Even the enhanced ACA subsidies came in under the original ACA budget

[Greenbeard]

As funding for ACA subsidies takes center stage, it's worth remembering one underappreciated budgetary fact: all along, even after the subsidies were beefed up in 2021, the ACA subsidies have been cheaper than expected, coming in under budget every single year.

Eleven years ago the CBO released its Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, which provided the budgetary estimates for the first eleven years of the subsidies' existence. Much happened over the last decade, of course, but two developments in particular are worth noting when considering how those projected costs compare with the actual numbers.

First, a dollar isn't quite the same in the predicted world as in the real world thanks to the post-COVID bout of inflation. On that basis alone, you might expect the cost of the subsidies in nominal dollars would be higher than predicted, since the economy-wide price-level is 5-6% higher than anticipated. Second, and more significantly, the ACA was changed. The 2014 projections are based on the original, skimpier subsidies, but their structure was altered in 2021, making them both more generous and more broadly available. Thus you would expect that costs in the 2021-2024 period would be higher than anticipated simply because the subsidies in the real world today are more generous than the original ones the CBO used in its projections.

But when you bump the predicted costs from that 2014 publication against the actual costs, you find something remarkable:

ACA Marketplace Subsidies (in $ Billions)

2014​

2015​

2016​

2017​

2018​

2019​

2020​

2021​

2022​

2023​

2024​

2014-2024​

Predicted Cost

$15​

$50​

$84​

$104​

$103​

$109​

$116​

$123​

$129​

$134​

$137​

$1,104​

Actual Cost

$15​

$38​

$42​

$48​

$49​

$56​

$57​

$72​

$86​

$91​

$122​

$676​

Actual vs. Predicted

$0​

($12)​

($42)​

($56)​

($54)​

($53)​

($59)​

($51)​

($43)​

($43)​

($15)​

($428)​

The subsidies have cost more than $400 billion less than expected. Even in the 2021-24 period during which the enhanced (i.e., more expensive) subsidies were in place, spending was always less than what was projected for the old, skimpier original ACA subsidies.

Enhancing the original ACA subsidies has always been a no-brainer.

 

[SNOWFLAKE]

No no no. You can NOT post details, charts, facts. No!

Better to turn on Fox or such and be told that Democrats want to provide health care to illegals and that the subsidies are socialism and that Obamacare needs to be abolished, which will be replaced by a far BIGGER and BETTER Trumpcare plan, which will be put forth any day now.

 

[BirdinHand]

People deserve healthcare and insurance.

Period.

Wanting to strip Americans of that is monstrous.

 

[Greenbeard]

Worth also recognizing that not only did enhancing the ACA subsidies still come in below the financial envelope of the original un-augmented ACA, it substantially improved the program.

Obviously the enhanced subsidies made coverage materially more affordable for millions of American families, and we'll hear more about that in the coming days as open enrollment begins without them.

But it also improved the functioning of the marketplace. Enrollment more than doubled, from 11.4 million Americans in 2020 to 24.3 million this year.

It increased competition, with the number of participating insurers rebounding from a nadir under Trump 1, rising from an average of 6.7 insurers per market in 2020 to 9.6 on average this year.

And premiums have been largely flat in nominal dollars, with benchmark premiums coming in at $462 in 2020 and $497 today (which, given the rising general price level over that period, is about a 13% drop in real dollars).

All that and making the ACA materially better didn't cost any more than we were expecting the original ACA to cost. This is about as clear a slam dunk policy as it gets, yet the ideologues in the GOP can't bring themselves to endorse more affordable premiums for families shopping in more competitive markets at essentially no additional federal budgetary impact.

The streak of 15+ years of total insanity from the GOP on all things ACA continues unbroken.

 

[Popeye2]

People deserve healthcare and insurance.

Period.

Wanting to strip Americans of that is monstrous.

people deserve available doctors and hospitals, they don't deserve paying for illegals from off our tax dollars. You want to pay for them, go for it, there is nothing anywhere that illegals are deserved of healthcare.

 

[Popeye2]

Worth also recognizing that not only did enhancing the ACA subsidies still come in below the financial envelope of the original un-augmented ACA, it substantially improved the program.

Obviously the enhanced subsidies made coverage materially more affordable for millions of American families, and we'll hear more about that in the coming days as open enrollment begins without them.

But it also improved the functioning of the marketplace. Enrollment more than doubled, from 11.4 million Americans in 2020 to 24.3 million this year.

It increased competition, with the number of participating insurers rebounding from a nadir under Trump 1, rising from an average of 6.7 insurers per market in 2020 to 9.6 on average this year.

And premiums have been largely flat in nominal dollars, with benchmark premiums coming in at $462 in 2020 and $497 today (which, given the rising general price level over that period, is about a 13% drop in real dollars).

All that and making the ACA materially better didn't cost any more than we were expecting the original ACA to cost. This is about as clear a slam dunk policy as it gets, yet the ideologues in the GOP can't bring themselves to endorse more affordable premiums for families shopping in more competitive markets at essentially no additional federal budgetary impact.

The streak of 15+ years of total insanity from the GOP on all things ACA continues unbroken.

again, all a birdsnest created by demofks. obammycare is demofks, they made healthcare unaffordable, so then subsidies were needed, then demofks pushed wuhan and more subsidies were installed, and BTW, the demofks inserted deadlines like the one coming up. Why add deadlines if they wanted it permanent? Again, has nothing whatsoever to do with the current fund the government CR. That's Xiden's

 

[BirdinHand]

people deserve available doctors and hospitals, they don't deserve paying for illegals from off our tax dollars. You want to pay for them, go for it, there is nothing anywhere that illegals are deserved of healthcare.

No worries.

These cuts happen and there will be fewer hospitals.

Especially in those bright red rural areas.


MAGA!



Bring on the leopards.

 

[Popeye2]

No worries.

These cuts happen and there will be fewer hospitals.

Especially in those bright red rural areas.

that's been happening since Biden was in office. Again, for the lame of brain, the BBB isn't active. So no money has been touched. None, zero, and, that begins in January. Are you living in the future or something?

MAGA!

you're obsessed with.

Bring on the leopards.

and the unicorns.

 

[Greenbeard]

again, all a birdsnest created by demofks. obammycare is demofks, they made healthcare unaffordable, so then subsidies were needed, then demofks pushed wuhan and more subsidies were installed, and BTW, the demofks inserted deadlines like the one coming up. Why add deadlines if they wanted it permanent? Again, has nothing whatsoever to do with the current fund the government CR. That's Xiden's

This is borderline unintelligible.

 

[Popeye2]

This is borderline unintelligible.

sorry you can't read.

 

[BirdinHand]

This is borderline unintelligible.

Borderline?

 

[multivita-man]

As funding for ACA subsidies takes center stage, it's worth remembering one underappreciated budgetary fact: all along, even after the subsidies were beefed up in 2021, the ACA subsidies have been cheaper than expected, coming in under budget every single year.

B, b, but...OBAMA!

 

[MAGAnificent]

People deserve healthcare and insurance.

Period.

Wanting to strip Americans of that is monstrous.

Government funded health insurance is not and never has been a birthright. And the original subsidies were only intended for those at or below 400% of the federal poverty level. The enhanced subsidies that expire at the end of the year were not designed to be permanent. They were only to assist during the Covid pandemic. This thread is basically the left admitting that the ACA as it was written is a failure. I predicted that ultimate failure when it was passed.

 

[MAGAnificent]

No worries.

These cuts happen and there will be fewer hospitals.

There were already fewer hospitals before Trump. And that was due to the stupid ACA rating system that rated hospitals based on best outcomes without taking into account that the hospitals with worse outcomes largely served indigent and poor rural areas with poor diets and poor health habits.

 

[Greenbeard]

This thread is basically the left admitting that the ACA as it was written is a failure.

Try reading it again! Covering more people, making their coverage more affordable than advertised, increasing competition and dropping real premiums, and doing it all while coming in hundreds of billions of dollars under budget puts the Biden-enhanced ACA in the running for one of the most successful policies of all time. All the original ACA needed was a little more faith in its ability to bend the cost curve, which it did, making the enhancements to the subsidy structure a no brainer.

 

[BirdinHand]

There were already fewer hospitals before Trump. And that was due to the stupid ACA rating system that rated hospitals based on best outcomes without taking into account that the hospitals with worse outcomes largely served indigent and poor rural areas with poor diets and poor health habits.

Well then I guess those populations deserve it?

That what you are saying?

 

[MAGAnificent]

Try reading it again! Covering more people, making their coverage more affordable than advertised, increasing competition and dropping real premiums, and doing it all while coming in hundreds of billions of dollars under budget puts the Biden-enhanced ACA in the running for one of the most successful policies of all time. All the original ACA needed was a little more faith in its ability to bend the cost curve, which it did, making the enhancements to the subsidy structure a no brainer.

That is hilarious spin on your part. Successful Private health insurance police would mean no subsidies whatsoever. It it has to be propped up by the government; there is nothing successful about it. Having said that, after the ACA was passed and implemented, you libruls claimed it was the best thing to come along since sliced cheese. You continued to praise it for years. Then when Covid hit, temporary increased subsidies were passed. Now that we are well past the pandemic, you want the temporary subsidies made permanent. That is an admission that the ACA as it was written was a failure to begin with. As for Biden, why are you giving him credit for anything? He was barely able go to the bathroom without assistance. Those enhanced subsidies were signed by autopen.

 

[MAGAnificent]

Well then I guess those populations deserve it?

That what you are saying?

Try comprehending what you read. The ACA hospital rating system is what caused many of those hospitals to close.

 

[BirdinHand]

Try comprehending what you read. The ACA hospital rating system is what caused many of those hospitals to close.

How?

By requiring transparency?

By holding them accountable for poor performance?

 

[Airyaman]

Government funded health insurance is not and never has been a birthright. And the original subsidies were only intended for those at or below 400% of the federal poverty level. The enhanced subsidies that expire at the end of the year were not designed to be permanent. They were only to assist during the Covid pandemic. This thread is basically the left admitting that the ACA as it was written is a failure. I predicted that ultimate failure when it was passed.

Police and fire protection aren't birthrights either, guess we should do away with them.

 

[BirdinHand]

Police and fire protection aren't birthrights either, guess we should do away with them.

Get rid of those pesky EMTs also.

 

[Greenbeard]

Successful Private health insurance police would mean no subsidies whatsoever.

You’re not living in the real world.

Now that we are well past the pandemic, you want the temporary subsidies made permanent.

I wanted them made permanent when they were first proposed and introduced in Congress in early 2019 and made no secret of it at the time. The ACA came in so far under budget, the enhancements have always been a no-brainer.

Musings on the ACA subsidies - House Dem, Biden, Buttigieg plans

So what's next? The House Dems have put forth their plan, based on more generous subsidies achieved by: (1) lowering the family premium contribution used to calculate the subsidy, and (2) making subsidies available to people over 400% FPL.

Meanwhile, Joe Biden has his plan and Pete Buttigieg just released his. A quick read suggests that as far as the subsidies go, they are the same thing (though Mayor Pete has a lot of extra stuff that's interesting, like a central clearinghouse for insurance claims, a national all-payer claims database, and greater antitrust oversight of providers).

Both B's would also make the subsidies more generous, but not quite the way the House Dems would. They would make the benchmark a gold plan, instead of the current silver, while as far as I can tell leaving the contribution percentage the same, other than lowering the upper limit of it to 8.5%. (I'm pretty sure Families USA was the first to suggest rescaling the subsidies to gold plans years ago.)

My read of where things stand in short:

Household income​	Max % of income put toward premiums (ACA)​	Max % of income put toward premiums (House Dems)​	Max % of income put toward premiums (Biden-Buttigieg)​
	Silver Benchmark	Silver Benchmark	Gold Benchmark
100%-133% FPL	2.08%	1.04%	2.08%
133%-150% FPL	4.15%	2.07%	4.15%
150%-200% FPL	6.54%	4.15%	6.54%
200%-250% FPL	8.36%	6.23%	8.36%
250%-300% FPL	9.86%	7.27%	8.5%
300%-400% FPL	9.86%	8.82%	8.5%
400% FPL and up	-	8.82%	8.5%

...

So a family buying the benchmark under B-B pays the same premium as it does today under the ACA (except at the upper end of the income distribution, due to the lower cap)--but it's for a more generous benchmark plan! If you're lower income and eligible for a CSR plan, that part matters less since you're probaby already getting something more generous than gold coverage. But if you're not, this helps substantially with getting a lower deductible/OOP spending plan.

Whereas under the House Dem plan a family would pay less in premiums toward the benchmark--but it's the same benchmark as today. The result is that the subsidies are more generous and thus it's easy to buy up to the gold tier. But not nearly as easy as under B-B. I'd estimate that, all things being equal, B-B would pump at least 3-4 times as much money into affordability as the House Dem plan, meaning it would make that much more of a difference for families. Of course B-B would likely be more effective at pulling more people into the marketplaces, which has a positive feedback on premiums so perhaps some of that expense would be offset.

But as far as I can tell, neither B mentions reinsurance, which would re-set premiums downwards and thus can be more than revenue neutral by drawing into the market people currenty sidelined by high premiums. The House Dems' bill does have reinsurance.

Perhaps we'll end up with an amalgamation: the House Dems' reinsurance and B-B's gold benchmarks.

 

[MAGAnificent]

Police and fire protection aren't birthrights either,

No, which is why our local property taxes pay for Police and fire protection.

 

[MAGAnificent]

How?

By requiring transparency?

By holding them accountable for poor performance?

You are making yourself look bad. The hospitals that receive the best ratings under the ACA are the hospitals that largely serve more well to do and gated communities where their patients have better diets, better health habits and better more available healthcare. Of course they are going to have better outcomes than those hospitals serving indigents in the inner cities and poor rural areas and are much more of a challenge to treat. Why is that so hard for you to understand?

 

[Blue Dog]

If the public option had been included in the PPACA bill, maybe the outcome would have been different.