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j   Congressional Budget Office
       Cost Estimate


May 23, 2019


By Fiscal Year, Milions of Dollars 2019             20192024             2019-2029
Direct Spending (Outlays)             0                   0                    0


Revenues

Deficit Effect


0

0


0

0


0

0


S. 1378 would repeal the multi-state plan program established by Section 1334 of the
Affordable Care Act (ACA). Section 1334 requires the Office of Personnel Management
(OPM) to contract with health insurers to offer multi-state plan (MSP) insurance options on
each exchange in each state. Under current law, the plans generally must meet the various
insurance requirements under the ACA and are available to eligible individuals and small
business. The repeal would be effective January 1, 2020. Within 60 days of enactment, the
bill also would require OPM to brief the Senate Committee on Homeland Security and
Governmental Affairs; the Senate Committee on Health, Education, Labor, and Pensions; the
House Committee on Oversight and Reform; and the House Committee on Energy and
Commerce on OPM's efforts to wind-down the program.

OPM reports that in 2019 Arkansas Blue Cross and Blue Shield is the only insurer to offer
MSPs, and such plans are only available in Arkansas. Premium data from the Department of
Health and Human Services (HHS) show that MSPs are not the lowest cost or second-lowest
cost silver plans in any rating areas where they are offered. Because premiums for silver
plans with the second-lowest-cost are the basis for calculating federal subsidies for health
insurance purchased through the marketplaces, eliminating plans with premiums higher than
those second-lowest cost plans would not affect subsidies and thus the bill's enactment
would not affect the federal budget.
The CBO contact for this estimate is Kevin McNellis. The estimate was approved by
Leo Lex, Deputy Assistant Director for Budget Analysis.


                See also CBO's Cost Estimates Explained, www cbo.gov/publicationi54437;
  How CBO Prepares Cost Estimates, www.cbo.gov/publication/53519; and Glossary, www cbo~govipublication/42904.

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