Kind of a Big Deal: HealthAffairs publishes our work re. CSR Broad Load Threat

99% of what I write is posted either exclusively here at or, at most, is cross-posted over at Daily Kos. Once in blue moon I've written a freelance piece for, and I even wrote one piece for last year. Today I'm proud to announce that an article which I co-wrote with three other healthcare wonks (David Anderson, Louise Norris and Andrew Sprung) has been published by HealthAffairs:

Implications Of CMS Mandating A Broad Load Of CSR Costs

In October 2017, the Trump administration eliminated federal funding to reimburse insurers for cost-sharing reduction (CSR) subsidies, which they are obligated to provide to qualifying enrollees in the Affordable Care Act (ACA) Marketplace. President Donald Trump had threatened to eliminate CSR funding throughout 2017, so insurers and insurance regulators in many states had anticipated the move by adding the cost of CSRs to premiums for 2018.

As I understand it, HealthAffairs is considered one of the more prestigious healthcare analysis outlets, so getting published there is kind of a Big Deal. I'm also honored to be a co-author with Anderson, Norris and Sprung, each of whom has served as a mentor of mine on various wonky healthcare analysis stuff over the past 4+ years.

The essence of the piece is this:

  • While doing so did cause some damage, most state insurance regulators worked with the insurance carriers themselves as well as most of the state-based exchange boards to come up with a clever premium pricing workaround called "Silver Loading" (or "The Silver Switcharoo" depending on which version they used) which not only mitigated the pricing damage for most people, it actually helped millions of low-income enrollees.

Our collaborative piece explains the background on the impact of CSRs being cut off, how Silver Loading mitigated the damage, and explores just how ugly things would get if Broad Loading was mandated across the nation.

Anyway, it's a wonkier piece than you'll usually read here, but if you want to understand yet another one of the back-end sabotage efforts being mulled over by the Trump Administration, I'd advise reading it over.

(Oh, and for the "Don't give them any ideas!" crowd, believe me, Verma is already pondering trying to do exactly this.)