BREAKING: CMS does complete 180º on #SilverLoading, now actively PUSHING states to do the full #SilverSwitcharoo!

2018 MIDTERM ELECTION

Time: D H M S

March 20, 2018:

Azar Says He Is Not Aware Of Discussions On Blocking ‘Silver-Loading’ in 2019

HHS Secretary Alex Azar said that he has not been involved in discussions about blocking ‘silver-loading’ plans in 2019 and is not aware of any agency discussions about ending the practice at the moment.

...In recent weeks, some stakeholders have speculated that the Trump administration could block silver-loading in 2019. Several pro-ACA experts say that even though the administration may have authority to stop silver-loading, it would be a self-destructive move, especially leading up to the November midterm elections.

CMS Administrator Seema Verma told reporters on Thursday (March 22) that she was “very concerned” about certain aspects of ‘silver loading’ plans, namely that it raises costs for unsubsidized consumers and the federal government. Verma did not commit to allowing or blocking the process for the 2019 plan year.

...“That’s where we continue to be very concerned about the folks that are not being subsidized and where they’re going. We’re very concerned about the 27 million people, as the premiums go up where do they go?” Verna added.

As I noted at the time, Verma's "raises costs" and "concern about 27 million people" made zero sense whatsoever. In any event, there was concern about whether or not they'd try to block Silver Loading, which looked even more likely a few weeks later:

April 12, 2018:

The administration has left one more potential disruptive option on the table. Last year, when President Trump canceled a disputed set of payments to insurers, state insurance regulators allowed the health plans to shuffle around prices to absorb the loss. In a call with reporters Monday, Ms. Verma said her agency was considering barring that practice. Without the price adjustment, consumers in the Obamacare-compliant market will have a harder time finding an affordable plan.

However, in June, this problem appeared to be a moot point anyway:

HHS won’t ban silver-loading this year, Azar admits after being pressed. No time to write broad-loading regs for 2019 plan year.

— Alex Ruoff (@Alexruoff) June 6, 2018

Azar tells House committee that HHS is not going to mess with "silver loading" that mitigates Trump's cancelation of CSR payments for 2019. "That would actually require regulations which simply couldn't be done in time for the 2019 plan period in any event" he says

— Peter Sullivan (@PeterSullivan4) June 6, 2018

Since then, a good half-dozen or so states have joined the Silver Loading bandwagon, either via "standard" Silver Loading or "upgrading" to "full" Silver Switcharoo status.

Cut to today (h/t Dave Anderson):

Date: August 3, 2018
From: Samara Lorenz, Director, Oversight Group
Title: Insurance Standards Bulletin Series -- INFORMATION
Subject: Offering of plans that are not QHPs without CSR “loading”

I. Purpose

To address increases in premiums of qualified health (QHPs) on account of the cessation of federal funding for cost-sharing reduction (CSR) payment to issuers, or “loading,” and its effect on unsubsidized enrollees, the Centers for Medicare & Medicaid Services (CMS) is encouraging states to allow Exchange issuers to offer individual market plans that do not include this load, and that will only be available outside the Exchange. Thus, CMS encourages the offering of unloaded silver plans outside the Exchange in states where the issuer has placed the load on silver QHPs on the Exchange, and encourages the offering of unloaded plans of all AV levels outside the Exchange in states where the issuer has placed the load on all AV level plans.

That last sectoin ("...in states where the issuer has placed the load on all AV level plans") is a bit of a turd in the punchbowl, since it refers to broad loading states...and broad loading is the worst way of handling the CSR load issue to begin with. Fortunately, very few states broad loaded this year, and several of them have "upgraded" to Silver Load or Silver Switch status anyway.

Here's a full explanation about how Silver Loading and Silver Switching actually work and why they're a Good Thing for ACA enrollees, both subsidized and unsubsidized.

I actually don't expect this to have that much real world impact, since at least 40 states were already planning on either silver loading or silver switching next year anyway...but it could encourage a few holdouts to jump on board, and it should also convince a few more states to upgrade to "full" Silver Switch status.

So...why is CMS doing this after mulling over banning the practice?

Well, as I said back in March, that would've been among the stupidest moves they could make, as it would raise premiums on millions of middle class and lower-income people just a week ahead of the midterms.

Some people at CMS still care about keeping healthcare costs down for the average person. Or, at the very least, someone looked at the political landscape for November and decided to do some damage control.