Margaret A. Murray, M.P.A., on ACA marketplace shifts, nonnetwork plans

The expiration of enhanced premium tax credits is pushing Affordable Care Act (ACA) marketplace enrollees toward cheaper, high-deductible bronze plans — a shift that could ultimately cost some consumers thousands more than staying in a silver plan, according to Margaret A. Murray, M.P.A., founding CEO of the Association for Community Affiliated Plans (ACAP) and a longtime member of the Managed Healthcare Executive (MHE) editorial advisory board.

In this excerpt from a wide-ranging interview with MHE, Murray said ACAP anticipated the trend in a paper produced with the consulting firm Wakely, which found that enrollees moving to ACA bronze plans for lower premiums could end up paying roughly $8,000 more out of pocket than they would have in a silver plan, once deductibles and cost sharing are factored in. Whether people will continue paying premiums once they understand what is not covered, she said, is an open question.

Most ACAP-affiliated plans are seeing overall marketplace enrollment declines, Murray said, with a few exceptions tied to state-specific dynamics, such as plans that picked up members after Aetna exited the ACA marketplaces. Because Medicaid and marketplace eligibility are both income-based but at different levels of income, she added, people losing Medicaid coverage are not generally shifting over to the ACA marketplace plans, or vice versa.

Murray said ACAP is also concerned about the Trump administration unwinding Biden-era restrictions on short-term, limited-duration "junk insurance" and a proposal to let consumers use ACA premium tax credits toward nonnetwork plans. She described nonnetwork plans as functioning like a coupon a patient can take to any provider, with the plan paying a set amount

“With a nonnetwork plan, you get a coupon, essentially, to go to a provider and say, ‘I have coverage with this coupon for so many dollars.’ But then the provider ends up charging you more — and there’s no reason they wouldn't — [and] you are on the hook for the additional amount. It’s really underinsurance,” says Murray. “We have come out very strongly against nonnetwork plans and, in fact, led the charge and drafted a letter to the administration with some of the other insurance associations and the hospitals, saying why these were so problematic.”