Credit: James Steidl/Thinkstock
If Congress really lets the current high federal individual health insurance premium subsidies expire, that could increase employer health plan enrollment by 3.2 million in 2026, to 150 million.
That would amount to a 2.2% increase in employer plan enrollment.
Enrollment in "noncompliant nongroup" plans — plans such as farm bureau plans, mini medical plans, plans based on use of short-term health insurance policies and other arrangements that fall outside the reach of the Affordable Care Act major medical insurance requirements — could climb by 119,000, or 5.2%, to 2.3 million.
The number of people with individual major medical coverage could fall by 7.7 million, or 29%, to 19 million.
The number of people any public or private insurance could fall 1.9%, or 4.9 million, to 251 million, and the number of uninsured people could rise by 4.8 million, or 21%, to 28 million.
Analysts at the Urban Institute have put those predictions in a recent report about the impact of letting the current ACA premium tax credit subsidy rules expire.
Institute analysts have cut their forecast for employer plan growth from a figure released earlier in the year. In June, the analysts predicted that returning to the 2019 ACA premium tax credit rules could boost employer plan enrollment by 4 million people.
What it means: The individual and family policies people buy for HealthCare.gov and other ACA public exchange programs tend to operate like catastrophic health plans, with some "free" preventive care available before an enrollee meets the deductible, unlimited coverage for a patient who does meet the deductible, and little sick care coverage available for a patient who has not yet met the deductible.
The average bronze plan deductible is about $7,400.
If the current ACA subsidy levels expire and exchange plans send large numbers of enrollees into employer plans, those enrollees could be people in great health, who will have very low claims.
But the new employer plan enrollees could be people who have neglected looking into moles, lumps and headaches, because of concerns of out-of-pocket costs, and that means some of those new employer plans could have very high claims.
The backdrop: The Affordable Care Act originally limited access to premium tax credits to people with household income under 400% of the federal poverty level. That's $62,000 for an individual this year and $128,600 for a family of four.
Subsidy levels depended on income levels. For people with income from 300% to 400% of the federal poverty level, premium tax credits would be available only if the cost of coverage would exceed 9.96% of those people's income.
Changes made in response to the COVID-19 pandemic made subsidies available to people at any income level if the cost of coverage would exceed 8.5% of those people's income.
Democrats in Congress back keeping the current subsidy levels. Republicans in Congress appear to have mixed feelings about extending the current rules or letting them expire.
Democrats have attributed their refusal to vote for the legislation needed to fund the federal government and keep it running at normal levels to a requirement that Republicans keep the current subsidy levels in place.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.