Actuarial Value and the Importance of Bipartisanship in Health Care Reform

In 2009 and 2010, Congress wrote a bill with the goal of providing health care coverage for the uninsured in America.  With the decision to include the individual mandate, Congress decided to include a requirement in the Affordable Care Act (ACA) that penalizes people who do not purchase insurance (with a few exceptions).  In 2017, through a continuous coverage requirement in the American Health Care Act and the proposed Better Care Reconciliation Act, Congress still considers it important to require insurance coverage, albeit through different means. If the proposed ACA replacement includes a requirement to purchase insurance, a subsequent critical question must be answered:  How much does someone have to pay for the coverage they must purchase? In the world of health care coverage, there is no such thing as a free lunch: someone always pays. Through tax deductions taken by an employer or direct subsidies, the taxpayer currently pays for a lot of health care coverage.  There will always be a share that is paid for by the insurance plan and a share that a consumer pays. This ratio, the percentage of expected health care benefit costs a specific health plan is expected to cover, is known as actuarial value (AV).  It sets out how much an individual is expected to pay for the cost of their care through premiums, coinsurance, copayments, and deductibles. Because of the benchmark plan designation in the ACA, it also determines how much the government will subsidize for them,...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Following the ACA ACA repeal and replace Actuarial Value Politics Trumpcare Source Type: blogs