#ACA marketplace enrollees are real people – not phantoms. Policymakers should not let false arguments get in the way of extending the premium tax credit enhancements to prevent people’s premiums from spiking and allow them to stay covered.

While insurance broker fraud is real, the federal government has already taken steps to curtail bad actors. Targeted solutions protect people from improper conduct without raising their premiums or causing them to lose coverage. tinyurl.com/2zzfx5yv

And allowing premium tax credit enhancements to expire would raise premium costs for over 20 million people and cause 3.8 million to become uninsured. tinyurl.com/zndd97k7

Disallowing marketplace plans from offering $0 premium options or requiring people to make minimum premium payments could cause roughly a million people to lose marketplace coverage due to additional red tape, researchers estimate. tinyurl.com/2wkzmexn

And the ACA includes a backstop: if insurers take in too much in premiums compared to what they pay out for health care services, the money has to go back to consumers.

More enrollees without claims also doesn’t mean more money for insurance companies: if enrollment goes up but there are no additional claims, the cost per enrollee goes down. That means the premium per enrollee – and the federal cost per enrollee – also goes down.

The prevalence of enrollees without claims increased in recent years, but that’s because enhancements to premium tax credits pulled in people who use less medical care – because they’re enrolled for shorter periods & because they’re younger and healthier. tinyurl.com/5t2kd9y4

The existence of ppl w/out claims is a normal feature of all health & other insurance markets– not evidence of fraud, & certainly not evidence that enrollees are “phantoms.” Ppl can’t always predict when they’ll need to use their insurance, but it’s meant to be there when they do.

The context is that HSAs are currently being touted by some as an alternative to extending the premium tax credit enhancements.

HSAs are projected to cost $181B over 10 yrs. That amount would cover - and be better spent - extending the enhanced premium tax credits for ~6 yrs or closing the Medicaid coverage gap for ~9 years. Govt resources are limited, and HSAs have very little bang for the buck in improving affordability.

A better way would be to extend ACA marketplace premium tax credit enhancements. See table 2 for estimates for every state: www.cbpp.org/research/hea...