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1/14 Zero premium plans on the ACA marketplace - do they matter and how do they matter?
This is the question me, @cdrake219 @STingCai and @sacksdaniel are asking and attempting to answer in a new working paper (Comments gratefully welcomed!)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3743009
This is the question me, @cdrake219 @STingCai and @sacksdaniel are asking and attempting to answer in a new working paper (Comments gratefully welcomed!)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3743009
2/N First the disclaimers: We received funding from @NIHCMfoundation and data support from @C4HCO
As always all opinions, analysis, conclusions and errors are those of the authors only!
As always all opinions, analysis, conclusions and errors are those of the authors only!
3/N Is Zero the Hero?
Does having a no net premium plan instead of a $1 or $5 or $.73 plan as the cheapest plan available to you matter on the intensive and extensive margin as well as duration of coverage?
Does having a no net premium plan instead of a $1 or $5 or $.73 plan as the cheapest plan available to you matter on the intensive and extensive margin as well as duration of coverage?
4/N We have reason to think so.
@cdrake219 @bjdickmayhew big enrollment jumps on http://HC.Gov for 151-200% FPLers conditional on $0
@LauraDague found huge changes in Medicaid enrollment when zero was replaced with small premiums
$0 became way more common 2018-2021
@cdrake219 @bjdickmayhew big enrollment jumps on http://HC.Gov for 151-200% FPLers conditional on $0
@LauraDague found huge changes in Medicaid enrollment when zero was replaced with small premiums
$0 became way more common 2018-2021
5/n We used @C4HCO household data to conduct a regression discontinuity analysis of the effect of zero premium vs not quite zero premiums. Colorado is great source of variation as they went from regular reimbursement of CSR to #BroadLoad to #Silverload from 2017-2019
6/N So what happens when people are exposed to at least one zero premium?
Bronze and silver plan selections don't change much, and everything else is basically what we would expect
Bronze and silver plan selections don't change much, and everything else is basically what we would expect
7/N So do people stay in for more of the year?
We thought that it is hard to terminate people for non-payment of premium when there is no premium --- but December 31st enrollment at the end of year is about the same.
We thought that it is hard to terminate people for non-payment of premium when there is no premium --- but December 31st enrollment at the end of year is about the same.
8/N however duration goes up by ~50 days contingent on someone buying a Zero Premium plan
How is that happening if December 31st enrollment is about the same
January 1st is what matters --> WELL ACTUALLY December 15th is what matters....
How is that happening if December 31st enrollment is about the same
January 1st is what matters --> WELL ACTUALLY December 15th is what matters....
9/N Open Enrollment on http://Healthcare.gov in the #Silverload era goes to 12/15 (sign up today!) but on @C4HCO OEP goes through January.
3 Phase Process to start 1/1 coverage
1) Pick plan
2) Pay for plan
3) Insurer activates ("effectuates" plan
3 Phase Process to start 1/1 coverage
1) Pick plan
2) Pay for plan
3) Insurer activates ("effectuates" plan
10/N People who pick a zero premium plan get to avoid the second step --- it is the 7 minute abs version of enrollment.
Effectively they effectuate for January 1 coverage the moment they finalize the selection of a zero premium plan on or before December 15th.
Effectively they effectuate for January 1 coverage the moment they finalize the selection of a zero premium plan on or before December 15th.
11/n People who don't select a zero-premium plan have to navigate another bureaucratic step of arranging payment (credit card, auto-draft, check, money order etc) in a short time period over the Christmas holidays to start their plan.
Some fall through the cracks....
Some fall through the cracks....
12/N On http://Healthcare.gov this matters a lot as there is no OEP in late December or January to climb out of the crack and make another attempt at selecting-paying-effectuating. People might be able to find an SEP but that is a narrow pathway to coverage.
13/N However on @C4HCO runs their OEP through January. December 15th is not the absolute cut-off; it is only the cut-off for January 1 coverage. OEP coverage can be February 1 or March 1 coverage. People who mess up the 1st time due to #administrativeburden have save chances
14/14 Zero reduces/eliminates the need for a save opportunity in Colorado while Zero on http://Healthcare.gov allows for a lot more January 1 enrollment than $1 because it removes administrative burden and friction.
