If policy makers want to instigate more competition in the ACA, they can start by broadening “credibility adjustments” to make it easier for new plans to get started. The exemptions should cover all new carriers that enter the exchanges. They should be deeper and apply for an extended period over which a new carrier faces high startup costs.
A far better alternative would be to scrap the caps on health plan operating margins altogether, and make it easier for new plans to channel revenue into startup costs and investors to turn profits off these investments. The law already provides some flexibility toward these ends. It states that the HHS Secretary can adjust the individual market cap if “the Secretary determines that the application of the 80% may destabilize the individual market in such State.” So long as consumers have transparency (and reliable metrics) on the value of the benefits that different plans offer, the exchanges would benefit from giving new health plans far more flexibility on how they allocate their capital.
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