Alaska 1332 Waiver- Economic Analysis
|The four guardrails that a successful 1332 waiver must meet are as follows: 1. Coverage - There must be at least a comparable number of individuals with coverage under the waiver as would have had coverage without the waiver. 2. Affordability – The waiver should not result in an increase in out-of-pocket spending required of residents to obtain coverage, relative to income. 3. Comprehensiveness – The waiver should not decrease the number of individuals with coverage that meets the essential health benefits (EHB) benchmark. 4. Deficit Neutrality – The waiver should not have any negative impact on the federal deficit. In this report, the first three guardrails are briefly discussed to reaffirm that the actuarial analysis conducted by Oliver Wyman demonstrates that the proposed waiver meets them. The actuarial report from Oliver Wyman projects that the proposed waiver will increase the number of individuals taking up insurance in the individual market, lower average premiums, and have no impact on the comprehensiveness of coverage. The numbers reported in the actuarial analysis are then used to help evaluate the impact that the proposed waiver will have on the federal budget. There are at least four ways in which the waiver will have an important impact on the federal budget, which are summarized in Table 1. Table 1: Impact of Proposed Waiver on Budget Direction of Effect APTC Savings + Individual Shared Responsibility Payments - Health Insurance Providers Fee - Federal Exchange User Fees - Overall Impact on Budget + The first and most important impact of the waiver is that it will lead to a reduction in premiums. The reduction in premiums reduces the amount of Advanced Premium Tax Credits (APTC) that individuals will be eligible for and generates savings of $50 - $100 million per year from 2018 through 2026. There are also three routes through which the waiver will negatively impact the budget by decreasing revenue: individual shared responsibility payments, health insurance providers fees, and federal exchange user fees. Because the waiver will lead to more individuals taking up insurance in the individual market, fewer individuals will owe 2 Attachment 4 Alaska 1332 Waiver - Economic Analysis December 23, 2016 the individual penalty for not having health insurance. The health insurance providers fee depends on the amount of premiums aggregated to the national level. Because the waiver depresses premiums in the Alaska individual insurance market, it will have a secondary negative effect on the total amount collected through the providers fee for years 2019 through 2026. Lower premiums also reduce the amount collected in federal exchange user fees, a 3.5% tax imposed on premiums sold through the Federally Facilitated Marketplace. The aggregate impact on the budget is positive, because the APTC savings outweigh the combined negative impact of the other three channels. Table 2 summarizes the aggregate impact of the four components on the federal budget. Year Final Savings 2016 $0 2017 $0 2018 $48,973,684 2019 $52,260,336 2020 $56,108,411 2021 $61,486,732 2022 $65,612,013 2023 $72,213,851 2024 $77,717,467 2025 $84,814,665 2026 $91,785,506 Table 2: Estimated Savings from Waiver (Before Pass-Through Funding) The overall impact through these four components is about $49 million in savings in 2018. Savings increase in every year thereafter, reaching nearly $92 million in 2026. The savings listed in Table 2 are before the granting of any pass-through funding, so they suggest that as long as pass-through funding is less than or equal to these figures, the proposed waiver will meet the federal deficit neutrality requirement.
|Alaska Division of Insurance
|Institute of Social and Economic Research, University of Alaska Anchorage
|Alaska 1332 Waiver
|Alaska 1332 Waiver- Economic Analysis