King vs. Burwell is on the horizon. If the plaintiffs are successful, so goes the theory, subsidies end in 37 exchanges operated by the Department of Health and Human Services and serviced by HealthCare.gov. Coverage gets more expensive, and people won’t be able to afford their policies.
But, this outcome was foretold all the way back in the Senate mark-up of the proposed ACA legislation. Purposely requiring subsidies in state-run exchanges remains the incentive for states to set them up. The administration did not expect so many states elected not to set up their own exchanges, and it is now a big problem. As was noted in 2009 by critics of the bill, if states don’t hand out subsidies, people won’t be able to afford to buy coverage.
In the health savings account industry, the problem is compounded. The ACA law also created a perpetual rule change engine. For example, every year HHS issues what’s called the Letter to Issuers letter to Federal-facilitated Marketplaces (FFMs), in which it discusses all of the fixes that need to be made to exchange operations. This year, HHS has proclaimed that we would all be better off if out-of-pocket maximums (OOPM) for “other than self-only coverage” were restricted to the OOPM for individuals or $6,850 for 2016.