Building on the Affordable Care Act: Strategies to Address Marketplace Enrollees’

While the report and recommendations focus on marketplace cost sharing, marketplace plans are part of a broader health system that includes employer-based coverage, which accounts for the vast majority of individuals in private plans and is rife with affordability issues and other problems.8 Both the pain points and policy recommendations discussed below are also relevant for other forms of privat. [...] During availability of zero-deductible plans in most states and the the COVID-19 pandemic, Congress expanded the growing use of coinsurance instead of copayments.11 generosity and availability of PTCs to lower premiums for Insurers’ increased use of coinsurance, particularly for high- marketplace coverage. [...] Finally, the challenges caused by the complexity of the health insurance system, including the investment of time and energy in navigating a labyrinth of plan decision points, are frustrating and directly affect access to care. [...] Bills have been introduced in Congress to raise the CSR income eligibility threshold for individuals from 250 percent FPL to 400 percent and the amount of help CSRs provide by raising the AV of each income-eligibility band within the CSR structure.37 Massachusetts enacted a version of this option using supplemental state subsidies, and the cost sharing savings for individuals with incomes just ove. [...] Researchers believe the biggest impact of switching to the gold standard would be to increase the availability of lower-deductible plans.40 This option could represent a more limited, incremental step as compared to raising the actuarial value of plans but would lower deductibles and cost sharing for many enrollees.