The Lesser Known Problem with Subsidies

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Generally called “subsidies”, there are actually two different subsidies available to consumers depending on their income level within the Affordable Care Act’s public exchange.  Premium assistance tax credits and cost-sharing reductions.  Cost-sharing reductions are available to help consumers with the out of pocket expenses for treatment or services.  There is a wide range of how different insurance plans pass these cost-sharing subsidies onto the consumer.  Most plans choose to lower deductibles or out of pocket maximums.

An analysis by Avalere Health examined the impact of cost-sharing reductions on prescription drug access. With the majority of cost-sharing reductions being applied to deductibles, consumers receive very little help with pharmacy copays or coinsurance, especially for those medicines in the highest tier.  Those expensive medications often treat chronic disease like cancer, HIV, or multiple sclerosis.  Any difficulty in accessing these drugs is a significant barrier to managing a chronic illness.  If a consumer cannot access medication to treat a chronic illness the consumer may go to the ER or costly specialist which the Affordable Care Act hoped to prevent by giving more people access to health insurance.

 

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