For the unsubsidized, “silver-loading” creates categories of plans to avoid, and all else equal, we would expect the unsubsidized to do best in states with this pricing strategy.
Parsing premiums for the unsubsidized
The premium of the least expensive bronze plan on or off the exchange is a useful measure of affordability for the unsubsidized. Nationally, the average lowest-price bronze plan increased from about $250 in 2017 to about $300 in 2018, and the average percent increase was about 20 percent.
In some states, the unsubsidized face steep prices. The monthly premium for a 27-year old for the least expensive bronze plan in the most expensive 15 states exceeds $335, which is the threshold for an affordability exemption from the individual mandate for someone with an income of $50,000. In the five most expensive states the least expensive premium exceeds $403, the threshold for an exemption for those with an income of $60,000. Approximately 20 percent of the unsubsidized will face premiums for the lowest cost bronze that exceed $335. Given that premiums increase with age, this is clearly a lower bound estimate. Yet the outlook elsewhere is far better. In the cheapest nine states, the lowest price bronze plan costs less than $225. Ten states had an increase of less than 5 percent in their cheapest bronze plan. More than one-third of the unsubsidized will be able to buy a plan for less than $250 per month.
Implications for 2018 and beyond
The unsubsidized are unique among health care consumers in that they must confront the full retail price of health insurance. While many states took action to protect consumers from premium increases, others raised premiums on all products, a decision which most adversely affected their unsubsidized residents. Unsurprisingly, this segment of the market has the lowest take-up rate, and is most susceptible to diversion to limited coverage plans. Growth in the individual market depends in large part on improving affordability for the unsubsidized, and results thus far are decidedly mixed.