68,420 1,763,713 637
7-Apr-21 64,032 1,590,184 624
31-Mar-21 63,844 1,374,986 730
24-Mar-21 56,774 966,514 731
17-Mar-21 53,191 1,028,148 876
10-Mar-21 53,998 957,466 1,148
3-Mar-21 60 982 916 637 1,405
February 24-21 64 228 847,638 1780
17-Feb-21 73,730 746,423 1940
10-Feb-21 99,865 703 230 2,379
3-21 Feb 128,984 486,150 2,724
27-Jan-21 159,012 337,569 3 167

Sources: Centers for Disease Control and Prevention Trends in COVID-19 cases and deaths in the United States, and Trends in COVID-19 vaccinations in the United States.

Note: The population of the United States is 332,472,594.

The health of the team

Medicaid and the Goldilocks testPresident of the AAF Douglas Holtz-Eakin
The Biden administration will likely use all administrative avenues at its disposal to keep individuals on Medicaid.

Worth the detour

Axes: The growing threat of invasive drug-resistant fungi

New York Times: More masks? The spread of Delta Variant invites reconsideration of precautions.

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About Christopher Easley

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