In the ACA, Congress chose market-based cost controls over measures that are common internationally, such as global budgets. Mandating coverage while requiring affordable premiums without enacting other cost-control mechanisms almost inevitably gives rise to increased cost sharing as the simplest mechanism for reducing premiums. The ACA is therefore expected to cause a “seismic shift” in HDHP enrollment. Small employers newly required to purchase employees’ insurance may well choose HDHPs as the least expensive coverage option. Larger employers might adopt HDHPs to achieve ACA-regulated premium levels and avoid the 2018 “Cadillac tax.”
–J. Frank Wharam, Dennis Ross-Degnan, and Meredith Rosenthal, the New England Journal of Medicine
