is what about the unsubsidized uninsurable. idea that i bright read somewhere, what if we tax the noncompliant plans to help subsidize those that otherwise would not qualified. it's becoming a high-risk pool. way,u think about it that it may be some type of way to deal with split markets. it could be the best path forward for some states. theme ofuces a final uncertain path forward. i will draw on this long because my time is up at the bottom line , it sure would be nice if we could take the politics out of this and work together to see if we can make these markets better. good open things up for honest discussion. thank you. [applause] >> good morning to everybody in the room and everybody watching us online. thea senior fellow here at workings institution. i'm delighted to be chairing this panel which will take us more deeply into what is going on in particular states. nathan, who has been mentioned as the father this kind of field research, recognized when the affordable passed thatt -- this would be a huge opportunity to ob

but for the unsubsidized it is really in trouble. enrollment is dropping off quickly and that is where you are hearing and pending spiral and stuff like that. >> the prices are same across subsidized in the unsubsidized. but they are becoming increasingly unaffordable for the unsubsidized. the metaphor is the subsidy close. the idea is subsidies for half the cost of insurance $50,000 for a single family. if you started out with a $5000 for a single and $10,000 for a family, being at this border of subsidized and unsubsidized wouldn't make much difference. 10% of your income is roughly what insurance would cost without subsidies. >> you might get a little bit of a benefit for being just below, but you wouldn't lose very much if you were just about. insurance prices have doubled since year two. now it cost 10,000 for single or 20,000 for a,. -- family. you suddenly lose the subsidy by earning $100 more than the subsidy level. it is in -- extraordinarily uneconomic. it was a structure put in place initially where people that things woul

unsubsidized were largely unaffected. they just had to go through the hoops of moving from on the exchange to on the exchange. there's further complications that louise can tell us about, because if there are income change in the middle of the year, they're trapped off exchange, and it's more complicated than reflecting. but essentially, they had options that reflected what they had previously, but the federal government ends up spending $30 billion more, roughly speaking, because again, subsidy amounts went up. and so at the end, there was all that. and insurers were comforted to hear that the silver loading would be allowed for this year. and in fact, when it was proposed in congress that we reinstore the desperately needed the cost sharing reduction funds which everybody decried the loss of, public interest groups said we don't want the money back. it's working better without the money. so the story was very, i don't know, interesting. mandate repeal, i'm going to pick up even more speed. it's less destabilizing than e

so its effect on the unsubsidized are diluted or indirect. what if we took the same money and reduced the amount for the subsidized in some subsidy fashion. so that idea was suggested but not developed. let me get to my final topic and sort of borrow five minutes and i'll give it back on my other presentation. we have these non-compliant plans that i mentioned. they're popping up in various ways. we did hear a fair amount of concern about destabilizing effects based on adverse selection. if only the healthy people can get these, it's going to pull them out of the regulator market, raise prices even more. you add to that the repealed individual penalties that before you had to pay the penalty if you pursued an option. that makes it even more attracti attractive so at least this gives them something. the problem, though -- and the simulation models actually show that because things like short-term plans are considerably less expensive because they're less protective, still the number of people signing up will actually go up by a million or so,

and that tended to be people in the unsubsidized part of the individual market. now, they didn't have the leverage necessarily to unravel everything but that's what some are responding to through these various halfway measures. and you can push and you can pull and you can try to find money from somewhere else, or shift it around, but ultimately, not everybody goes home happy. and our health policy debate is basically trying to find the least objectionable parties being the ones who are unhappy. >> just one comment related to that. i think important to keep in mind, though, if we wanted to mark's proposal of extend the 10% of income cap above 400% of the poverty line, that is probably a order of magnitude, $100 billion to $200 billion over 10 years type of expenditure. that's a lot of money. that's not chump change. range of types of money one could imagine the federal government spending so this is very much within the realm of achievable policy. i mean, certainly, if you compare it to the amount of money that has been moving around in recent tax legislation, it

constituent in that unsubsidized individual market and i want to pick up a couple of things one thing that is very clear is the divergence among the states they brought up some convergence but since last year it is in increasing divergence agrees that because the state where i live now the rates are going up i ran into a republican yesterday at the metro paying $36,000 per year for a family of four i am paying0or $9.1 -- 9000 i am probably losing that state potentially facing a 95% increase in premiums next year. so my question is do you think within your state operations how this affects economic development and prosperity and job growth with entrepreneurs? i live in a state it was very progressive of years ago with their individual small group market drew people and for starting businesses because they knew they didn't have to worry about how to get insurance for the new employees or themselves while they took this venture to invest their time and money into the new venture. source states thinking about the market as part of their economic development policy? thank you. >> it is saf

i am the face of the constituent in that unsubsidized individual market. i want to bring up a couple things because one thing that is very clear sabrina mentioned divergence, there was a great divergence in the state before the aca, the aca brought up divergence. the state where i now live the rates are going up very much and i ran into a friend who is republican yesterday in the metro, he is paying $36,000 a year for his family of four, i'm paying about 9. i'm probably going to be leaving that state of maryland before the end of the year because potentially facing a 95% increase in premiums next year. my question is to brian and the two state insurance commissioners, do you guys think within your state operations how this affects economic development and prosperity and job growth, particularly around entrepreneurs and the gig economy. i was living in a state that was very progressive years ago and what they did in their individual small group market was drawing people in who were starting businesses bus because they knew they didn't have to worry about ho

what that suggests is they are now figuring out how to play to both the subsidized and unsubsidized market. so they can potentially end of their transitional plans and for the group that would be qualified for subsidies that can pursue them in the marketplace, but for other individuals who are in better shape and healthier, younger, maybe not subsidized they can go after them through these farm bureau plans and i will leave it there. thank you. >> fms book called what's the matter with kansas? i think we can say what's the matter with iowa? tell us about minnesota. >> we will try to do this in ten minutes. so minnesota like other states has had a very volatile individual market. we are a very small market so we started when we started with the aca implementation, we had about 300,000 people. that is diminished to about 160,000 so is lost a lot. it's unique, states who are smaller, so we have, and rural, so we have 300,000 people compared to 1.5 million in california's individual market. so it creates a different dynamic. it's smaller numbers, small problems but also very volatile and not e

un-substance died -- diesed is -- unsubsidized is too expensive. how can i get coverage more affordable to them? that's where the states are headed. now let's turn to the states. >> a point of clarification. people may not know the difference between association health plans and multiple employer welfare arrangements. >> if i could do -- going back to school. all association are -- it doesn't matter. association health plans are all because they all involve multiple employers. not all -- are association health plans. there are entities that are always multiple employer welfare arrangements. and everything they've talked about in the final rule. every new plan and everything they said could be created are multiple -- states regulate. >> 84 invitation to join you here >> thank you for the invitation to join you today. i'm not sure which button i'm supposed to push. i didn't push hard enough. that was my problem. what you can see from this first graph is that we have about 270,000 people that are insured through the individual market in the state of w

i am the face of your constituent in that unsubsidized individual market. i want to bring up a couple of things that ryan brought up is one thing that is very clear sabrina mentioned divergence and there's a great deal of diversions for the aca. in the last few years it's been increasing. in the state i live the rates are going up very much. ran into a friend who's a republican and he's paying $36,000 a year for a family of four and i'm paying about nine. i'm probably going to be leaving the state of maryland before the end of the year because i'm potentially facing a 95% increase in premiums next year. my question is the state insurance commissioners do you guys think within your state operations how this affects economic development and prosperity and job growth particularly in this economy. i was living in a state eight years ago at what they did in their small group market was drawing people in who are starting businesses and they knew they didn't have to worry about how to get insurance for the new employees or for themselves while they were going on t

legislators is there has been a tremendous pressure on legislators to address the needs of the unsubsidized, the folks who really are facing these unaffordable premiums. and so that is -- that we are seeing legislators respond in different ways to that, but at the same time we see at the advocates, consumer patient advocates, insurance companies, and other step up in coalition to sort of counteract some of those forces. one example would be north carolina, where there was a bill that was moving very quickly through the legislature to adopt a sort of iowa style farm bureau type of postal. what was -- proposal. what was interesting there was the coalition that came up to try to kill the bill. they said there would be some harmed by that initiative and they were successful. i think there is -- particularly on the advocacy side there has been so much focus on medicaid been --n that there has they have been slower to move to these private insurance issues, but they are starting to step up to the plate. north carolina is a great example of that. >> thank you. any of our other panelists have sort

that tended to be people of the unsubsidized part of the individual market. they did not have the leverage necessarily to unravel everything, but that is what some are responding to. you can push, pull, and try to find money from somewhere else, but ultimately, not everybody goes home happy. our policy debate is basically trying to find the least objectionable parties being the ones who are unhappy. >> one comment related to that. it is important to keep in mind, if we wanted to extend the 10% of income above 400% of poverty line, that is probably a order of magnitude 100 to 200 billion dollar 200 expenditure. that is a lot of money. that is well within the range of the type of money one could imagine the federal government spending. this is very much in the realm of achievable policy. if you compare it to the amounts of money that has been moving around and recent tax legislation, it is chump change. >> do you comment on what exactly is going on with risk adjustment, and then will that have an impact on offering market for the fall, both in terms of who show

and there is a tremendous pressure on legislators to address the needs of the unsubsidized. the folks who are really facing the unaffordable premiums. so we're seeing legislatures respond in different ways to that. we're seeing consumer advocates and patient advocates and others step up in coalition to counteract the forces. one example is north carolina where there was a bill that was moving very quickly through the legislature to adopt a sort of iowa style farm bureau type of proposal. and what was interesting there was the coalition that really came up to try to kill that bill out of concern that, in fact, while, you know, there would be a number of folks with pre-existing conditions in the subsidized population that would be harmed by that. and they were successful. there is so much focus on medicaid expansion that there have been a little slower to move to some of the private insurance issues. but they are starting to step up to the plate in north carolina is a great example of that. >> thank you. any of our other panelists have sort of state highlights, specific storie

couple years ago were they created a specific state discount program for those people who were unsubsidized. unfortunately, it did not work well because it was announced really late in open enrollment, so there were other complicated factors related to that, but that was something that states could consider. i think the budget questions are a big one. the individual market does not get the same taxpayer the -- the same tax parity that you get with a small group coverage. thinking about that, only individuals up to the 400% qualify for that premium tax credit. does there need to be a debate around sort of that. and other things we think are important, especially in the access tos, expanding telemedicine and other things to really help get at that cost of care lever. how do you get the underlying cost down that we really think are important to consider, not ance,-- we love re-insur but i think they're looking that in concert with other things that really sort of address more the underlying root causes and the things i slowed in my slides, as to why the cost of the smaller pool of people conti

, these reports show the high price plans on the individual market are unaffordable in forcing unsubsidizediddle-class consumers to drop coverage. that is a different reality than the one pres. obama promised. >> if you don't like your healthcare plan you are able to keep your healthcare plan. >> democrats believe phrase your plans are the product of a republican-led majority with their priorities backwards. >> the tax scam for the rich republican donors, wealthy shareholders, reward big corporations, shipping american jobs overseas and driving up healthcare costs for hard-working americans. >> the most popular option is the silver plan and there are 13 states where premiums are at least 40% higher this year than last year including sen. john barash so's wyoming. >> we have lots of ranches in wyoming, it was made illegal by the obamacare regulations and said it is not good enough for the government. >> control of congress could be determined by rising health insurance premiums or which party voters blame for the price tag going up because the next round of premium increases will be announce

these reports show the high-priced planes on the individual market are unaffordable and forcing unsubsidizeders to drop coverage. that is a different reality from the one pres. obama promised. democrats believe place your plans are product of a republican-led majority with their priorities backwards. >> the tax bill scam for the rich republican donors, wealthy shareholders on wall street, big corporations shipping american jobs overseas and driving up healthcare costs. >> the most popular option on the government run marketplace is the silver plan. there are 13 states where they are already 40% higher this year than last year including sen. john barroso's wyoming. >> we have lots of ranchers in wyoming, it was made illegal by the obamacare regulations that said it is not good enough. >> reporter: next round of premium increases will be announced right before the midterms. >> democrat jumping ship, new york assemblyman doug hagan slamming chuck schumer over his recent attacks on donald trump writing on facebook, quote, sen. schumer, i ask you to restore sanity and honesty to our party so i ca

from 2016-2017 hhs down the number of unsubsidized enrollees dropped by about 20%.he only factor keeping the individual market alive is that tens of billions of dollars of subsidies applied directly to interest each year. fundamental flaw of the ac is that it narrowed the competition for insurance options and lay down have had a controls on the prices it could be charged. one of the most notable price control that doesn't get enough attention in a free market young people, individual insurance for about 16 of what it cost older people because younger people use fewer health care resources. younger americans must be charged at least one-third of what old americans pay. this kind of price control chokes off private market. can't people are by definition getting less than a the pay-fos of the opt out of the system and then that's not a good deal for older americans either. because they're the only ones left paying into the system so the premiums rise. .. >> remember, if it's still moving, regulate it. we care deeply about consumers having the information they need. so

from 2016 to 2017, hhs found the number of unsubsidized enrollees dropped by eight percent. the only factor keeping the individual market alive is the tens of billions of dollars in subsidies supplied to insurers each year. a fundamental flaw of the aca is a narrow the competition for insurance options and lay down heavy-handed controls on the prices. one of the most notable price controls that doesn't get enough attention, in the free-market young people can buy individual insurance because younger people use healthcare sources but the aca imposed a price floor. younger americans must be charged one third of what over older americans pay. this price control chokes off private markets. young people are by definition getting less than they pay for so they opt out of the system and then that's not a good deal for older americans either because they are the only ones left paying the system for their premium rise. congress created this broken system and it's going to create an act of congress to fix it but we have flexibility to track him re-market reforms and we've done so in t

. >>> now the changes would bring the average cost of an unsubsidized policy to $547 a month. but 88% of individuals who buy coverage receive subsidies and pay much less. >> there is a permanent plaque to honor those killed in the collapse. they gathered at mlk civic center park. the plaque in clouds the names of the six victims who were visiting from ireland. first responders joined the family. he was the first firefighter in 2015 on the street. >> we rolled up on scene and it was a pile of bodies on the sidewalk so it was a little difficult for all of us to take in at the time. >> investigators say the dry rot caused the balcony to collapse. they strengthened standards on the construction of balconies since. >>> it might save you some money. >> plus phil sits down with scott weiner and discuss what to do with illegal immigrants who commit a crime. deport them or keep them safe in a sanctuary city? ♪ you know when you're at ross and that cute dress gets even cuter? yes. or when you can say yes... to both? sure. or when you find that brand at that price? are you kidding me? ye

the changes would bring the average cost of an unsubsidized policy to $470 month. 80% of individuals that by coverage on the exchange receive subsidies and pay much less. >>> coming up, the ride share rape suspect pleads not guilty with his wife and family in the courtroom. >>> a car, found at the bottom of the cliff in the south bay, but where is the driver? the mystery baffling investigators. >>> the biggest rugby event ever in the us, happening in the bay area. the ceremonies in games drying tens of thousands of fans and athletes from all over the world. this is customizable streaming tv for your family, whatever size. it's saving money with flexible channel packs. live tv and the latest shows to stream. and all your streaming apps in one place... - even netflix. this is how xfinity makes life simple. easy. awesome. get started with xfinity internet and tv at a new low price, just $44.99 a month for 12 months. plus, ask about flexible channel packs. click, call or visit a store today. "rideshare rapist"... in court today... his lawyer p >>> we are learning utility -- details in th

these reports show the high-priced plans on the individual market are unaffordable and forcing unsubsidized middle class consumers to drop coverage. that's a different reality than the one president obama promiseed. >> if you like your health care plan, you'll be able to keep your health care plan. reporter: democrats believe pricier plans are a product of a republican-led majority with priorities backwards. >> we've watched the gop tax bill scam for the rich and rich republican donors, wealthy shareholders and wall street. reward big corporations. shipping american jobs overseas and driving up health care costs for hard working americans. reporter: the most popular option on the government run marketplace is the silver plan, and there are 13 states where premiums for silver plans are already at least 40% higher this year than last year, including senator john barrasso's wyoming. >> we have lots of ranchers that had insurance and could work for them but it was made illegal by the obamacare regulations that said no, no, it's not good enough for the government. reporter: experts say when prem

from many of the public commenters, the children at said rodriguez are primarily low income and unsubsidizedon and a speech and learning center there. and the impact on the children of the noise and the dust and the chemicals that are released could be quite severe. that was not analyzed specifically in the e.i.r., so could you discuss that and whether or not that is a problem. and why you don't believer that it is a problem? >> yes. chris curn, department staff. the c.p.e. and e.i.r. didn't specifically address the socioeconomic status of the students at the school. what it did address or what the analyses did address is physical health effects, and just for reference with respect to the air quality thresholds of significance for health protection, we use very health protective standard. it is actually the threshold is based on the breathing rates of an infant in utero and exposed 24/7 for a period of 30 year. these are extremely health protective standards that we apply. again t noise mitigation measures that are required are the state-of-the-art noise control measures during construction.

reports show that the high-priced plans on the individual market are unaffordable and forcing unsubsidizede-class consumers to drop coverage." that's a different reality than the one president obama promise promised. >> if you like your health care plan, you will be able to keep your health care plan. >> democrats believe pricier plans are a product of a republic and majority with their priorities backwards. >> we watched the g.o.p. tax bill scam for the rich and rich republican donors, wealthy shareholders and wall street, reward big corporations shipping american jobs overseas and driving up health care costs for hardworking americans. >> the most popular option on the government run market place is the silver plan, and there are 13 states were premiums for silver plans are already at least 40% higher this year than last year. including senator john barrasso's wyoming. >> we have lots of ranchers in wyoming. they had insurance they could afford and work for them but it was made illegal by the obamacare regulations that said it's not good enough for the government. >> experts say that whe

i bought an unsubsidized policy. i bought on price. what's the cheapest thing can i afford? that's the bronze plan. the premium was unbelievable. it was three times what i had paid for a premium before for my so-called junk insurance, which i had for years, which had covered every medical contingency that occurred in my family's life for a number of years. now i have to buy this policy that the premium sun believably high. but that wasn't the worst part, mr. speaker. the worst part was the deductible. i had a health savings account. i bought one as soon as the old medical savings accounts were allowed with the passage of the kennedy-castle balm bill, july of 1996. the rules got written the next year. people were allowed to buy medical savings accounts. i converted to health savings account in 2004. i thought i knew what a high deductible was. that was the whole purpose of having that medical savings account and now health savings account. you have a higher deductible so your premium will be lower. my premium certainly wasn't lower. but that deductible was something unlike an