IRONY: Trump/GOP CSR sabotage could cancel out their OTHER sabotage.
As I noted earlier today, there’s a gazillion ways the Trump Administration could sabotage (and in some cases, is already sabotaging) the 2018 Open Enrollment period this fall, doing everything in their power to dampen, obstruct and otherwise minimize the number of people who actually enroll in a healthcare policy via the federal ACA exchanges.
However, as I've noted before (and as the CBO confirmed last week), due to the confusing, inside out way in which the APTC and CSR subsidy formulas happen to work, there's also the potential for one of the most pressing sabotage schemes by Trump and the GOP to backfire completely, leading to the potential for a significant increase in ACA exchange enrollment.
Again: If CSR payments are cut off next year (or more to the point, if the insurance carriers en masse aren't convinced that CSR payments will be made and price their Silver plans accordingly), the net result will be that while the unsubsidized rates will shoot up dramatically, both the average APTC assistance amount and the number of people eligible for APTC assistance will also increase dramatically. This should, in other words, mean two things: A significant number of people who otherwise wouldn't be eligible for financial assistance now would be, and those who are eligible would qualify for higher subsidies even if they don't enroll in a Silver plan.
I've been a bit iffy about this prospect...personally, I suspect this will only cause a significant increase in exchange enrollment if the carriers go the full #SilverSwitcharoo route, as California has in mind (other carriers/states may be doing this as well but I haven't heard anything specific about it). However, David Anderson of Balloon Juice seems to think it's likely to happen with the "Full Silver Load" scenario as well, which is what most carriers seem to be angling towards last I heard:
What he is saying is that people who are in the market will readily switch if there is a better deal. The market is not particularly sticky for the people. This confirms other reports and research. He is also saying that the decision to get into the individual market is a highly resistant decision. Post-subsidy premiums that are significantly lower in 2018 compared to 2017 will be needed to move people into the market.
And we might get that. In states that are adapting Silver only loading plans to deal with CSR uncertainty, Bronze and Gold plans will be dramatically less expensive in 2018 than they were in 2019 for people who earn under 400% FPL. Zero dollar Bronze plans will be common for individuals making over 300% FPL as Silver Benchmarks will now be priced thirty actuarial value points above Bronze instead of six to eight actuarial value points above Bronze.
In other words, Anderson is pretty confident that, assuming the carriers "Silver Load" (whether across all silver plans or #Switcharoo plans only), several million "bargain shoppers" will indeed jump in to take advantage of the CSR/APTC pricing weirdness this November/December.
The good news is that this could potentially cancel out some/all of the enrollment losses due to all the other shenanigans being pulled by Trump/Price/Verma/the GOP.
The bad news is that, again, this would be happening during the first six week long enrollment period, which would be confusing and hectic enough without all the bizarre/confusing pricing and so forth.
In short, I'm not making any projections about how many people I think will actually enroll in ACA exchange policies this year (at least on the federal exchange; the state exchanges should do quite well, especially since many of them are extending their Open Enrollment Periods by weeks or even to the full 3 month period). I'd say the final tally could be as low as 8 million...or as high as 14 million if Trump/Price decide to do a full strategic 180º and attempt to "take credit" for "saving Obamacare from incompetent Democrats", etc etc at the last minute.
In fact, you could even see the total individual market shrink by a couple million people even as the exchange-based indy market grows. Right now the ratio is roughly 10.7 million on the exchange and 7.1 million off exchange (17.8 million total); that could potentially shift to, say, 12M on exchange and 4M off, or 16M total. Basically, anything is possible at this point.