A House Republican has come up with an idea for a new way to help moderately low-income U.S. residents pay for health care.
Rep. Greg Steube, R-Fla., wants to replace some of the subsidies that now help people use their Affordable Care Exchange exchange plan coverage with contributions to health savings accounts.
H.R. 5608 — the Affordable Care and Comprehensive Economic Support Through Savings Act bill, or ACCESS Act bill — would let an exchange plan user who is eligible for an ACA cost-sharing reduction subsidy get cash in an HSA in place of the cost-sharing reduction subsidy.
The federal government would pay an amount equal to the available subsidy to the insurer, and the insurer would put the cash in an HSA.
What it means: For Republicans, many health system change proposals continue to involve efforts to find new ways to use HSAs and similar types of accounts.
The ACA exchange system: When members of Congress were drafting the two-law package that created the Affordable Care Act of 2010, they included the ACA public exchange provisions in an effort to get more young, healthy to pay for coverage, and to help hold down the average amount of claims per enrollee
Drafters wanted the exchange system to create a Travelocity for health insurance, where consumers could shop for individual major medical insurance policies without worries about medical underwriting and use federal subsidies to pay for the coverage.
The U.S. Department of Health and Human Services provides exchange plan services in many states through HealthCare.gov.
Some states operate their own state-based exchange programs, such as Covered California and Your Health Idaho.
The ACA exchange plan subsidies: The federal government provides two types of subsidies: premium tax credit subsidies and cost-sharing reduction subsidies.
Premium tax credit subsidies help pay the plan premiums for people with income between 100% and 400% of the federal poverty level, or between $13,590 and $53,360 for an individual in most of the country.
Cost-sharing reduction subsidies help exchange plan users cope with "cost-sharing" bills, or the money a patient with insurance spends on deductibles, copayments and coinsurance amounts.
