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I'm suspecting that there's a diversity of situations among the people in the individual market that would make this challenging. These are people who are self

I'm suspecting that there's a diversity of situations among the people in the individual market that would make this challenging. These are people who are self-employed, or have low wages, or irregular work.

tanzam75 13y ago
> I'm suspecting that there's a diversity of situations among the people in the individual market that would make this challenging. These are people who are self-employed, or have low wages, or irregular work. I'm afraid I don't follow. Why would self-employment or low wages make it more challenging to sign up directly rather than through an exchange? I'm not proposing any changes to the subsidies. Simply remove the requirement to go through an exchange to get the subsidy.
- wildgift 13y ago
  I don't know how it would be done, but I can only see two scenarios. One is to charge the insured the full, unsubsidized premium, and give the tax credit in 2015. The other is to pay the subsidy to the insurance company throughout the year. In the former situation, some people just cannot afford it. In the latter situation, you can have some fraud (by the insurance companies). I guess they could offer both options, and if you choose the latter, you need to apply through the government, so they can verify that you exist, etc.
  - tanzam75 13y ago
    I'm not convinced that insurance fraud will actually be a big problem. Just do a random spot-check of all the policyholders that the insurance company is claiming a subsidy for. If the amount claimed is more than x% over the amount calculated by the government, then the insurance company gets cut off. Right now, by forcing people to buy on-exchange to get the subsidy, we're essentially doing the spot-check interactively. This is putting tremendous load on the healthcare.gov back-end. There's no reason this couldn't have been done as a batch process instead.

tanzam75 13y ago

> I'm suspecting that there's a diversity of situations among the people in the individual market that would make this challenging. These are people who are self-employed, or have low wages, or irregular work. I'm afraid I don't follow. Why would self-employment or low wages make it more challenging to sign up directly rather than through an exchange? I'm not proposing any changes to the subsidies. Simply remove the requirement to go through an exchange to get the subsidy.

wildgift 13y ago
I don't know how it would be done, but I can only see two scenarios. One is to charge the insured the full, unsubsidized premium, and give the tax credit in 2015. The other is to pay the subsidy to the insurance company throughout the year. In the former situation, some people just cannot afford it. In the latter situation, you can have some fraud (by the insurance companies). I guess they could offer both options, and if you choose the latter, you need to apply through the government, so they can verify that you exist, etc.
- tanzam75 13y ago
  I'm not convinced that insurance fraud will actually be a big problem. Just do a random spot-check of all the policyholders that the insurance company is claiming a subsidy for. If the amount claimed is more than x% over the amount calculated by the government, then the insurance company gets cut off. Right now, by forcing people to buy on-exchange to get the subsidy, we're essentially doing the spot-check interactively. This is putting tremendous load on the healthcare.gov back-end. There's no reason this couldn't have been done as a batch process instead.