Uprate premium inputs by premium series, not CMS out-of-pocket spending

changelog.d/premium-inputs-cms-uprating.changed.md

@@ -0,0 +1 @@
+Uprate premium inputs by premium series instead of CMS out-of-pocket spending per capita, which excludes premiums: reported and other health insurance premiums follow CMS's employer-sponsored insurance premium per enrollee (the series pre-tax premiums follow), directly supplied premiums follow a new CMS direct purchase premium per enrollee series, long-term care premiums follow a new CPI-U medical care series (BLS and CBO), and reported Medicare Part B premiums follow a new Part B standard premium series (Medicare Trustees Report).

docs-quarto/methodology/spm-poverty.qmd

@@ -41,16 +41,16 @@ Benefit amounts are computed from statute for the eligible population. Whether a
 
 [`spm_unit_medical_out_of_pocket_expenses`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/variables/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.py) is health insurance premiums plus non-premium medical spending.
 
-- Premiums the model computes from rules: Medicare Part A and Part B (including IRMAA), the Part D IRMAA surcharge, CHIP premiums in the states with encoded schedules, and Marketplace net premiums after the premium tax credit. Medicaid expansion premium schedules for Indiana, Michigan and Montana are encoded for reform analysis but are zero in the 2024 and 2025 baselines. Other reported premiums, including the employee share of employer plans, stay as reported in the survey.
-- Non-premium spending ([`other_medical_expenses`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/variables/household/expense/health/other_medical_expenses.py) and over-the-counter health expenses) is imported from the survey and uprated with CMS per-capita spending. No rule changes it.
+- Premiums the model computes from rules: Medicare Part A and Part B (including IRMAA), the Part D IRMAA surcharge, CHIP premiums in the states with encoded schedules, and Marketplace net premiums after the premium tax credit. Medicaid expansion premium schedules for Indiana, Michigan and Montana are encoded for reform analysis but are zero in the 2024 and 2025 baselines. Other reported premiums, including the employee share of employer plans, stay as reported in the survey and are uprated with CMS's employer-sponsored insurance premium per enrollee.
+- Non-premium spending ([`other_medical_expenses`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/variables/household/expense/health/other_medical_expenses.py) and over-the-counter health expenses) is imported from the survey and uprated with CMS per-capita out-of-pocket spending. No rule changes it.
 
 The [MOOP decomposition page](moop-decomposition.qmd) records the design and the remaining double-count risks.
 
 ## Population
 
 Population results use the Microcosm US dataset. The current default is Build P: 57,240 Current Population Survey Annual Social and Economic Supplement households with 166,321 people, whose weights are fitted to 5,659 administrative and demographic targets (IRS Statistics of Income by state and by income, Census population estimates by age, sex and state, CMS Medicaid and Marketplace enrollment, USDA SNAP participation and benefits, SSA SSI, TANF, state tax collections and BEA national accounts). Poverty rates are never a target. That is a rule of the calibration, not an accident: a model whose weights were fitted to survey-based poverty rates could not be checked against them.
 
-2025 values are the 2024 survey values carried forward by the model's uprating parameters: each uprated input grows by the ratio of its uprating series between the two years. Household weights grow with total population, so an input that follows a national total grows by that total divided by population ([`per_capita_uprating.py`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/tools/per_capita_uprating.py)); its weighted total then tracks the national total. The main income sources (employment, self-employment and partnership income, Social Security, pensions and retirement account distributions, capital gains, dividends, interest, rental and farm income, alimony received and paid, and unemployment compensation) follow [IRS Statistics of Income series](https://github.com/PolicyEngine/policyengine-us/tree/main/policyengine_us/parameters/calibration/gov/irs/soi). Each series holds IRS totals through its last recorded year and a CBO projection extends it from there, so the growth applied from 2024 to 2025 is CBO's, per capita. These health inputs follow [CMS's projection of per-capita out-of-pocket health spending](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/hhs/cms/moop_per_capita.yaml), which is already a per-person series: the other medical expenses, over-the-counter health expenses and other health insurance premiums that enter SPM resources; physician services, inpatient, outpatient, emergency room, urgent care, ambulance, imaging, lab and prescription expenses; and health insurance premiums in total, long-term and excluding Medicare Part B, and reported Medicare Part B premiums. These expenses, assets and debts follow [CPI-U](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/bls/cpi/cpi_u.yaml): rent, child care and other care costs, child support paid and received, utilities, phone and broadband, tuition, homeowners insurance and association fees, transportation costs, real estate taxes and the energy subsidy; the person-level home mortgage interest input, student loan interest, investment interest expense and vehicle loan interest; bank account, stock and bond assets and the value of the primary residence; the value, equity and debt of business assets, rental property and other real estate; and vehicle equity and debt, the auto loan balance and net worth. These pay and wage-replacement inputs follow the IRS employment income series: hourly wages, tips, overtime premiums, military and government pay, the W-2 wages of qualified businesses, desired 401(k), 403(b) and IRA contributions, workers' compensation and disability benefits. Desired self-employed pension contributions follow the IRS self-employment income series. Health savings account payroll contributions, which the Microcosm data do not fill, follow [the HSA contribution limit for family coverage](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/irs/gross_income/health_savings_account_contributions/limit/family.yaml) in 26 U.S.C. 223(b)(2). Section 223(g) indexes that limit to chained CPI-U, and after the IRS's last published year the model computes it from the statute, so a contribution at the limit stays at the limit. Employer-sponsored insurance premiums and pre-tax health insurance premiums, the employer's and the employee's shares of employer plans, follow [CMS's employer-sponsored insurance premium per enrollee](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/hhs/cms/esi_premium_per_enrollee.yaml), also a per-person series, which CMS projects to 2034; it grows at its 2033 to 2034 rate from 2035 to 2100 and holds the 2100 value after that. Veterans' benefits follow the [Social Security cost-of-living index](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/ssa/uprating.yaml). Every other uprated dollar input follows [CBO's projection of total adjusted gross income](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/cbo/income_by_source.yaml), the default that [`default_uprating.py`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/tools/default_uprating.py) assigns, per capita like every national total. Inputs on the default include tax units' first and second home mortgage interest and balances, home equity, personal property, SPM unit assets, mortgage payments, charitable donations, casualty losses, educator expenses, tax preparation fees, energy efficiency and clean energy property expenditures, state unemployment insurance wage and earnings inputs, employer payroll totals and local earnings and wage tax inputs. Household weights follow the model's [total population series](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/census/populations/total.yaml), which takes its values from CBO's demographic outlook; person and SPM unit weights read the household weight. Inputs without an uprating parameter (ages, take-up indicators, tenure, geography) carry over unchanged, so household composition is held at its 2024 state. The population is projected, not resampled.
+2025 values are the 2024 survey values carried forward by the model's uprating parameters: each uprated input grows by the ratio of its uprating series between the two years. Household weights grow with total population, so an input that follows a national total grows by that total divided by population ([`per_capita_uprating.py`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/tools/per_capita_uprating.py)); its weighted total then tracks the national total. The main income sources (employment, self-employment and partnership income, Social Security, pensions and retirement account distributions, capital gains, dividends, interest, rental and farm income, alimony received and paid, and unemployment compensation) follow [IRS Statistics of Income series](https://github.com/PolicyEngine/policyengine-us/tree/main/policyengine_us/parameters/calibration/gov/irs/soi). Each series holds IRS totals through its last recorded year and a CBO projection extends it from there, so the growth applied from 2024 to 2025 is CBO's, per capita. These health inputs follow [CMS's projection of per-capita out-of-pocket health spending](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/hhs/cms/moop_per_capita.yaml), which is already a per-person series: the other medical expenses and over-the-counter health expenses that enter SPM resources; and physician services, inpatient, outpatient, emergency room, urgent care, ambulance, imaging, lab and prescription expenses. CMS counts premiums outside out-of-pocket spending, so premium inputs follow premium series instead, each a per-person series that grows at its last published one-year rate to 2100 and holds the 2100 value after that. These expenses, assets and debts follow [CPI-U](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/bls/cpi/cpi_u.yaml): rent, child care and other care costs, child support paid and received, utilities, phone and broadband, tuition, homeowners insurance and association fees, transportation costs, real estate taxes and the energy subsidy; the person-level home mortgage interest input, student loan interest, investment interest expense and vehicle loan interest; bank account, stock and bond assets and the value of the primary residence; the value, equity and debt of business assets, rental property and other real estate; and vehicle equity and debt, the auto loan balance and net worth. These pay and wage-replacement inputs follow the IRS employment income series: hourly wages, tips, overtime premiums, military and government pay, the W-2 wages of qualified businesses, desired 401(k), 403(b) and IRA contributions, workers' compensation and disability benefits. Desired self-employed pension contributions follow the IRS self-employment income series. Health savings account payroll contributions, which the Microcosm data do not fill, follow [the HSA contribution limit for family coverage](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/irs/gross_income/health_savings_account_contributions/limit/family.yaml) in 26 U.S.C. 223(b)(2). Section 223(g) indexes that limit to chained CPI-U, and after the IRS's last published year the model computes it from the statute, so a contribution at the limit stays at the limit. Employer-sponsored insurance premiums, pre-tax health insurance premiums and the premiums people report paying (health insurance premiums excluding Medicare Part B, and the other health insurance premiums that enter SPM resources) follow [CMS's employer-sponsored insurance premium per enrollee](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/hhs/cms/esi_premium_per_enrollee.yaml), which CMS projects to 2034. These are the employer's share of employer plans, the employee's share paid through payroll, and the premiums survey respondents report, most of which people with employer coverage pay; with one series for all three, a premium the data move from the reported inputs to the pre-tax input keeps growing the same way. Health insurance premiums supplied directly, which the survey data hold only for self-employed people under 65 without employer coverage, follow the closest CMS series for that group, [CMS's direct purchase premium per enrollee](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/hhs/cms/direct_purchase_premium_per_enrollee.yaml) (individually bought plans, Marketplace plans and Medigap), also projected to 2034. Long-term care insurance premiums, which no dataset fills and for which CMS's health expenditure projections have no premium series, follow [the medical care component of CPI-U](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/bls/cpi/cpi_u_medical_care.yaml) by calendar year, which CBO projects to 2036. It stands in for the index that sets the deductible limits on those premiums, the chained CPI-U medical care component for August of the preceding year (26 U.S.C. 213(d)(10)(B)), which the CBO and CMS projections do not provide. Reported Medicare Part B premiums follow [the Part B standard premium](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/hhs/cms/medicare_part_b_premium_per_enrollee.yaml), which the Medicare Trustees project to 2035; within an income tier, a premium with its income-related adjustment is a fixed multiple of the standard premium before rounding. The series is a growth proxy, not a forecast of each person's premium: hold-harmless limits and Medicare Advantage premium reductions move some premiums differently. Veterans' benefits follow the [Social Security cost-of-living index](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/gov/ssa/uprating.yaml). Every other uprated dollar input follows [CBO's projection of total adjusted gross income](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/cbo/income_by_source.yaml), the default that [`default_uprating.py`](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/tools/default_uprating.py) assigns, per capita like every national total. Inputs on the default include tax units' first and second home mortgage interest and balances, home equity, personal property, SPM unit assets, mortgage payments, charitable donations, casualty losses, educator expenses, tax preparation fees, energy efficiency and clean energy property expenditures, state unemployment insurance wage and earnings inputs, employer payroll totals and local earnings and wage tax inputs. Household weights follow the model's [total population series](https://github.com/PolicyEngine/policyengine-us/blob/main/policyengine_us/parameters/calibration/gov/census/populations/total.yaml), which takes its values from CBO's demographic outlook; person and SPM unit weights read the household weight. Inputs without an uprating parameter (ages, take-up indicators, tenure, geography) carry over unchanged, so household composition is held at its 2024 state. The population is projected, not resampled.
 
 ## What the model does not do
 

policyengine_us/parameters/calibration/gov/hhs/cms/direct_purchase_premium_per_enrollee.yaml

@@ -0,0 +1,50 @@
+description: The Centers for Medicare and Medicaid Services (CMS) reports and projects this direct purchase insurance spending per enrollee, which is the premium per covered person for private plans bought outside an employer, before any premium tax credit.
+metadata:
+  unit: currency-USD
+  label: CMS direct purchase insurance premium per enrollee
+  reference:
+  # Table17 Health Insurance Enrollment and Enrollment Growth Rates,
+  # "Spending per Enrollee ($)", "Direct Purchase" row: direct purchase
+  # spending divided by direct purchase enrollment. Its footnote 2: direct
+  # purchase "includes those with Medicare supplemental coverage and
+  # individually-purchased plans, including coverage purchased through the
+  # Marketplaces." ZIP Last-Modified 2026-09-03, sha256
+  # 264f822618a5e1829138aea57cc6c8bf45bbaf072a72898fef5547f7ece6cd70,
+  # retrieved 2026-10-11 from
+  # https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/projected
+  - title: CMS National Health Expenditure Projections 2025-2034, Table 17
+    href: https://www.cms.gov/files/zip/nhe-projections-tables.zip
+  # Direct purchase "includes premiums paid by individuals for policies that
+  # are not available through an employer or a union-based plan. This
+  # includes Medigap policies, Marketplace plans, and other directly purchased
+  # health insurance."
+  - title: "CMS National Health Expenditure Accounts: Methodology Paper, 2024"
+    href: https://www.cms.gov/files/document/definitions-sources-and-methods.pdf#page=29
+values:
+  # Historical.
+  2013-01-01: 2_263
+  2014-01-01: 3_134
+  2015-01-01: 3_454
+  2016-01-01: 3_695
+  2017-01-01: 4_175
+  2018-01-01: 4_831
+  2019-01-01: 4_812
+  2020-01-01: 4_791
+  2021-01-01: 4_979
+  2022-01-01: 5_149
+  2023-01-01: 5_458
+  2024-01-01: 5_871
+  # Projections.
+  2025-01-01: 5_994
+  2026-01-01: 6_969
+  2027-01-01: 7_174
+  2028-01-01: 7_456
+  2029-01-01: 7_752
+  2030-01-01: 8_115
+  2031-01-01: 8_364
+  2032-01-01: 8_743
+  2033-01-01: 9_158
+  2034-01-01: 9_589
+  # 2035 to 2100 grow at the 2033-2034 rate (9_589 / 9_158, 4.7% a year)
+  # and later years hold the 2100 value; see set_all_uprating_parameters in
+  # uprating_extensions.py.

policyengine_us/parameters/calibration/gov/hhs/cms/medicare_part_b_premium_per_enrollee.yaml

@@ -0,0 +1,45 @@
+description: The Centers for Medicare and Medicaid Services (CMS) sets, and the Medicare Trustees project, this standard monthly Medicare Part B premium per enrollee.
+metadata:
+  unit: currency-USD
+  period: month
+  label: Medicare Part B standard monthly premium per enrollee
+  reference:
+  # Table III.C2, "Standard Part B Monthly Premium Rates, Actuarial Rates, and
+  # Premium Rates as a Percentage of Part B Cost" (file pages 89-90), for
+  # 2013-2026; Table V.E2, "SMI Cost-Sharing and Premium Amounts" (file page
+  # 213), intermediate estimates for 2027-2035. Report transmitted
+  # 2026-06-09, retrieved 2026-10-11, sha256
+  # ffa56b9137006872300b0346149eae1613d09a172b6ba118aad48e66dfc48fa8.
+  - title: "2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables III.C2 and V.E2 #page 89-90,213"
+    href: https://www.cms.gov/oact/tr/2026#page=89
+  - title: 2026 Medicare Parts A & B Premiums and Deductibles
+    href: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
+values:
+  # Historical.
+  2013-01-01: 104.9
+  2014-01-01: 104.9
+  2015-01-01: 104.9
+  2016-01-01: 121.8
+  2017-01-01: 134
+  2018-01-01: 134
+  2019-01-01: 135.5
+  2020-01-01: 144.6
+  2021-01-01: 148.5
+  2022-01-01: 170.1
+  2023-01-01: 164.9
+  2024-01-01: 174.7
+  2025-01-01: 185
+  2026-01-01: 202.9
+  # Trustees' intermediate estimates.
+  2027-01-01: 209.5
+  2028-01-01: 224.5
+  2029-01-01: 238.5
+  2030-01-01: 255.5
+  2031-01-01: 272.1
+  2032-01-01: 290.2
+  2033-01-01: 313.6
+  2034-01-01: 338.5
+  2035-01-01: 360.6
+  # 2036 to 2100 grow at the 2034-2035 rate (360.6 / 338.5, 6.5% a year) and
+  # later years hold the 2100 value; see set_all_uprating_parameters in
+  # uprating_extensions.py.