Dan Grunebaum is a data journalist and visualization developer for HealthCare.com. Dan has experience with surprise medical bills and seeks to bring clarity to the healthcare conversation.
Updated on June 11th, 2021
In 2013, when neither the government nor the mainstream media provided consistent, reliable reporting of enrollment data for the Affordable Care Act, Charles Gaba launched ACASignups.net as a hobby, using crowdsourcing to track enrollments in real time. He has since expanded his analysis to include the impact of the ACA’s Medicaid Expansion, SHOP exchanges, BHP provision, Silver Loading, off-exchange individual market enrollment, annual average premium rate changes and a wide range of healthcare policy/health insurance-related issues.
His work has been cited and used as a resource ever since by media outlets spanning the ideological spectrum including the Washington Post, Forbes, Bloomberg News, Vox.com, MSNBC, the New Republic, USA Today, the CATO Institute, National Review Online and The New York Times among others, as well as prominent medical journals such as the New England Journal of Medicine and The Lancet.
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Source: U.S. Centers for Medicare & Medicaid Services.Deductibles for health insurance plans available under the Affordable Care Act have risen steadily since the federal and state exchanges launched in 2014.
The rising cost of deductibles under the ACA has been a consistent complaint, but they should be viewed against a backdrop of increasingly pricy deductibles in the much larger employer health benefits market. A Kaiser Family Foundation annual survey, for example, showed that in 2016 the average employer group plan deductible rose 12%. 2 The average median deductible for ACA marketplace plans was up in 2016 by the same figure: 12%.
Experts generally point to “cost-shifting” as the reason for rising deductibles. As American healthcare costs have risen, insurers have responded by shifting more of the costs onto enrollees in the form of higher deductibles and out-of-pocket costs. In turn, higher deductibles can reduce health service utilization and hold premiums down.
However, a Kaiser study shows that many lower income people who may be discouraged from purchasing a marketplace plan due to the high deductibles could in fact receive a subsidy that would allow them to purchase a lower deductible silver plan for the same price as a higher deductible bronze plan. 3
Kaiser’s study finds that four million uninsured people in the U.S. could get a bronze plan on the ACA Marketplace for nothing, after accounting for their cost-sharing reductions, or CSR subsidies. The same study finds that nearly two-thirds of these people (who earn less than 250% of the Federal Poverty Line) are eligible for much lower deductibles if they buy a silver plan. 4 In addition, some residents of over 190 counties (including the entire state of Wyoming) are even eligible for $0 premium gold plans, which have significantly lower deductibles still. 5
The populations hardest hit by the ACA’s high deductibles have been those on the higher end of the income spectrum. Millions of people make too much to qualify for subsidies and end up paying the full price for high deductible plans. To address this, the Biden administration boosted subsidies for people whose incomes are below 400% of poverty and expanded eligibility for those above the current 400% cutoff.