ACA Waiver Proposals Are Hard to Score: CBO Chief

Hall writes in his letter about the step the CBO takes to ensure objectivity and its approach to estimating how money will have health coverage.

When the CBO came up with projections for the 2016 insured rate, and the number of people who would have ACA exchange plan coverage in 2016, in March 2016, those projections turned out to be correct, Hall writes.

Hall also talks about why the CBO did not try to estimate how MacArthur’s state ACA waiver proposals might affect health insurance premiums in states that applied for waivers.

Waiving the ACA rules might cut coverage costs for some people, but it would increase premiums for others, Hall writes.

Analysts “were uncertain how high those premiums could go, because insurers there might decide to not offer policies with high premiums, and their decisions are hard to predict,” Hall writes.

The uncertainty would have little effect on the number of people of coverage, but it could have a big effect on the accuracy of premium projections, Hall says.

Budget analysts can come up with a rough idea of how many states might apply for waivers, without necessarily predicting which states will adopt waivers, by looking at how states have handled benefits mandates and underwriting in the past, Hall says.

Local hospitals, local medical providers and local insurers may also affect states’ decisions about waivers, Hall says.

Insurers would ask for waivers, but other market participants could oppose the requests for waivers, Hall says.

— Read Health Insurance Bill Dealmaker Draws Fire From Both Sides on ThinkAdvisor.

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