The Congressional Budget Office estimated that the cost-sharing subsidies would total around $7 billion in 2017, yet not funding them was expected to cost the government more through higher premium assistance. A bipartisan effort in Congress to fund the payments ultimately failed to gain traction, even after the White House requested the appropriations in February 2018.
Exchange enrollees who did not qualify for premium assistance were vulnerable to the premium increases, prompting the vast majority of states to take a unique approach to shield those consumers from higher rates.
Since the cost-sharing subsidies were only offered for silver-level plans, most states restricted the premium increases to silver plans.
Because premium subsidies are calculated according to silver plans, which are the most popular, the result was disproportionately lower premiums for some less generous bronze plans and more expensive gold plans.
Congress recently enacted legislation protecting states' ability to "silver-load," as the practice is known, after the Centers for Medicare and Medicaid Services indicated it might ban the technique.
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