Still Seeking Clarity on Private Score

I am still seeking to better understand the assumptions of the private score of the health policy proposal put forth by Republican Senators Burr, Coburn and Hatch. Yesterday, around 11:20am EST, I emailed the following addresses at the organization that put out the private score of the PCARE proposal, Center for Health and Economy ( and seeking more information. I have still not gotten a reply.

I traded emails with Steve Parente (I am not putting out his email response because it was rushed and I didn’t tell him I was going to do that; I will publish verbatim any clarifications that he and/or Health and Economy want to offer), whose peer reviewed work is the basis of the model. He has offered to talk by phone but we haven’t worked that out yet. Here is pdf of his HSR paper Parente.hesr_12036 that models ACA uptake after SCOTUS case using the underlying model used in the private score. Steve told me the out of pocket modelling of PCARE follows the trends shown in this Health Care Cost Institute report. He did say that that the biggest impact of modelling the changes of PCARE as compared to the ACA same from moving away from a maximum 3:1 age banding (unclear if they modeled 5:1, or no limit), and “relaxing” the OOP cost limits in the ACA. He said that the out-of-pocket cost assumptions were that trends would stay pre-ACA (meaning slowing lots) as outlined in this report.

Finally (and crucially for understanding this plan), there has been a change in the way the tax treatment of employer sponsored insurance modification is described by the Senators. It is unclear if this is simply a change in the language used to describe something that is difficult to do clearly, or if they have changed their proposal  (screen shot of language difference from TPM):

ScreenHunter_01 Jan. 31 09.30

Some of the questions that need to be answered to understand the private score:

  • Does the private score represent the current proposal by the Senators to alter the tax treatment of ESI? Did the language used to describe it only change, or the policy itself? What limitation on ESI does the private score include (what is the dollar amount above which is subjected to taxes)?
  • What was assumed about benefits in the modelling exercise? Was it a less generous package than the mandated ACA benefits? If yes, in what ways?
  • Did the analysis assume a 5:1 max difference allowed for premiums by age (as compared to 3:1 in ACA)?
  • Did the analysis impose a maximum out of pocket spending cap on plans? Can you please provide the out of pocket spending distribution in your analysis, by age?
  • Will you provide an age-based distribution of the insured/uninsured as compared to the ACA?
  • Loren Adler raises a series of important questions on twitter; some relate to seeming errors, other to desire for clarity
  • Note: the private score compares PCARE to their own scoring of ACA. This does not bother me as it shows the impact of different policies given the same uptake model. Of course it is important to understand how CBOs model differs from this one.

Anyone with info on what was done, let me know. I will publish it verbatim.

cross posted at freeforall

Author: Don Taylor

Don Taylor is an Associate Professor of Public Policy at Duke University, where his teaching and research focuses on health policy, with a focus on Medicare generally, and on hospice and palliative care, specifically. He increasingly works at the intersection of health policy and the federal budget. Past research topics have included health workforce and the economics of smoking. He began blogging in June 2009 and wrote columns on health reform for the Raleigh, (N.C.) News and Observer. He blogged at The Incidental Economist from March 2011 to March 2012. He is the author of a book, Balancing the Budget is a Progressive Priority that will be published by Springer in May 2012.