To some, many of the new bronze-level health plans sold in public exchanges are de facto catastrophic plans. Others say, "Not so," as young people especially need more low-premium plans.
Just as new Health and Human Services Secretary Sylvia Mathews Burwell takes the reins of Affordable Care Act implementation, insurance advocates are looking to tweak the law to make tax credit subsidies available to those who purchases catastrophic plans.
Available only to Americans under 30 -- without tax credits -- the ACA-approved catastrophic plans accounted for only 2 percent of the total 8 million public exchange enrollees for 2014.
But there remains large demand among the young and healthy for low premium plans that offer protection from financial calamity, according to America's Health Insurance Plans.
As part of a suite of new ideas, AHIP is lobbying Congress to make ACA tax credits available to consumers buying catastrophic plans, which have deductibles limited to $6,400 for self-only coverage and $12,800 for family coverage and actuarial values equivalent to bronze-level plans.
AHIP has in mind a catastrophic plan with an actuarial value just below the bronze plans' 60 percent but still including all essential health benefits, free preventive services and no lifetime benefit limits.
"We know that affordability, stability, and accessibility are top of mind for consumers when it comes to their health care," AHIP President and CEO Karen Ignagni said in a media release.
"These solutions demonstrate health plans' ongoing efforts to advance these key priorities, and we intend to work with all stakeholders to provide consumers with greater peace of mind in the new marketplace," she said.
The change would require an act of Congress and would likely draw the ire of consumer advocacy groups. The cost-sharing in bronze plans, which have a deductible limit of $5,081 for single coverage, can already be cost-prohibitive for low-income consumers, some argue.
But AHIP sees a need for more catastrophic options, in large part for young people saddled with large student loans, working freelance or multiple jobs and some of them perhaps skeptical of the need for insurance with generous benefits they may not use for some time.
Better they enroll in a high-deductible plan -- protecting themselves from costs above $6,000 while also supporting the greater risk pool -- then go uninsured, the group argues.
AHIP is hoping to convince Congress to make other tweaks to the ACA, including a proposed 30-day transition period for individuals to be able to see their physicians at in-network prices if they switch insurers or if their physicians stop participating in their plan's network.