Higher Premium Impact on Older and Low-Income Populations Under BCRA
Premium comparisons reveal that low-income, older adults face substantial increases in premiums under the Senate BCRA compared to the ACA. States with older, lower-income, and rural populations would experience over 100% higher average premiums under the BCRA. The BCRA could result in significant disparities in premium costs across different demographics and states, impacting access to healthcare for vulnerable populations.
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For a middle-age person, before tax credits, premiums for comparable coverage would be similar under each plan Annual individual market premium for a silver plan, before and after tax credit (175% FPL), 2026 40-year-old ACA $6,500 Senate BCRA $6,400 (-2%) House AHCA** $6,550 (+1%) Before tax credit $1,700* $3,000 (+76%) $2,900 (+71%) After tax credit 21-year-old Before tax credit $5,100 $4,100 (-20%) $4,200 (-18%) After tax credit $1,700* $2,200 (+29%) $1,750 (+3%) 64-year-old Before tax credit $15,300 $20,500 (+34%) $21,000 (+37%) After tax credit $1,700* $6,500 (+282%) $16,100 (+847%) Congressional Budget Office *Under the ACA, a person of this income buying a silver plan would be eligible for cost-sharing assistance (87% Actuarial Value) making their silver plan more similar to a gold or platinum plan. ** Premiums shown for a state without a waiver. Average AV is 65%, which is somewhat less generous than a silver plan (70%).
Low-income, older adults would face highest premium increases under Senate BCRA Monthly Premium for a Silver Plan Among Exchange Enrollees (By Income and Age), 2020 Income Below 200% of Poverty ACA Premium After Tax Credit After Tax Credit $26 $58 Income 200% of Poverty or Above ACA Premium After Tax Credit After Tax Credit $176 $170 $247 $247 $296 $369 $323 $556 $399 $782 $439 $862 $311 $489 BCRA Premium % Change BCRA Premium % Change Age < 18 121% -4% 18-34 $57 $103 82% 0% 35-44 $69 $149 117% 25% 45-54 $67 $215 223% 72% 55-64 $69 $272 294% 96% 65 + $76 $296 288% 96% $61 $168 177% 57% Overall Source: Kaiser Family Foundation Kaiser Family Foundation. Premiums under the Senate Better Care Reconciliation Act, Jun 26 2017 http://www.kff.org/health- reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/
States with older, lower-income, rural populations would see average premiums more than 100% higher under the BCRA than current law Percent Difference in Average Monthly Silver Premiums After Tax Credits under BCRA vs. ACA, 2020 Alabama 164% Alaska 142% Oklahoma 140% South Dakota 111% West Virginia 108% US Average 74% Washington 33% DC 22% Vermont 21% Mass. 14% New York 12% 0% 20% 40% 60% 80% 100% 120% 140% 160% 180% Kaiser Family Foundation. Premiums under the Senate Better Care Reconciliation Act, Jun 26 2017 http://www.kff.org/health- reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/
Some states would see higher average premium increases than others under the Senate BCRA Percent Difference in Average Monthly Silver Premiums After Tax Credits under BCRA vs. ACA, 2020 164% 74% 12% NM NY ND VT NH AR CT TX TN RI VA NV HI NE CA NC AK NJ CO MO ME AZ MN MD WV AL MA DC WA WY MT LA IN OH OR DE MI WI MS ID IA OK IL US SC GA PA SD UT FL KY KS Kaiser Family Foundation. Premiums under the Senate Better Care Reconciliation Act, Jun 26 2017 http://www.kff.org/health- reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/
Average Deductible in Marketplace Plans with Combined Medical and Prescription Drug Deductibles, 2017 $7,000 $6,105 Silver Plans with Cost-Sharing Reductions for Lower-Income Enrollees $6,000 $5,000 $4,000 $3,609 $2,904 $3,000 $2,000 $809 $1,000 $255 $0 Bronze Silver Income 200-250% of Poverty (73% AV) 150-200% of Poverty (87% AV) 150% of Poverty or Below (94% AV) (60% Actuarial Value) Income Over 250% of Poverty (70% AV) Source: Kaiser Family Foundation analysis of data from Healthcare.gov. Note: Under the ACA, people purchasing silver plans on- exchange who have incomes below 250% of the poverty level (about $30,000 for a single individual or $60,000 for a family of four) receive reduced cost-sharing, meaning their plans have lower deductibles. Typically, silver plans have an actuarial value of 70%, meaning that on average the plan pays 70% of the cost of covered benefits for a standard population of enrollees, with the remaining 30% of total costs being covered by the enrollees in the form of deductibles, copayments, and coinsurance.
