Tag Archives: Cost Sharing Reduction Payments

HHS general counsel candidate vows to uphold ACA

Posted on by • Posted in Uncategorized • Tagged , , , , • Leave a comment

http://www.healthcaredive.com/news/hhs-general-counsel-candidate-vows-to-uphold-aca/448682/

Dive Brief:

  • During his nomination hearing in front of the Senate Finance Committee, Robert Charrow, who is a candidate for general counsel to the HHS, told senators he will resist changes to the Affordable Care Act (ACA) as long as it is law.
  • Charrow, who is an attorney with the international law firm of Greenberg Traurig, said he is a “firm believer in applying the law as written and passed by Congress. And if an action is inconsistent with the law, I will not approve it.”
  • The hearing, which also included the nominee for HHS assistant secretary for legislative affairs, Matthew Bassett, comes as the Government Accountability Office is looking into the use of official HHS communication channels to promote ACA repeal legislation.

Dive Insight:

While all of the Republican attempts to repeal the ACA have thus far failed, its supporters are still worried about threats, including from President Donald Trump, to sabotage the exchange markets. Trump said he wanted the ACA to “implode” and force senators to the negotiating table.

Charrow’s expressed willingness to defend the ACA could certainly come into play if he is approved. His boss would be HHS Secretary Tom Price, who is a vocal opponent of the ACA. If confirmed, Charrow may need to stand up to both his boss and the president.

The most immediate concern for the ACA is cost-sharing reduction (CSR) payments to payers, which Trump called a “bailout” for insurance companies. Payers say that without those subsidies they will need to raise rates or leave the ACA market. Because of the uncertainty, some payers have increased rates by more than 20% for 2018, dropped out of the market or cut down on their footprint.

The issue appears to be in limbo for now, with Congress out for its annual summer break and Trump beginning a 17-day vacation.

The Senate Finance Committee didn’t vote on the Charrow’s nomination, but we’ll soon know whether his statements were enough to quell Democratic fears.

Put Out The Fire Instead Of Burning Exchanges To The Ground: Extend Cost-Sharing Reduction Payments

Posted on by • Posted in Uncategorized • Tagged , , , • Leave a comment

https://www.forbes.com/sites/billfrist/2017/08/03/put-out-the-fire-instead-of-burning-exchanges-to-the-ground-extend-cost-sharing-reduction-payments/#46afbeb21bc9

Eight years ago, former Democratic Senator John Breaux and I wrote: “Given the acrimony that’s developed over efforts to reform our nation’s health insurance system, many Americans wonder whether true bipartisan agreement on health reform can ever be possible. In short, it can.” Back then, we watched contentious debate over what came to be known as Obamacare, and we never saw bipartisanship materialize. But in 2003 we both participated in creating and enacting the bipartisan Medicare Modernization Act that established the enormously successful Medicare Part D. Bipartisanship was alive then. We missed an opportunity eight years ago, but over the next few weeks we have another prime chance.

The healthcare (and health) of 11 million Americans hangs in the balance. This may sound like a small portion of America’s insured population, and as a percentage it is, but these are all people we know. The 6 percent of Americans who buy their insurance on the individual market are the small business people, contract workers, entrepreneurs, musicians, stay-at-home parents, job seekers, and the millions of Americans who can’t receive coverage through their employers. They are Republicans, Democrats, and Independents. Trump supporters and Hillary voters. And their ability to purchase coverage on the exchanges is in jeopardy, as mixed signals from Congress and the Administration have left insurers scrambling to decide whether to hike already costly premiums or pull out entirely—triggering the beginnings of collapse in some regions.

In my home state of Tennessee, two thirds of our 95 counties are projected to only have one insurer in 2018, while hundreds of counties nationwide at are risk of having no insurer offering individual coverage at all. Waiting for collapse may force Congress to the negotiating table as some have suggested, but it would hurt many innocent, poor, and sick people in the process.

The American people agree. A Kaiser Family Foundation surveyfound three-quarters of the public—including over half of Trump supporters—want the President and his administration to do what they can to make the Affordable Care Act work rather than trying to make it fail so they can replace it later.

My former colleague and current Chairman of the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP), Senator Lamar Alexander, said, “There are a number of issues with the American health care system, but if your house is on fire, you want to put out the fire, and the fire in this case is the individual health insurance market.”

The first step in extinguishing this fire is to extend the cost-sharing reduction (CSR) payments. These are the payments President Donald Trump has repeatedly threatened to cut off, creating serious uncertainty and instability in the markets. The Affordable Care Act requires insurance companies to offer discounts to lower-income consumers on the exchanges (those who make 100 – 250 percent of the Federal Poverty Level, or roughly $30,000 for an individual or $60,000 for a family of four). Thus would be a money-losing proposition for insurers without the federal reimbursement provided by the CSR payments. If insurers don’t get reimbursed through the CSRs, they will drop out of the market or raise rates significantly to cover their projected $7 billion loss. States that did not expand Medicaid—which are more likely to have Republican elected leadership and Trump voters—will be hardest hit, since they have a greater number of low-income individuals reliant on the individual market.

Some have termed the CSR payments “bailouts” for insurers, but the irony is that failure to extend them will actually cost taxpayers 23% more than the savings generated by their elimination. According to the Kaiser Family Foundation, the resulting premium hikes would trigger automatic increases in the size of premium tax credits paid by the federal government, totaling a net increase cost of $2.3 billion for fiscal year 2018.

Extending these payments not only makes sound fiscal sense, it will help millions of Americans maintain access to health care coverage and give Congress the breathing room necessary to craft meaningful reforms to the system that accounts for nearly one-fifth of our economy.

In the last few days, we have seen hopeful signs of bipartisanship returning to Washington, with the Senate HELP Committee announcing hearings in September with input from all committee members, to the bipartisan House Problem Solvers Caucus coming forward with a short-term plan for stabilization supported by over 40 Republicans and Democrats. We are seeing growing support for the use of waivers to establish reinsurance programs for high-cost, high-need individuals – as has been proposed in Alaska and Minnesota—and for a “stabilization fund” for states to be used in multiple ways including premium support or reinsurance. These are bipartisan concepts that appeal to both red and blue states and deserve serious debate in Congress. As Senator John McCain wisely said on the Senate floor last week, “The Obama administration and congressional Democrats shouldn’t have forced through Congress without any opposition support a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.” Any lasting, successful reform to our healthcare system depends on a bipartisan solution,and we must stabilize the markets now to give our Congress time to begin these negotiations in earnest.

Since last March I have co-chaired with former Senator Tom Daschle a bipartisan group of healthcare leaders at the Bipartisan Policy Center (BPC). This politically diverse group of five Republicans and five Democrats have consistently called for a two-year extension of the CSR payments. We reiterate that call again today. Time is of the essence. Right now, insurers are filing corrections to their 2018 plan rates and petitioning states to change their service areas. Final premium prices are due August 16, and by September 27 health insurers must sign the final marketplace participation contracts. Many insurers, with the uncertainty of whether CSR payments will continue, have initially filed two different pricing options. Without more certainty of extension, they will use the higher rates that are nearly double what they would be if the CSR payments were continued. Or worse, they may simply pull out altogether at the last minute if the payments are still in jeopardy when these deadlines hit (four major insurers—Anthem, Cigna, Health Care Service Corp and Molina Healthcare—have all said they are weighing pulling out).

At the BPC we have held numerous roundtables and listening sessions with insurers, providers, healthcare leaders, state policymakers, and those on the ground implementing care, and routinely the number one recommendation to stabilize markets in the short-term is to extend the CSR payments . The White House has indicated it plans to make a decision this week, and I urge President Trump to heed the advice of our nation’s healthcare industry and policy leaders, as well as the very real needs of 11 million Americans, and allow payments to continue . It would also avoid ensnaring the Administration in costly lawsuits with states over the payments, which a federal appeals court ruled on August 1st could be permitted.

It’s time to stop the partisan sniping and get to work on crafting sound policy. We should put out the fire and begin to rebuild, instead of letting it all burn to the ground.

The Latest Motion In House v. Price Has A Significant Impact On The Future Of CSR Payments

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://healthaffairs.org/blog/2017/08/01/the-latest-motion-in-house-v-price-has-a-significant-impact-on-the-future-of-csr-payments/

Image result for us court of appeals

 

On August 1, 2017, the United States Court of Appeals for the District of Columbia granted the motionof the attorneys general of 17 states and the District of Columbia to intervene in House v. Price. House v. Price is before the D.C. Circuit on appeal from the ruling of a district court judge in favor of the House of Representatives in its lawsuit claiming that the reimbursement of insurers for reducing cost sharing for low-income qualified health plan enrollees is illegal because Congress had not appropriated funding for the payments. The judge enjoined the payments but stayed her order pending an appeal and the Obama administration in fact appealed. The states had moved to intervene, claiming that they had an interest in the action and that the Trump administration was not adequately defending their interest.

The three-judge appellate panel held first that the states had demonstrated that they had standing to intervene because they “would suffer concrete injury if the court were to grant the relief the plaintiffs seek.” The states established that a judgment for the House terminating the payments would “lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the States will have to provide health care.” This would in turn result in state-funded hospitals suffering financially when they have to cover emergency care for uninsured individuals.

The court further held that the states had established a right to intervene in the action. First, the states had established an interest in the subject matter of the lawsuit.

Second, the court held that allowing the injunction of the court below would impair the states’ rights. The court observed that the administration’s “claim that it could unilaterally suspend payments is a debated legal question, not an answer to the injury the States have evidenced. The injunction sought, which would forbid the payments at issue, would erect a roadblock to the States’ goal of either persuading or compelling the Department to make the payments.”

Third, the court held that the states had raised a sufficient doubt concerning the adequacy of the administration’s representation of their interest. The court noted that the administration had nowhere argued that it would protect the states’ interest or continue to pursue the appeal.

Fourth, the court held that the motion to intervene was timely. The states, the court held, “had filed within a reasonable time from when their doubts about adequate representation arose due to accumulating public statements by high-level officials both about a potential change in position and the Department’s joinder with the House in an effort to terminate the appeal.” The court, in short, took President Trump’s threats to terminate the cost-sharing reduction (CSR) payments seriously.

Finally, the court held that permissive intervention was also warranted in the case.

The court further ordered that the case would continue to be held in abeyance, with status reports at 90-day intervals and the next one due on October 30, 2017. With their status as parties to the case, however, the states may well next seek to get the case moving again.

The decision does not mean that the Trump administration is barred from ending the cost-sharing reduction payments. It does mean, however, that the administration cannot unilaterally stop the CSR payments, dismiss the appeal, and claim judicial imprimatur for its doing so. If the administration does stop making the payments, the states—or insurers, or possibly consumers—would be able to sue to require the payments to be made and the injunction entered by the lower court would not be as much of a “roadblock” to their prevailing. Finally, if the states ultimately convince the appellate court that the CSR funding has in fact been appropriated, the administration would be required to pay it. The decision is, therefore, a major development in the ongoing CSR saga.

Five tough decisions for the GOP on healthcare

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

Five tough decisions for the GOP on healthcare

Image result for Five tough decisions for the GOP on healthcare

 

Republicans have left Washington for the August recess with healthcare decisions hanging overhead, many of which must be addressed by the end of September.

Here are five decisions looming for the GOP.

  1. Should there be one more effort at ObamaCare repeal?

While the GOP attempt at repealing ObamaCare has stalled for now, some in the party are not giving up.

“This ain’t over by a long shot … we won’t rest until we end the ObamaCare nightmare once and for all,” Vice President Pence said at the Tennessee GOP 2017 Statesmen’s Dinner Thursday, according to a pool report.

Yet Republicans are running out of time to take action, as the legislative vehicle they were using to gut the health law and avoid a Democratic filibuster expires at the end of September.

Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are pushing a new plan to redirect money currently spent on providing coverage through ObamaCare and instead give it to states to spend as they choose.

They have been meeting with White House officials, who are also pushing Congress not to give up on repeal.

“I hope that our leadership will pay attention to this effort because the idea of leaving ObamaCare without a replacement is pretty naive,” Graham said this week.

Still, Senate GOP leadership has largely signaled they are moving on from repeal for now, with the legislative session in September likely to be dominated by work on funding the government and raising the debt ceiling.

And there are so far no signs that any of the three GOP “no” votes who sunk repeal, Sens. Lisa Murkowski (Alaska), Susan Collins (Maine), or John McCain (Ariz.), are changing their minds.

However, Graham said he is working with conservative Sens. Mike Lee (R-Utah) and Ted Cruz (R-Texas) to try to incorporate their ideas on repealing ObamaCare regulations into the plan.

And Majority Leader Mitch McConnell (R-Ky.) left the door open to bringing repeal back in some form, noting the fast-track procedure being used to avoid a filibuster had not expired.

“There’s still an opportunity to do that,” he said.

  1. Should we work with Democrats?

Lawmakers are ramping up bipartisan talks on the next steps for healthcare legislation, some more enthusiastically than others.

Sen. Mike Rounds (R-S.D.) said that following the failure of the Senate GOP’s ObamaCare repeal vote, Democrats have been more willing to talk with Republicans about ways to fix the law.

“Both sides are moving a little bit more to the middle,” Rounds said. “The discussions I’m having have been positive with Democrats, saying ‘look we are open to these changes, we will listen, we will work with you.’”

Sen. Roy Blunt (R-Mo.), a member of the GOP leadership, told The Hill he still wants to repeal ObamaCare “and start over, but that doesn’t mean an effort to hold up the collapsing structure in the short term isn’t the right thing to do.”

Both the Senate’s Health and Finance committees plan to hold bipartisan hearings in September when lawmakers return from recess.

Sen. Lamar Alexander (R-Tenn.) — the chairman of the Health, Education, Labor and Pensions Committee — said the goal is for the panel to craft a bipartisan, short-term proposal by mid-September, as insurers must sign contracts saying they’ll sell plans on the federal exchange by the end of that month.

Finance Committee Chairman Orrin Hatch (R-Utah) did not suggest the panel would produce legislation, but said there was bipartisan interest in a hearing.

“We’ve also heard a lot of demands from members of the committee for a healthcare hearing. I intend to do that as well shortly after the recess,” Hatch said Thursday.

But it’s not clear that the renewed interest in bipartisanship will yield legislation.

Alexander’s committee runs the ideological gamut from conservative Sen. Rand Paul (R-Ky) to progressive Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.).

Getting everyone behind a bill could prove a tall order, especially as some Republicans like Paul are committed to repealing ObamaCare, not repairing it.

  1. Should we back legislation to make key payments to insurers?

Insurers are desperate to know whether they’re going to continue to receive critical ObamaCare payments from the federal government.

President Trump has threatened to halt the payments, which compensate insurers for subsidizing out-of-pockets costs for certain healthcare consumers.

But Congress could take the matter out of his hands by authorizing the payments the administration has been making on a monthly basis, which total about $7 billion for fiscal 2017.

Even if Trump doesn’t halt the cost-sharing reduction payments, a yearlong appropriation from Congress would give insurers certainty that they’ll continue to receive the funds.

Republicans are divided on what to do.

Many say the ObamaCare marketplaces need to be stabilized and are open to funding the payments. Alexander took the first concrete step forward to do so, saying that any stabilization package his committee produces should fund the payments.

But conservatives are vehemently opposed.

“I think it is a mistake to simply go forward with bailouts for big insurance companies,” Cruz said. “For whatever reason, the Democrats’ central priority seems to be providing billions of dollars in subsidies and bailouts to giant insurance companies.”

  1. What’s to be done with CHIP?

Time is of the essence for Congress to reauthorize the Children’s Health Insurance Program (CHIP). Funding is set to expire Sept. 30.

CHIP has historically had bipartisan support, and the Senate Finance Committee announced on Thursday it would hold a post-recess hearing on CHIP.

Congress last reauthorized the CHIP program in 2015 as part of a broader health package.

However, for Republicans still searching for a way to pass provisions of their failed ObamaCare repeal legislation, the authorizing legislation may be a tempting vehicle.

If CHIP funding expires, states will be forced to make difficult decisions about coverage. Millions of families would have to find other sources of insurance for their children at a time of uncertainty around the stability, availability and affordability of other types of coverage.

  1. What’s to be done with ‘bare’ counties?

Insurance commissioners have a big fear: That the ObamaCare health marketplaces will open for business, but people in some areas won’t have any plans to choose from.

This scenario has never happened before, but as of Friday, 17 counties have zero insurers committed to their exchange, according to Kaiser Family Foundation.

The deadline to participate is looming. Insurers sign contracts with the federal government at the end of September, saying they’ll offer plans on the ObamaCare exchanges.

If the Senate Health Committee is able to meet its goal — hammering out a bipartisan short-term stabilization bill by mid-September — then that could help prevent more insurers from fleeing the marketplaces.

And behind the scenes, insurance commissioners have been offeringinsurers previously unheard of flexibilities to keep or entice them into the marketplaces.

Congress is aware of the situation, and has proposed several other solutions.

One bill from Tennessee’s Republican senators, Bob Corker and Alexander, would let people use their ObamaCare subsidies to purchase plans off the exchange — that is, if they live in a “bare county” without any ObamaCare plans to buy.

A counter bill from Sen. Claire McCaskill (D-Mo.) would allow those in bare counties to buy coverage on Washington, D.C.’s exchange, where Congress members and their staff purchase insurance.

Florida insurance regulators ask payers to file backup rates in case Trump administration withholds CSRs

Posted on by • Posted in Uncategorized • Tagged , , , , • Leave a comment

http://www.fiercehealthcare.com/aca/florida-insurance-regulators-ask-payers-to-file-back-up-rates-case-trump-administration?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWkRKbFpUZzBZVFl6TkdGaSIsInQiOiJwMDRSM0NHYzQ1MFdOVlJuUFMxUEpQbGpYM0tHZUZzNjZXaFJ5eDNEMTVsOTV2WDRHOWxEYWZpeml0eEpjTW4zSitjZGdrWE1kSzI5RGI2QnVZSDNSZVJIbHhycWRZWHFKU1N3cjdrbXhOS0lxQURRWW5cL1llanZ6UXpLVXI2MzQifQ%3D%3D

Health insurance, pen and stethoscope

Uncertainty over the Trump administration’s plans for cost-sharing reduction payments has payers on edge as they file their individual market rates for 2018. And in one state, regulators have asked insurers to file back-up plans.

The Florida Office of Insurance Regulation asked the nine payers that participate in the state exchanges to file rates in case the CSR payments don’t come through, the agency told FierceHealthcare. The average rate increase was already 17.8% for 2018, according to reported (PDF) from FOIR. With CSR payments out of the picture, rates are more than likely to jump.

Blue Cross Blue Shield of Florida, the state’s largest insurer, is projecting increases of about 20% if the Trump White House does not fund CSRs, according to its filings. Darnell Smith, the payer’s market president for North Florida, said in a July interview with the Jacksonville Daily Record that it would likely make insurance unaffordable for some of its members.

“If those go away, the coverage that we provide could become unaffordable for quite a few folks,” Smith said.

The fate of the CSR payments rests at least in part in President Donald Trump’s hands. Experts have named continued funding for those payments as key to stabilizing the individual insurance markets.

A court ruling earlier this week, though, may have made a notable dent in Trump’s power to use CSRs as a health reform bargaining chip. A U.S. appeals court ruled that states can intervene in Congress’ ongoing suit against the payments.

The uncertainty about CSRs is reflected in rate filings beyond Florida as well. Median premiums in New Hampshire could rise 43% based on state filings (PDF) and significant increases are also expected in states like Wyoming (PDF). Molina Healthcare, which posted significant losses in its second quarter, could hike its Affordable Care Act plan rates by as much as 55%.

America’s Health Insurance Plans spokeswoman Kristine Grow told FierceHealthcare that payers are in desperate need of certainty when planning for 2018 and beyond.

“As plans make decisions for 2018, they do so with a view of wanting to serve consumers in the market for the full year,” she said. “That’s why it’s so important to know what will happen with CSRs long term.”

 

What’s the Near-Term Outlook for the Affordable Care Act?

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

http://www.kff.org/health-reform/issue-brief/whats-the-near-term-outlook-for-the-affordable-care-act/?utm_campaign=KFF-2017-August-Health-Reform-Outlook-ACA&utm_medium=email&_hsenc=p2ANqtz–oP5wlywrzGCg7hZVAatEjF0shnUXWvPMPB7MBQfAJJXiDqeMCZIkw7rhXhhVQ7bv4RTl4IFWk3zbvJFTnYv730hVqBQ&_hsmi=54950542&utm_content=54950542&utm_source=hs_email&hsCtaTracking=b35f36e5-60c0-4e14-ba27-3e14c4025b79%7Cf0a0cb87-2715-4168-b499-2000076067bf

If Congress abandons efforts to repeal and replace the Affordable Care Act (ACA), President Trump has said he would “let Obamacare fail.” This Q&A examines what could happen if the Affordable Care Act, also called “Obamacare,” remains the law and what it might mean to let Obamacare fail.

Is Obamacare failing?

The Affordable Care Act was a major piece of legislation that affects virtually all payers in the U.S. health system, including Medicaid, Medicare, employer-sponsored insurance, and coverage people buy on their own. One of the biggest changes under the health reform law was the expansion of the Medicaid program, which now covers nearly 75 million people, about 14 million of whom are signed up under the expansion. Most Americans, including most Republicans, believe the Medicaid program is working well.

When people talk about the idea of the ACA failing, they are usually referring to the exchange markets, also called Marketplaces. These markets, which first opened in 2014, are part of the broader individual insurance market where just 5-7% of the U.S. population gets their insurance. People who get insurance from other sources like their work or Medicaid are not directly affected by what happens in the individual insurance market.

The exchange markets have not been without problems: There have been some notable exits by insurance companies and premium increases going into 2017, and in the early years of the exchanges, insurers were losing money. The structure of the ACA’s premium subsidies – which rise along with premiums and cap what consumers have to pay for a benchmark plans a percentage of their income – prevents the market from deteriorating into a “death spiral.” However, premiums could become unaffordable in some parts of the country for people with incomes in excess of 400% of the poverty level, who are ineligible for premium assistance.

Insurer participation in this market has received a great deal of attention, as about 1 in 3 counties – primarily rural areas – have only one insurer on exchange. Rural counties have historically had limited competition even before the ACA, but data now available because of the Affordable Care Act brings the urban/rural divide into sharper focus. On average at the state level, competition in the individual market has been relatively stable – neither improving nor worsening.

Premiums in the reformed individual market started out relatively low and remained low in the first few years – about 12% lower than the Congressional Budget Office had projected as of 2016 –before increasing more rapidly in 2017. Most (83%) of the 12 million people buying their own coverage on the exchange receive subsidies and therefore are not as affected by the premium increases, but many of the approximately 9 million people buying off-exchange may have difficulty affording coverage, despite having higher incomes. As might be expected, after taking into account financial assistance and protections for people with pre-existing conditions, some people ended up paying more and others paying less than they did before the ACA. Our early polling in this market found that people in this market were nearly evenly split between paying more and paying less. About 3 millionpeople who remain uninsured are not eligible for assistance or employer coverage and many of them may be going without coverage due to costs.

Our recent analysis of first quarter 2017 insurer financial results finds that the market is not showing signs of collapse. Rather, insurers are on track to be profitable and the market appears to be stabilizing in the country overall. In other words, those premium increases going into 2017 may have been enough to make the market stable without discouraging too many healthy people from signing up. However, there are still markets – particularly rural ones – that are fragile.

U.S. governors urge Trump to make insurance payments

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

https://www.reuters.com/article/us-usa-healthcare-idUSKBN1AI28L

Image result for U.S. governors urge Trump to make insurance payments

Democratic and Republican U.S. governors on Wednesday urged the Trump administration, as well as Congress, to continue funding payments to health insurance companies that make Obamacare plans affordable, calling it critical to stabilizing the insurance marketplace.

Republican President Donald Trump, frustrated that Obamacare survived attempts to repeal it, has threatened to cut off about $8 billion in subsidies that help control costs for low-income Americans under the Affordable Care Act, Democratic former President Barack Obama’s signature domestic initiative.

“The Administration has the opportunity to stabilize the health insurance market across our nation and ensure that our residents can continue to access affordable health care coverage,” said a statement by the Health and Human Services Committee of the National Governors Association.

“A first critical step … is to fully fund CSRs (cost-sharing reduction payments) for the remainder of calendar year 2017 through 2018,” the statement said, adding this was needed as Congress and the administration address long-term reform efforts.

The committee is led by Virginia Governor Terry McAuliffe, a Democrat, and Massachusetts Governor Charlie Baker, a Republican. Earlier this year, the governors sent a letter calling on Congress to fully fund the cost-sharing payments.

Some Congressional Republicans have joined Democrats in urging Trump to continue the payments. Republican Senator Lamar Alexander, chairman of the health committee, said Tuesday the president should pay the subsidies through September while lawmakers work on bipartisan legislation to fund the outlays for another year.

But the Senate’s No. 2 Republican John Cornyn hesitated when asked Wednesday if he would support such legislation.

“I’ve said before that I’m not in favor of throwing money at insurance companies without reform, so that’s going to be the nature of the conversation,” Cornyn told reporters outside his office.

Asked what reforms he’d like to see, Cornyn mentioned the “skinny” Obamacare repeal bill the Senate voted down last week. Among other things, it would have repealed the requirement that every American have health insurance or pay a penalty.

Insurers say that the cost-sharing payments are passed onto customers in the form of lower deductibles and co-pays that make care more affordable for low income Americans.

Insurers are finalizing 2018 premium rates for the individual Obamacare market, with many saying their decision hinges on government guarantees for cost-sharing subsidies.

Molina Healthcare Inc said on Wednesday it would stop selling Obamacare plans in Utah and Wisconsin, joining a slew of health insurers that have exited Obamacare markets amid uncertainty over the healthcare law.

Anthem Inc, one of the largest sellers of these plans in 2017, has pared back offerings or mostly exited five states including California and may exit more.

White House budget director Mick Mulvaney told CNN the administration was still considering whether to end cost-sharing subsidies.

 

Bipartisan drive to pay health insurers faces Senate hurdles

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://abcnews.go.com/Health/wireStory/bipartisan-drive-pay-health-insurers-faces-senate-hurdles-48995691

Image result for political hurdles

A bipartisan Senate effort to continue federal payments to insurers and avert a costly rattling of health insurance markets faces a dicey future. The uncertainty shows that last week’s wreck of the Republican drive to repeal the Affordable Care Act hasn’t blunted the issue’s sharp-edged politics.

President Donald Trump is threatening to halt the payments in hopes of forcing Democrats to negotiate an end to the Obama-era law. The insurance industry and lawmakers from both parties say blocking the money would lead insurers to raise premiums for people buying individual policies and might induce companies to abandon some markets.

Into the fray has stepped Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee.

He said he will work with the committee’s top Democrat, Sen. Patty Murray of Washington state, on a bill next month that would pay insurers through 2018. In exchange, he wants Democrats to agree to make it easier for states to choose their own health coverage standards that insurers must provide, and not heed consumer-friendly requirements of former President Barack Obama’s law.

While that is an idea Democrats say they will discuss, it’s unclear whether the two parties can reach a deal.

For the GOP’s failed effort to repeal and replace Obama’s overhaul, Senate Republicans used special rules allowing passage by a simple majority. But this developing bill would need 60 votes to succeed. Republicans hold a 52-48 advantage in the Senate, which means Democratic backing will be crucial.

Democrats will be reluctant to strike an agreement that would pull back far on Obama’s protections, which include a set of services insurers must cover and guarantees that premiums for healthy and seriously ill people are equal.

“It’s going to be hard to get common ground,” said Sen. Chris Murphy, D-Conn., a committee member. “Republicans are going to want some initial flexibility” for coverage requirements, “and that’s not an easy thing to achieve.”

Republicans are divided, too.

Many, including Trump, have called the payments an insurers’ bailout. Conservatives are reluctant to continue payments to help sustain a law the GOP has pledged for years to toss out.

“I was a total repeal guy,” said Sen. Richard Shelby, R-Ala. “I don’t know if I want to prop it up.”

Added GOP Sen. Ted Cruz of Texas: “I think it’s a mistake to bail out insurance companies.”

Obama’s law requires insurers to reduce out-of-pocket costs such as deductibles and copayments for millions of low- and middle-income customers. It also requires the government to reimburse insurers for those costs.

But a federal court found that Congress hasn’t properly approved money to do that. Both Obama and Trump have continued making the payments as the case has dragged on.

Besides the outright opponents, some Republicans say they would be reluctant to support an Alexander bill unless whatever eased regulations Democrats agree to are worthwhile. It’s unclear what Alexander or other Republicans are willing to accept.

“We certainly should get some structural change to bring down premiums in exchange for that,” said Sen. Ron Johnson, R-Wis. “We can’t just throw money at the problem.”

That echoes what Senate Majority Leader Mitch McConnell, R-Ky., said last Friday after the Senate rejected the third health proposal he advanced, effectively sinking the repeal effort.

“Bailing out insurance companies with no thought of any kind of reform is not something I want to be part of,” McConnell said.

Alexander said Wednesday that he has kept McConnell apprised of his effort. Asked if he had received a commitment that McConnell would bring such legislation to the full Senate, Alexander said, “Well, he doesn’t know what bill we’re going to have.”

But Alexander does have allies.

“We’ll eventually repeal Obamacare and put something in its place,” said Sen. John Kennedy, R-La. “In the meantime, I think it’s very important not to see any Americans get hurt.”

If the GOP divisions persist, McConnell and House Speaker Paul Ryan, R-Wis., might have to decide whether to have votes on legislation opposed by substantial numbers of Republicans. That’s always an uncomfortable proposition for party leaders.

“That’s a question for McConnell,” said the second-ranking Democratic senator, Illinois’ Dick Durbin, said asked whether he thought the GOP leader would allow a vote on a bill opposed by many Republicans.

Durbin said if Republicans are truly concerned about keeping insurance markets stable, “they have to do something.”

Would Ryan support a measure like Alexander’s?

The speaker “believes repeal and replace is the best course of action and that the Senate needs to act,” spokeswoman AshLee Strong said.

Court complicates Trump’s threat to cut ‘Obamacare’ funds

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

https://www.washingtonpost.com/politics/federal_government/trump-on-tricky-legal-ground-with-obamacare-threat/2017/08/01/436cfc8e-771e-11e7-8c17-533c52b2f014_story.html?utm_term=.35d0bd8ec053

Image result for us court of appeals circuits

President Donald Trump’s bold threat to push “Obamacare” into collapse may get harder to carry out after a new court ruling.

The procedural decision late Tuesday by a federal appeals panel in Washington has implications for millions of consumers. The judges said that a group of states can defend the legality of government “cost-sharing” subsidies for copays and deductibles under the Affordable Care Act if the Trump administration decides to stop paying the money.

Trump has been threatening to do just that for months, and he amped up his warnings after the GOP’s drive to repeal and replace “Obamacare” fell apart in the Senate last week. The subsidies help keep premiums in check, but they are under a legal cloud because of a dispute over the wording of the ACA. Trump has speculated that he could force Democrats to make a deal on health care by stopping the payments.

The court’s decision is “a check on the ability of the president to sabotage the Affordable Care Act in one very important way,” said Tim Jost, professor emeritus at Washington and Lee University School of Law in Virginia, a supporter of the ACA who has followed the issue closely.

Because of the ruling, legal experts said, states can now sue if the administration cuts off the subsidies. Also, they said, the president won’t be able to claim he’s merely following the will of a lower court that found Congress had not properly approved the money.

“We’re not going to wait to find out what Donald Trump wants to do,” said California Attorney General Xavier Becerra, who is helping steer the states’ involvement. “My team is ready to defend these subsidies in court.”

The Justice Department had no comment. The White House re-issued an earlier statement saying, “the president is working with his staff and his Cabinet to consider the issues raised by the … payments.”

Trump has made his feelings clear on Twitter. “If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies,” he tweeted early Monday.

He elaborated in an earlier tweet, “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies…will end very soon!”

In a twist, the appeals court panel seemed to take such statements into account in granting 17 states and the District of Columbia the ability to intervene on behalf of consumers.

The judges’ decision said states’ doubts that the administration could adequately defend their interests in court were fanned by “accumulating public statements by high-level officials…about a potential change in position.”

“He’s really a terrible client, President Trump is,” University of Michigan law professor Nicholas Bagley said. “The states point to his public statements and say, ‘Are you kidding me? We know the president is poised to throw us under the bus and we know because he said so.’”

The health law requires insurers to help low-income consumers with their copays and deductibles. Nearly 3 in 5 HealthCare.gov customers qualify for the assistance, which can reduce a deductible of $3,500 to several hundred dollars. The annual cost to the government is about $7 billion.

The law also specifies that the government shall reimburse insurers for the cost-sharing assistance that they provide.

Nonetheless, the payments remain under a cloud because of a disagreement over whether they were properly approved in the health law, by providing a congressional “appropriation.”

House Republicans trying to thwart the ACA sued the Obama administration, arguing that the law lacked specific language appropriating the cost-sharing subsidies.

A district court judge agreed with House Republicans, and now the case is before the U.S. appeals court in Washington

If Trump makes good on his threat, experts estimate that premiums for a standard “silver” plan would increase by about 19 percent. And more insurers might decide to leave already shaky markets.

In Congress, some prominent lawmakers in both parties are saying they hope to provide at least a temporary guarantee for the subsidies before open enrollment season for 2018 starts Nov. 1.

California, 16 other states pledge to defend Obamacare subsidies if Trump drops out of lawsuit

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

http://www.sacbee.com/news/local/health-and-medicine/article165045532.html

Image result for California, 16 other states pledge to defend Obamacare subsidies if Trump drops out of lawsuit

Now that California, 16 other states and the District of Columbia have been given legal standing in a critical court appeal, California Attorney General Xavier Becerra said Wednesday they will fight to preserve the federal funds that underpin their Obamacare health exchanges if the Trump administration bows out of the lawsuit.

“My team is ready to defend these (federal) subsidies in court,” Becerra said. “We’re going to do everything we can to work with whoever is interested, whether it’s the Trump administration or Congress, to make sure that we continue to provide people with affordable health care. … We’re not going to go back to the days when health care was for the healthy or the wealthy.”

In this legal case, Republicans in the U.S. House of Representatives filed suit in 2014 against then-Secretary of Health and Human Services Sylvia Burwell, asserting that she had overstepped her authority by appropriating billions of dollars to cover discounts that insurers were mandated to give low-income consumers under the Patient Protection and Affordable Care Act, commonly called Obamacare.

While the Affordable Care Act promised reimbursement for the discounts, it provided no mechanism to pay the so-called cost-sharing reductions. Last year, U.S. District Judge Rosemary M. Collyer ruled that, while Congress clearly authorized the program, it had not appropriated funds and thus it was unconstitutional to pay the subsidies. However, she put her decision on hold, pending appeal to the U.S. Court of Appeals for the District of Columbia Circuit.

The dean of the UC Davis School of Law, Kevin R. Johnson, said the states could argue that since Congress mandated the cost-sharing program, that body should be compelled to provide the funding that states and insurers need to make it work.

Becerra, a Democrat who represented the 34th congressional district from 2013 to 2017, said the states would argue that Congress did contemplate the cost-sharing subsidies. “I say that, not only as someone who will argue that in court, I say that as a former member of Congress who helped draft the legislation,” Becerra said.

Becerra said he and other attorneys general filed a motion to join the appeal in May because they thought the president wasn’t going to protect health insurance marketplaces such as Covered California. Before and after the U.S. Senate failed to pass legislation to repeal the Affordable Care Act, Trump has tweeted that he and the Republican leadership should “let Obamacare implode” and then broker a deal.

“You could smell it. You could read it in tweets,” Becerra said. “When we intervened in May, we saw no one was really standing up for the millions of American families that rely upon the Affordable Care Act insurance plans to be able to send their kids to doctors and believe that they could afford to have their child in a hospital. The record is replete with evidence that the Trump administration is not willing to defend the Affordable Care Act.”

The appeals court ruled Tuesday that the states had standing in the lawsuit. Becerra said his office will work in concert with attorneys general in New York, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, North Carolina, Pennsylvania, Vermont, Virginia, and Washington, and the District of Columbia. Ten of the states are led by Democratic governors and seven by Republicans.

Because of ongoing uncertainty about the availability of federal funds, Covered California announced Tuesday that it was planning to impose a surcharge on premiums for those consumers whose copayments and deductibles qualified for the insurer discounts.

While the action sounds ominous for the 650,000 silver-tier policy holders it affects, it is actually a bit of creative accounting that protects them from seeing sharp increases in payments and ensures financial stability for insurers. The health law imposes a cap on out-of-pocket costs for those consumers, whose incomes cannot exceed 250 percent of the federal poverty level. Under the Affordable Care Act, the federal government must pick up costs once consumer spending hits that out-of-pocket ceiling.

The insurers still discount copayments and deductibles on a sliding scale linked to income, and the premiums provide enough funding to cover those discounts on the front end rather than after care is provided.

Peter Lee, executive director of Covered California, has said California will move forward with the plan if an annual appropriation is not made for cost-sharing reductions. All rate changes are subject to state regulatory approval.

“We hope that we do not need to implement this work-around that would cause unnecessary confusion and ultimately cost the federal government more than it would to continue to make the payments directly,” Lee said.