Add ACA cost-sharing reduction actuarial values

changelog.d/added/8188.md

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+Add selected Marketplace plan categories and ACA cost-sharing reduction actuarial value variables.

policyengine_us/parameters/gov/aca/csr/actuarial_value/highest.yaml

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+description: The Affordable Care Act sets this actuarial value for the highest ordinary silver cost-sharing reduction plan variation.
+values:
+  2014-01-01: 0.94
+metadata:
+  unit: /1
+  period: year
+  label: ACA CSR highest silver plan actuarial value
+  reference:
+    - title: 45 CFR § 156.420(a)(1)(ii) - Plan variations
+      href: https://www.law.cornell.edu/cfr/text/45/156.420#a_1_ii

policyengine_us/parameters/gov/aca/csr/actuarial_value/lowest.yaml

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+description: The Affordable Care Act sets this actuarial value for the lowest ordinary silver cost-sharing reduction plan variation.
+values:
+  2014-01-01: 0.73
+metadata:
+  unit: /1
+  period: year
+  label: ACA CSR lowest silver plan actuarial value
+  reference:
+    - title: 45 CFR § 156.420(a)(3)(ii) - Plan variations
+      href: https://www.law.cornell.edu/cfr/text/45/156.420#a_3_ii

policyengine_us/parameters/gov/aca/csr/actuarial_value/middle.yaml

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+description: The Affordable Care Act sets this actuarial value for the middle ordinary silver cost-sharing reduction plan variation.
+values:
+  2014-01-01: 0.87
+metadata:
+  unit: /1
+  period: year
+  label: ACA CSR middle silver plan actuarial value
+  reference:
+    - title: 45 CFR § 156.420(a)(2)(ii) - Plan variations
+      href: https://www.law.cornell.edu/cfr/text/45/156.420#a_2_ii

policyengine_us/parameters/gov/aca/csr/income_threshold/highest_av_maximum.yaml

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+description: The Affordable Care Act sets this maximum household income threshold for the highest ordinary cost-sharing reduction actuarial value.
+values:
+  2014-01-01: 1.5
+metadata:
+  unit: /1
+  period: year
+  label: ACA CSR highest actuarial value income threshold
+  reference:
+    - title: 45 CFR § 155.305(g)(2)(i) - Eligibility standards
+      href: https://www.law.cornell.edu/cfr/text/45/155.305#g_2_i

policyengine_us/parameters/gov/aca/csr/income_threshold/maximum.yaml

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+description: The Affordable Care Act sets this maximum household income threshold for ordinary income-based cost-sharing reductions.
+values:
+  2014-01-01: 2.5
+metadata:
+  unit: /1
+  period: year
+  label: ACA CSR maximum income threshold
+  reference:
+    - title: 45 CFR § 155.305(g)(1)(i)(C) - Eligibility standards
+      href: https://www.law.cornell.edu/cfr/text/45/155.305#g_1_i_C

policyengine_us/parameters/gov/aca/csr/income_threshold/middle_av_maximum.yaml

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+description: The Affordable Care Act sets this maximum household income threshold for the middle ordinary cost-sharing reduction actuarial value.
+values:
+  2014-01-01: 2
+metadata:
+  unit: /1
+  period: year
+  label: ACA CSR middle actuarial value income threshold
+  reference:
+    - title: 45 CFR § 155.305(g)(2)(ii) - Eligibility standards
+      href: https://www.law.cornell.edu/cfr/text/45/155.305#g_2_ii

policyengine_us/parameters/gov/aca/metal_actuarial_value/bronze.yaml

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+description: The Affordable Care Act sets this actuarial value for bronze Marketplace plans.
+values:
+  2014-01-01: 0.6
+metadata:
+  unit: /1
+  period: year
+  label: ACA bronze plan actuarial value
+  reference:
+    - title: 45 CFR § 156.140(b)(1) - Levels of coverage
+      href: https://www.law.cornell.edu/cfr/text/45/156.140#b_1

policyengine_us/parameters/gov/aca/metal_actuarial_value/silver.yaml

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+description: The Affordable Care Act sets this actuarial value for silver Marketplace plans.
+values:
+  2014-01-01: 0.7
+metadata:
+  unit: /1
+  period: year
+  label: ACA silver plan actuarial value
+  reference:
+    - title: 45 CFR § 156.140(b)(2) - Levels of coverage
+      href: https://www.law.cornell.edu/cfr/text/45/156.140#b_2

policyengine_us/tests/policy/baseline/gov/aca/csr/marketplace_csr_category.yaml

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+- name: Case 1, silver enrollee at 125 percent FPL receives 94 percent AV CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 1.25
+    selected_marketplace_plan_category: SILVER
+  output:
+    person_receives_aca: true
+    marketplace_csr_eligible: true
+    marketplace_csr_category: AV_94
+    selected_marketplace_plan_actuarial_value: 0.7
+    marketplace_csr_actuarial_value: 0.94
+    marketplace_effective_actuarial_value: 0.94
+
+- name: Case 2, silver enrollee at 175 percent FPL receives 87 percent AV CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 1.75
+    selected_marketplace_plan_category: SILVER
+  output:
+    marketplace_csr_eligible: true
+    marketplace_csr_category: AV_87
+    marketplace_csr_actuarial_value: 0.87
+    marketplace_effective_actuarial_value: 0.87
+
+- name: Case 3, silver enrollee at 225 percent FPL receives 73 percent AV CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 2.25
+    selected_marketplace_plan_category: SILVER
+  output:
+    marketplace_csr_eligible: true
+    marketplace_csr_category: AV_73
+    marketplace_csr_actuarial_value: 0.73
+    marketplace_effective_actuarial_value: 0.73
+
+- name: Case 4, silver enrollee at 275 percent FPL receives no CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 2.75
+    selected_marketplace_plan_category: SILVER
+  output:
+    marketplace_csr_eligible: false
+    marketplace_csr_category: NONE
+    marketplace_csr_actuarial_value: 0
+    marketplace_effective_actuarial_value: 0.7
+
+- name: Case 5, APTC-eligible silver enrollee below 100 percent FPL receives 94 percent AV CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 0.75
+    selected_marketplace_plan_category: SILVER
+  output:
+    person_receives_aca: true
+    marketplace_csr_eligible: true
+    marketplace_csr_category: AV_94
+    marketplace_csr_actuarial_value: 0.94
+    marketplace_effective_actuarial_value: 0.94

policyengine_us/tests/policy/baseline/gov/aca/csr/marketplace_csr_eligible.yaml

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+- name: Case 1, bronze enrollee is ineligible for ordinary CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 1.25
+    selected_marketplace_plan_category: BRONZE
+  output:
+    marketplace_csr_eligible: false
+    marketplace_csr_category: NONE
+    selected_marketplace_plan_actuarial_value: 0.6
+    marketplace_csr_actuarial_value: 0
+    marketplace_effective_actuarial_value: 0.6
+
+- name: Case 2, silver enrollee without PTC eligibility is ineligible for CSR.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: false
+    aca_magi_fraction: 1.25
+    selected_marketplace_plan_category: SILVER
+  output:
+    person_receives_aca: false
+    marketplace_csr_eligible: false
+    marketplace_csr_category: NONE
+    selected_marketplace_plan_actuarial_value: 0.7
+    marketplace_csr_actuarial_value: 0
+    marketplace_effective_actuarial_value: 0.7

policyengine_us/tests/policy/baseline/gov/aca/csr/marketplace_effective_actuarial_value.yaml

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+- name: Case 1, CSR changes effective actuarial value but not Marketplace net premium.
+  absolute_error_margin: 0.001
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    aca_magi_fraction: 1.25
+    selected_marketplace_plan_category: SILVER
+    selected_marketplace_plan_premium_proxy: 5_000
+    used_aca_ptc: 3_000
+  output:
+    selected_marketplace_plan_actuarial_value: 0.7
+    marketplace_csr_category: AV_94
+    marketplace_effective_actuarial_value: 0.94
+    marketplace_net_premium: 2_000

policyengine_us/tests/policy/baseline/gov/aca/ptc/marketplace_net_premium.yaml

@@ -41,3 +41,17 @@
     selected_marketplace_plan_premium_proxy: 8_000
     used_aca_ptc: 0
     marketplace_net_premium: 8_000
+
+- name: Bronze selected plan net premium uses actual bronze premium.
+  absolute_error_margin: 0.01
+  period: 2026
+  input:
+    pays_aca_premium: true
+    selected_marketplace_plan_category: BRONZE
+    slcsp: 10_000
+    lcbp: 5_000
+    aca_ptc: 3_000
+  output:
+    selected_marketplace_plan_premium_proxy: 5_000
+    used_aca_ptc: 3_000
+    marketplace_net_premium: 2_000

policyengine_us/tests/policy/baseline/gov/aca/ptc/selected_marketplace_plan_premium_proxy.yaml

@@ -63,3 +63,26 @@
     pays_aca_premium: true
     is_aca_ptc_eligible: false
     selected_marketplace_plan_premium_proxy: 8_000
+
+- name: Case 6, bronze selected plan uses the lowest-cost bronze premium.
+  absolute_error_margin: 0.01
+  period: 2026
+  input:
+    pays_aca_premium: true
+    selected_marketplace_plan_category: BRONZE
+    slcsp: 10_000
+    lcbp: 6_500
+  output:
+    selected_marketplace_plan_premium_proxy: 6_500
+
+- name: Case 7, silver selected plan keeps the benchmark-ratio proxy.
+  absolute_error_margin: 0.01
+  period: 2026
+  input:
+    pays_aca_premium: true
+    selected_marketplace_plan_category: SILVER
+    slcsp: 10_000
+    lcbp: 6_500
+    selected_marketplace_plan_benchmark_ratio: 0.9
+  output:
+    selected_marketplace_plan_premium_proxy: 9_000

policyengine_us/tests/policy/baseline/gov/aca/ptc/used_aca_ptc.yaml

@@ -13,7 +13,7 @@
     used_aca_ptc: 200
     unused_aca_ptc: 0
 
-- name: Case 2, a bronze-like ratio leaves some ACA PTC unused.
+- name: Case 2, a lower-than-benchmark selected-plan ratio leaves some ACA PTC unused.
   absolute_error_margin: 0.01
   period: 2025
   input:
@@ -56,3 +56,21 @@
     selected_marketplace_plan_premium_proxy: 0
     used_aca_ptc: 0
     unused_aca_ptc: 200
+
+- name: Case 5, bronze selected plan uses actual bronze premium before applying PTC.
+  absolute_error_margin: 0.01
+  period: 2026
+  input:
+    is_aca_ptc_eligible: true
+    pays_aca_premium: true
+    selected_marketplace_plan_category: BRONZE
+    slcsp: 10_000
+    lcbp: 7_000
+    aca_magi: 20_000
+    aca_required_contribution_percentage: 0.04
+    tax_unit_is_filer: true
+  output:
+    aca_ptc: 9_200
+    selected_marketplace_plan_premium_proxy: 7_000
+    used_aca_ptc: 7_000
+    unused_aca_ptc: 2_200

policyengine_us/variables/gov/aca/csr/marketplace_csr_actuarial_value.py

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+from policyengine_us.model_api import *
+from policyengine_us.variables.gov.aca.csr.marketplace_csr_category import (
+    MarketplaceCSRCategory,
+)
+
+
+class marketplace_csr_actuarial_value(Variable):
+    value_type = float
+    entity = TaxUnit
+    label = "Marketplace cost-sharing reduction actuarial value"
+    unit = "/1"
+    definition_period = YEAR
+    reference = "https://www.law.cornell.edu/cfr/text/45/156.420#a"
+    defined_for = "marketplace_csr_eligible"
+
+    def formula(tax_unit, period, parameters):
+        category = tax_unit("marketplace_csr_category", period)
+        p = parameters(period).gov.aca.csr.actuarial_value
+        return select(
+            [
+                category == MarketplaceCSRCategory.AV_94,
+                category == MarketplaceCSRCategory.AV_87,
+                category == MarketplaceCSRCategory.AV_73,
+            ],
+            [p.highest, p.middle, p.lowest],
+        )

policyengine_us/variables/gov/aca/csr/marketplace_csr_category.py

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+from policyengine_us.model_api import *
+
+
+class MarketplaceCSRCategory(Enum):
+    NONE = "None"
+    AV_94 = "94 percent actuarial value"
+    AV_87 = "87 percent actuarial value"
+    AV_73 = "73 percent actuarial value"
+
+
+class marketplace_csr_category(Variable):
+    value_type = Enum
+    possible_values = MarketplaceCSRCategory
+    default_value = MarketplaceCSRCategory.NONE
+    entity = TaxUnit
+    label = "Marketplace cost-sharing reduction category"
+    definition_period = YEAR
+    reference = "https://www.law.cornell.edu/cfr/text/45/155.305#g_2"
+
+    def formula(tax_unit, period, parameters):
+        eligible = tax_unit("marketplace_csr_eligible", period)
+        magi_fraction = tax_unit("aca_magi_fraction", period)
+        p = parameters(period).gov.aca.csr.income_threshold
+        return select(
+            [
+                eligible & (magi_fraction <= p.highest_av_maximum),
+                eligible & (magi_fraction <= p.middle_av_maximum),
+                eligible & (magi_fraction <= p.maximum),
+            ],
+            [
+                MarketplaceCSRCategory.AV_94,
+                MarketplaceCSRCategory.AV_87,
+                MarketplaceCSRCategory.AV_73,
+            ],
+            default=MarketplaceCSRCategory.NONE,
+        )

policyengine_us/variables/gov/aca/csr/marketplace_csr_eligible.py

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+from policyengine_us.model_api import *
+from policyengine_us.variables.gov.aca.ptc.selected_marketplace_plan_category import (
+    MarketplacePlanCategory,
+)
+
+
+class marketplace_csr_eligible(Variable):
+    value_type = bool
+    entity = TaxUnit
+    label = "Tax unit is eligible for ordinary Marketplace cost-sharing reductions"
+    definition_period = YEAR
+    reference = "https://www.law.cornell.edu/cfr/text/45/155.305#g_1"
+
+    def formula(tax_unit, period, parameters):
+        person = tax_unit.members
+        receives_aca = tax_unit.sum(person("person_receives_aca", period)) > 0
+        category = tax_unit("selected_marketplace_plan_category", period)
+        silver_selected = category == MarketplacePlanCategory.SILVER
+        magi_fraction = tax_unit("aca_magi_fraction", period)
+        income_eligible = (
+            magi_fraction <= parameters(period).gov.aca.csr.income_threshold.maximum
+        )
+        return receives_aca & silver_selected & income_eligible

policyengine_us/variables/gov/aca/csr/marketplace_effective_actuarial_value.py

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+from policyengine_us.model_api import *
+
+
+class marketplace_effective_actuarial_value(Variable):
+    value_type = float
+    entity = TaxUnit
+    label = "Marketplace selected plan effective actuarial value"
+    unit = "/1"
+    definition_period = YEAR
+    reference = (
+        "https://www.law.cornell.edu/cfr/text/45/156.140#b",
+        "https://www.law.cornell.edu/cfr/text/45/156.420#a",
+    )
+
+    def formula(tax_unit, period, parameters):
+        selected_plan_av = tax_unit("selected_marketplace_plan_actuarial_value", period)
+        csr_av = tax_unit("marketplace_csr_actuarial_value", period)
+        return max_(selected_plan_av, csr_av)