Silver appears to be the most popular metal-rated coverage among standard benefit levels in HIX plans thus far. But what if there were another option for prospective enrollees other than bronze, silver, gold or platinum — one that offered baseline coverage to help ease the transition for individuals who are reluctant to sign up?

The idea surfaced during a recent C-SPAN interview given by America’s Health Insurance Plans President and CEO Karen Ignagni, who made the suggestion to create a lower-cost tier that would help ensure that healthier individuals are part of the risk pool in public exchanges.

The issue arose when Ignagni was asked what fixes she’d like to see Congress make to the Affordable Care Act. One was to address the more than 2% premium tax, which she warned will rise by 40% next year and add to the cost of insurance products, including Medicare Advantage and Medicaid plans.

Ignagni also raised the intriguing idea of adding a lower cost tier whose benefits aren’t as comprehensive as a way of helping ease the transition from pre- to post-health care reform plans.

“The old market had very high deductibles,” she said. “That’s what people preferred to buy because they wanted to keep their premiums low.” The trouble is that a giant step up from 10 categories of essential health benefits coverage under the ACA “is a bridge too far for some people,” Ignagni said of consumer reaction. 

“I would create a lower tier so that people could gradually get into the program,” she continued, “so that they could be part of the risk pool so we don’t hold the healthier people outside so the process could be working the way it was designed – so we get the healthy and the sick.”

Gary Claxton, a vice president of the Kaiser Family Foundation, recently quipped in a Reuters report that there have been calls for a “lead” level plan that would drop down the 60% bronze coverage to just 50%.

The notion of introducing a cheaper tier could be seen almost as the HIX equivalent of the mini-med plan concept, which ACA architects have sought to significantly curtail because of its bare-bones approach to coverage. The U.S. Department of Health and Human Services has granted temporary waivers to these plans to prevent coverage gaps as well as built in consumer protections that alert plan participants about restrictive coverage and low annual limits. 

Ignagni cautioned against making assumptions that tie enrollment in a lower-tier plan to demographics, saying it wouldn’t necessarily draw only healthy individuals considering that 2014 HIX enrollees have favored the silver-plated plans over lower-cost bronze coverage. “They point is that people are choosing, and what I would do is give people more choices,” she explained. “Human nature suggests that people like that; they’re in control if they have more choices.”

Ignagni’s suggestion caught the attention of Julie Rovner, a health policy correspondent for National Public Radio who was one of two journalists conducting the C-SPAN interview. “There were a lot of complaints last year from people saying they had higher deductible plans with fewer benefits and that they wanted to continue in those plans and perhaps there should be an option for people to do that,” she commented afterward. Such a plan represents “a fundamental shift” in the notion of health care reform providing everyone comprehensive benefits, she added.

Shutan is a Los Angeles freelance writer.

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