Casey Mulligan has once again left me baffled by the economic analysis in his Economix blogpost. If I'm understanding him correctly he is saying that the deductibles for insurance provided through the exchanges in 2015 should be allowed to rise by 40 percent, based on a rise of this amount in the average premium of non-employer provided insurance policies in 2014 compared with 2013. This is based on the provision of the law that deductibles and other adjustable payments should rise in step with medical inflation.
However as Mulligan points out at length, the 40 percent rise in the cost of the average premium in 2014 was not due to medical inflation but rather due to the fact that policies being issued in 2014 under the provisions of the ACA were more comprehensive than the policies being issued in 2013. Since the insurers priced these benefits into the premiums they charged in 2014, and this was also priced into the original schedule of deductibles and subsidies, why would we expect these costs to rise by 40 percent in 2015 relative to 2014.
Based on this logic, the Department of Health and Human Services has set the target increase for a variety of indexed measures in the ACA at 4.2 percent, its calculation of the overall rate of increase in per capita health care costs. It's not clear where Mulligan sees a problem here. Perhaps he is a better lawyer than me and believes the law requires that these targted payments in future years should rise based on the one time increase in 2014, but it is certainly hard to see any economic logic behind this view. In other words, if there is a scandal in having the targeted payments in the ACA rise in step with health care costs, it's hard to see what it is.
Addendum: An earlier version wrongly said that Mullligan was referring to insurance prices.