If a person's income is below 250% FPL, then there is cost sharing subsidy on top of the premium subsidy. The fed government is paying for the premium subsidy, but who's paying for the cost sharing subsidy?
For the insurers, there is no difference between the premium they receive from a person making 500% FPL and a person making 150% FPL, because the fed government subsidies the premium for the person making 150% FPL. But for the same plan, the person making 150% FPL has much lower deductible and out-of-pocket maximum, a silver plan can be as good as or better than a gold plan, so the premium should theoretically be higher. Does the fed government pick up the tab by paying more to the insurer on top of the premium subsidy? Or does the insurer need to eat the cost themselves. If the latter is true, I would imagine that insurers will try hard in finding every way possible to deny issuing a policy to those making less then 250% FPL.
For the insurers, there is no difference between the premium they receive from a person making 500% FPL and a person making 150% FPL, because the fed government subsidies the premium for the person making 150% FPL. But for the same plan, the person making 150% FPL has much lower deductible and out-of-pocket maximum, a silver plan can be as good as or better than a gold plan, so the premium should theoretically be higher. Does the fed government pick up the tab by paying more to the insurer on top of the premium subsidy? Or does the insurer need to eat the cost themselves. If the latter is true, I would imagine that insurers will try hard in finding every way possible to deny issuing a policy to those making less then 250% FPL.