Though some people feel that the law is unfair and that they don't receive the tax credits as high as in other areas, the ACA exists to ensure that "people at certain income levels pay no more than a set share of income to buy the midlevel 'benchmark' health plan where they live," Snowbeck and Webster write. Some variation in price disappeared, though, because insurance companies can no longer refuse to cover people who have pre-existing health conditions, said Jonathan Gruber, a Massachusetts Institute of Technology economist who helped craft the reform law.
Sometimes the tax-credit system actually allows people in higher-cost cities to pay less than those from lower-cost areas. "Assessing which consumers wind up with the 'better deals' can be complicated, policy experts say, because the lowest-cost silver plans available in different regions likely have different coverage details, such as deductibles and networks of doctors and hospitals," Snowbeck and Webster write. Though some of argued that the new system doesn't offer incentives for regions that more effectively provide health care, Cox said "Insurers still have a financial incentive to keep premiums low to attract enrollees, particularly young enrollees who might not be tax-credit eligible." (Read more)