Tag Archives: Cost Sharing Reduction Payments

It’s not Obamacare anymore. It’s our national health-care system.

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https://www.washingtonpost.com/opinions/its-not-obamacare-anymore-its-our-national-health-care-system/2017/07/28/1a6583fe-73d3-11e7-9eac-d56bd5568db8_story.html?_hsenc=p2ANqtz-_10xQ2TJnkCz4MEJsaDnsHXCCw3ER2NJ8zCVrmfYjiPqgmqdP6OWrjVnUOubPP6QShf6CbIdNe4UZ2tz5kzjWXqpTvTQ&_hsmi=54785729&utm_campaign=7.29.17-drewlarry-wpost&utm_content=54785729&utm_medium=email&utm_source=hs_email&utm_term=.b68e51293cb3

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Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation. Larry Levitt is senior vice president of the Kaiser Foundation.

Republicans failed to repeal and replace the Affordable Care Act early Friday because of divisions within their own ranks, and because they tried not only to repeal and replace the ACA but also to cut and cap the Medicaid program, generating opposition from many red-state governors and their senators.

But most of all, they failed because they built their various plans on the false claim — busted by the Congressional Budget Office — that they could maintain the same coverage levels as the ACA and lower premiums and deductibles, while at the same time slashing about a trillion dollars from Medicaid and ACA subsidies and softening the ACA’s consumer protection regulations. Had they succeeded, they would have won a big short-term victory with their base, which strongly supports repeal, but suffered the consequences in subsequent elections as the same voters lost coverage or were hit with higher premiums and deductibles.

The challenge now is to stabilize the ACA’s insurance marketplaces. They are not in free fall or imploding, as President Trump suggests, and in most markets insurer profits have been improving. But these are fragile markets, especially in rural areas, and there are 38 “bare counties” where no insurer currently intends to participate in 2018. About 20 percent of marketplace enrollees have access to only one insurer, with the biggest problems in rural areas.

Senate Republicans failed to pass their ‘skinny bill’ that would repeal parts of the Affordable Care Act on July 28. Three republicans, including Sen. John McCain (R-Ariz.), voted against the bill. (Video: Amber Ferguson/Photo: Melina Mara/The Washington Post)

Insurers have submitted their initial rates to state regulators for 2018, and in some areas, the increases are steep. These companies are hedging their bets in the face of uncertainty emanating from Washington, and who can blame them? Now, with ambiguity over legislative action to repeal and replace the law lifted, the remaining uncertainty is whether Congress and the administration will take steps to stabilize markets or instead undermine them.

The immediate question is whether the administration will implement the law as intended or, in a sense, enact “skinny repeal” through administrative action. To stabilize the marketplaces, the administration would need to enforce the individual mandate as intended, commit to providing payments to insurers that compensate for reducing cost-sharing for low-income enrollees, and continue to provide outreach funds to support enrollment and consumer education activities.

Insurers need to finalize their 2018 rates soon and sign contracts with the federal marketplace by the end of September, so clarity on the $7 billion in cost-sharing payments to insurers is key. If they’re not made, insurers will need to raise premiums by about 19 percent, or they might just decide to exit the market entirely. These payments are subject to a lawsuit filed the House, so Congress might need to step in and assure that the payments will continue.

It is unclear whether Republicans and Democrats can work together on narrow legislation to stabilize the marketplaces without once again opening up a broader debate about the ACA. Republican bills included significant federal funds to help insurers cover the cost of high-risk patients, an idea that was also part of the ACA for its first three years of implementation. These reinsurance or risk-sharing pools would bring premiums down, especially for middle-class consumers not eligible for tax credits in the marketplaces, a primary goal for both parties.

Conservatives may be resistant to such spending, so Congress might also consider ideas they advocated in the recent debate, such as allowing premiums to be paid from health savings accounts. This, too, would provide premium relief to middle-class people buying their own insurance.

Still, only 7 percent of the American people get their insurance through the individual market. Finding consensus on the narrow issue of stabilizing this slice of the health insurance system should be possible if the larger, partisan debate about Obamacare is truly over.

It is also possible as the smoke clears on the health-care battlefield that more states will want to move forward with Medicaid expansions, now that federal funding for those expansions appears secure. Red states will likely seek a conservative stamp on their expansions, adding elements such as work requirements, drug testing, premium payments, time limits or testing private insurance models. Some of these policies will be controversial, and others may stretch what’s allowed under federal law too far. But some wrinkles will no doubt be necessary if Medicaid is to be expanded to the millions of people in the 19 holdout states.

But one thing is clear: 59 percent of the public says President Trump and the Republicans are now in control of government and are responsible for making the ACA work, and 74 percent says they should “do what they can to make the law work.”

It’s apparent what needs to be done to stabilize the marketplaces and who owns the ACA going forward. It’s no longer Obamacare; it’s now just the nation’s health insurance system.

What Could Happen If The Administration Stops Cost-Sharing Reduction Payments To Insurers?

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http://healthaffairs.org/blog/2017/08/02/what-could-happen-if-the-administration-stops-cost-sharing-reduction-payments-to-insurers/

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Although the decision of the Court of Appeals for the District of Columbia Circuit to allow attorneys general from 17 states and the District of Columbia to join the House v. Price cost-sharing reduction (CSR) litigation as parties complicates President Trump’s ability to simply stop the CSR payments, rumors continue that he is preparing to do so. The CSR payments are made monthly; the next installment is due on August 21, 2017. If the administration intends not to make the August payment, it must announce its decision soon.

Changes to qualified health plan (QHP) applications in the federally facilitated exchange (FFE) are due on August 16, 2017, as are final rates for single risk pool plans including QHPs. Final contracts with insurers for providing QHP coverage through the FFE must be signed by September 27. If the Trump administration is going to defund the CSRs, now is the time it will do it.

The back story on the CSR issue can be found in my post on July 31, while the intervention decision is analyzed in my post on August 1. This post focuses on issues that will need to be resolved going forward if the Trump administration decides to defund the CSRs.

The Choices Insurers Would Face If CSR Payments Were Ended

First, insurers would have to decide whether to continue to participate in the exchanges. Those in the FFE have a contractual right to drop participation for the rest of 2017, but how exactly they would do this would depend on state law, and would probably require 90 days notice. Insurers would also not be able to terminate the policies of individuals covered through the exchange, although once the insurers left the exchange premium tax credits would cease and many policyholders would drop coverage. Insurers that tried to leave immediately would likely suffer reputational damage, and those that could financially would likely try to hold on until the end of the year.

Some insurers might well decide that the government is an unreliable partner and give up on the exchanges for 2018. Indeed, some would conclude that the individual market is too risky to play in at all. The individual market makes up a small part of the business of large insurers; even though it has become more profitable in the recent past, some insurers might conclude that the premium increases that would be needed to make up for the loss of the CSRs would drive healthy enrollees out of the individual market. Rather than deal with a deteriorating risk pool, they might leave the individual market entirely (although they would probably have to give 180 days notice to do so.)

Insurers that decide to stay would have to charge rates that would allow them to survive without the $10 billion dollars the CSR payments would provide. They would need to raise premiums significantly to accomplish this. How they did so would depend on guidance that they got from their state department of insurance or possibly from the Centers for Medicare and Medicaid Services.

The California Experience

On August 1, 2017, Covered California announced its 2018 rates. The California state-based marketplace is an example of how the Affordable Care Act can work in a state that fully supports it and has a big enough market to form a balanced risk pool. For 2018, the average weighted rate increase in California is 12.5 percent, of which 2.8 percent is attributable to the end of the moratorium on the federal health insurance tax. Consumers can switch to plans that will limit their rate change to 3.3 percent in the same metal tier. All 11 health insurers in California are returning to the market for 2018 (although one insurer, Anthem, is leaving 16 of the 19 regions in which it participated for 2017) and 82 percent of consumers will be able to choose between three or more insurers. About 83 percent of hospitals in California participate in at least one plan.

Covered California instructed its insurers to file alternate rates that would go into effect if the Trump administration abandons the CSR payments. The insurers were instructed to load the extra cost onto their silver (70 percent actuarial value) plans, since the CSRs only apply to silver plans. The alternative rates filed by the insurers project that if the CSRs are not funded, they would have to essentially double their premium increases, hiking premiums by an additional 12.4 percent.

Virtually all of this increase would be absorbed by increased federal premium tax credits for those with incomes below 400 percent of the federal poverty level. As the premium of the benchmark second-lowest cost silver plan increased, so would the tax credits. A Covered California study concluded that the premium tax credit subsidy in California would increase by about a third if the CSR subsidies are defunded.

Bronze, gold, and platinum plan premiums would not be affected by the silver plan load. As the premium tax credits increased, many more enrollees might be able to get bronze plans for free, and gold plans would become competitive with silver plans in price. More people would likely be eligible for premium tax credits as people higher up the income scale found that premiums cost a higher percentage of their household income.

Consumers who are not eligible for premium tax credits would have to pay the full premium increase themselves. Covered California has suggested, however, that insurers load the premium increase only onto silver plans in the exchange, since CSRs are only available in the exchange. Insurers would likely encourage their enrollees who are in silver plans in the exchange to move to similar products off the exchange that are much more affordable. Bronze, gold, and platinum plans would cost more or less the same on or off the exchange.

Other States Would Likely Make Different Choices Than California’s

It is likely that not all states would follow California’s lead. If state departments of insurance do not allow insurers to increase their premiums, more insurers would leave the individual market. If state departments require insurers to load the CSR surcharge onto all metal-level plans, both on and off the exchange, bronze, gold, and platinum plans would be more expensive and individual insurance would become much more costly for all consumers who are not eligible for premium tax credits. If insurers leave the market or consumers drop coverage, more consumers would end up using care they cannot afford, increasing medical debt and the uncompensated care burden of providers, and of hospitals in particular.

Some insurers in other states have likely already loaded a substantial surcharge onto their 2018 premiums in anticipation of CSR defunding and of other problems, such as uncertainty about the Trump administration enforcing the individual mandate. If insurers in fact profit from excessive rates, consumers might eventually receive medical loss ratio rebates, but 2018 rebates would not be paid out until late in 2019, if the requirement is still on the books by then.

Other Ramifications Of Ending CSR Payments To Insurers

CSR defunding could have other effects as well. Insurers have been reimbursed each month for CSRs based on an estimation of what they are paying out to actually reduce cost sharing. Each year the insurers must reconcile the payments they have received with those they were actually due. Insurers were supposed to have filed their reconciliation data for 2016 by June 2, 2017, and were supposed to be paid any funds due them, or to refund overpayments, in August. Reconciliation payments may also be due in some situations for 2015. If the administration cuts off CSR payments, it could conceivably cut off reconciliation payments as well.

Finally, defunding of CSRs would likely have an effect on risk adjustment payments as well. The risk adjustment methodology has been set for 2018 in the 2018 payment rule. It would likely not be amended for 2018 in light of the CSR defunding. Defunding would increase the statewide average premium on which risk adjustment payments are based. This would generally exaggerate the effects that risk adjustment would otherwise have. In particular, insurers with heavy bronze plan enrollment would end up paying more in, while insurers with more gold or platinum plans might receive higher payments.

Looking Forward

President Trump claims to see the CSR payments as a “bailout” to insurers, which surely they are not. They are a payment for services rendered, much like a Medicare payment to a Medicare Advantage plan. The effects of defunding would reverberate throughout out health care system, likely causing problems far beyond those identified in this post.

Fortunately, Senators Alexander (R-TN) and Murray (D-WA), the chair and ranking member of the Health, Education, Labor, and Pensions Committee, have announced that they will begin hearings on a bipartisan approach to health reform when the Senate returns in September, and funding of the CSR payments for at least a year seems to be at the top of their list. A bipartisan group of House members has also called for funding the CSRs. And pressure to fund the CSRs continues from the outside, with the National Association of Insurance Commissioners calling for it again last week. It is to be hoped that President Trump will not take steps that would sabotage the individual market and that a solution can quickly be found to the CSR issue that will bring stability to the market going forward.

 

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

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

On August 1, 2017, the United States Court of Appeals for the District of Columbia granted the motion of 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.

Fitch: Failed ACA replacement efforts add to healthcare sector uncertainty

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http://www.beckershospitalreview.com/finance/fitch-failed-aca-replacement-efforts-add-to-healthcare-sector-uncertainty.html

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As ACA repeal and replace efforts stall, significant uncertainty remains surrounding how federal policy will affect nonprofit healthcare organizations, leading to a negative sector outlook for healthcare, according to Fitch Ratings.

The uncertainty and negative outlook comes as the Trump administration looks for ways to weaken the ACA even if the health reform law is not repealed.

Nonprofit hospitals experienced declines in uncompensated care under the ACA because of an increase in healthcare coverage due to Medicaid expansion, rollout of healthcare exchanges and allowing children to stay on their parent’s health insurance plan until age 26.

While repeal efforts cause uncertainty for hospitals, current discussions regarding a bipartisan healthcare bill could be beneficial for nonprofit hospitals. A bipartisan effort could potentially reduce the insurance premium price hikes, according to Fitch.

Trump’s Tweets Threaten To Destabilize Insurance Markets

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http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=54841830&_hsenc=p2ANqtz-_BS8nGbOG01O1u0VECBzsFH5X_-bRiY3X7lsxQ8ybqJDve3xJppemqizvSfn4B0RH50L84DFNZaG18htzfxHToUJIq2g&_hsmi=54841830

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President Trump took to Twitter this week to threaten insurance companies that he may withhold crucial government payments in an effort to undermine the Affordable Care Act.

It’s not the first time the president has threatened to cut off these payments to insurers, which he refers to as “BAILOUTS.

But these payments aren’t designed to compensate insurers for business failures. Rather, they reimburse insurance companies for discounts the law requires them to give to low-income people who buy insurance through the Affordable Care Act exchanges. The federal money that goes to insurers in these payments, known as cost-sharing reductions, or CSRs, offsets the money insurers lose by lowering the deductibles and co-payments they require of these policyholders.

Trump, who is angry that the Congress failed to pass a law to repeal and replace the Affordable Care Act, or Obamacare, is wielding his threat to withhold these CSRs — which could cause chaos in the insurance markets – in hopes of forcing lawmakers back to the table to try again to get rid of the health care law.

The next cost-sharing payments are due to be paid in a few weeks and the president has said he’ll announce this week whether he’ll pay the money or keep it in the Treasury.

“In the absence of the CSR, the rate increases could be astonishing,” says Dr. Marc Harrison, CEO of Intermountain Healthcare, which operates nonprofit hospitals and clinics and insures more than 800,000 people across Utah.

“We’ll see [the number of] people who are uninsured, or functionally uninsured, go way, way up,” he adds.

Harrison says he and his company filed two sets of proposed rates for policies sold on the insurance exchange next year. If the president cuts off the cost-sharing payments, he says, the rates will be much higher.

The Congressional Budget Office estimates the payments, if they’re all made, will total $7 billion this year. Margaret Murray is CEO of the Association for Community Affiliated Plans, which represents these “safety net health plans” aimed at people with lower incomes. She says she has been in touch with the Department of Health and Human Services to urge them to fund the payments.

“Should the payments cease, insurers will be required to fund cost-sharing reductions on their own,” Murray says. If that happens, “they will either raise their rates – our plans indicate that it could be by up to 23 percent – to compensate for these losses, or they will withdraw from the markets altogether.”

If Trump does decide to stop making the payments, it may end up costing the U.S. Treasury more, while insurance companies who remain in the markets could do just fine.

That’s because insurance companies will charge more in premiums to make up for the lost payments. And that will lead the Treasury to spend more on subsidies to policyholders who qualify, according to an analysis by the consulting firm Oliver Wyman.

If those subsidies go up enough, more people could be lured into the exchange markets.

Here’s the wonky reason why:

The Obamacare exchanges require insurance policies to conform to one of four “metal” levels — bronze, silver, gold or platinum — which coincide with how much an individual is expected to pay in premiums, deductibles and other out-of-pocket expenses. A bronze plan covers about 60 percent of a customer’s health care costs, with relatively low monthly premiums, while a platinum plan will cost more each month but pay 90 percent of total health costs.

The law provides income-based tax credits to people to buy insurance, and those credits are calculated based on the price of silver plans. Last year about 85 percent of people who bought Obamacare insurance got a credit, according to the Center for Medicare and Medicaid Services.

People with the lowest incomes also get those discounted deductibles and co-payments if they buy a silver plan; and then the government reimburses insurers through CSR payments.

If Trump decides not to make those payments, insurance companies are likely to raise rates about 19 percent, according to an analysis by the Kaiser Family Foundation.

That means subsidies will have to rise for many people to meet those higher premiums. Some people may take that bigger subsidy to buy a cheaper policy — and many could even get insurance for free, according to Oliver Wyman, because premiums on bronze plans probably would not rise as much as those on silver plans.

The higher subsidies could cost the government as much as $2.3 billion in 2018, according to the Kaiser Family Foundation’s Larry Levitt. Levitt notes that Congress could end the ambiguity over the payments by appropriating the money for them.

Sen. Orrin Hatch, R-Utah, said in an interview with Reuters that he thinks Congress will do just that.

“I’m for helping the poor; always have been,” Hatch said. “And I don’t think they should be bereft of health care.”

The reason CSRs are in limbo at all is because House Republican who did not want Obamacare to succeed sued the administration, claiming the payments to insurers were illegal because they had not appropriated money for them.

A federal judge agreed, but the Obama administration appealed. When Trump took the White House he continued the appeal, to allow lawmakers time to pass a bill to repeal Obamacare and make the payments disappear altogether.

Now that that effort has failed, the lawsuit and the cost-sharing money are once again in play.

Trump on tricky legal ground with ‘Obamacare’ threat

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http://abcnews.go.com/Health/wireStory/trump-tricky-legal-ground-obamacare-threat-48962076

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President Donald Trump’s threat to stop billions of dollars in government payments to insurers and force the collapse of “Obamacare” could put the government in a legal bind.

Law experts say he’d be handing insurers a solid court case, while undermining his own leverage to compel Democrats to negotiate, especially if premiums jump by 20 percent as expected after such a move.

“Trump thinks he’s holding all the cards. But Democrats know what’s in his hand, and he’s got a pair of twos,” said University of Michigan law professor Nicholas Bagley. Democrats “aren’t about to agree to dismantle the Affordable Care Act just because Trump makes a reckless bet.”

For months, the president has been threatening to stop payments that reimburse insurers for providing required financial assistance to low-income consumers, reducing their copays and deductibles.

Administration officials say the decision could come any day.

Playing defense, some insurers are preemptively raising premiums for next year. For example, BlueCross BlueShield of Arizona this week announced a 7.2 percent average hike for 2018. But there would likely be no increase if the subsidies are guaranteed, the company said. And BlueCross BlueShield of North Carolina earlier requested a 22.9 percent average increase. With the subsidies, the company said that would have been 8.8 percent.

The “cost-sharing” subsidies are under a legal cloud because of a dispute over whether the Obama health care law properly approved the payments. Other parts of the health care law, however, clearly direct the government to reimburse insurers.

With the issue unresolved, the Trump administration has been paying insurers each month, as the Obama administration had done previously.

Trump returned to the subject last week after the GOP drive to repeal the health care law fell apart in the Senate, tweeting, “As I said from the beginning, let ObamaCare implode, then deal. Watch!”

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

It’s not accurate to call the cost-sharing subsidies a bailout, said Tim Jost, a professor emeritus at Washington and Lee University School of Law in Virginia.

“They are no more a bailout than payments made by the government to a private company for building a bomber,” he said.

That’s at the root of the Trump administration’s potential legal problem if the president makes good on this threat.

The health law clearly 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 an “appropriation.”

The Constitution says the government shall not spend money without a congressional appropriation.

Think of an appropriation as an electronic instruction to your bank to pay a recurring monthly bill. You fully intend to pay, and the money you’ve budgeted is in your account. But the payment will not go out unless you specifically direct your bank to send it.

House Republicans trying to thwart the ACA sued the Obama administration in federal court in Washington, 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 on hold before the U.S. appeals court in Washington. A group of state attorneys general is asking the appeals court to let them join the case, in defense of the subsidies.

Both Bagley and Jost have followed the matter closely, and disagree on whether the health law properly approved the payments to insurers. Bagley says it did not; while Jost says it did.

However, the two experts agree that insurers would have a solid lawsuit if Trump stops the payments. Insurers could sue in the U.S. Court of Federal Claims, which hears claims for money against the government.

“The ACA promised to make these payments — that could not be clearer — and Congress has done nothing to limit that promise,” said Bagley.

“I think there would very likely be litigation if the Trump administration tries to cut off the payments,” said Jost.

Another way to resolve it: Congress could appropriate the money, even if temporarily, for a couple of years. Some prominent GOP lawmakers have expressed support for that.

If the president makes good on his threat, experts estimate that premiums for a standard “silver” plan would increase by about 19 percent. Insurers could recover the cost-sharing money by raising premiums, since those are also subsidized by the ACA, and there’s no question about their appropriation.

But millions of people who buy individual health care policies without any financial assistance from the government would face prohibitive cost increases.

And more insurers might decide to leave already shaky markets.

“This is not a game,” said California Attorney General Xavier Becerra. “Millions of people would not be able to afford health insurance for their families.”

Trump’s threats to end CSR payments may mean hospitals will see a rise in uncompensated care costs

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http://www.fiercehealthcare.com/finance/trump-s-threats-to-end-csr-payments-may-mean-hospitals-will-see-a-rise-uncompensated-care?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiT0RKaVpETTRORE5sTURNeSIsInQiOiJ0QlwvRURDeTZRRnpcL2g1eVp4ek4yVTgwM3hcL1lqcjVJdzlqcER3S0JMbFpcL3FwVzI4VEhkYktjWDdiZ3VRcTdBVVZmMml0cHIrc3lrRmhTYWlcL1wvaVRTZTA5VlczZ3I3Z3JkN0FYYTI4VWlJb3grTXZ2UDA5XC9hVTVVN2M3U2UxT3gifQ%3D%3D

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Hospitals had better brace themselves for a possible rise in uncompensated care costs if President Donald Trump makes good on an implied threat to end cost-sharing reduction payments to health insurers.

Trump indicated on Twitter this weekend that he may end “bailouts” for both insurance companies and Congress. Those bailouts refer to CSR payments, which subsidize the out-of-pocket healthcare costs of low-income Affordable Care Act exchange customers.

And if he follows through and decides this week to end those payments, the individual marketplaces could see disastrous consequences. And that means doctors and hospitals may see a spike in uncompensated care costs and bad debt, reports Forbes.

Hospitals have seen a drop in uncompensated care costs and bad debt in the years under the ACA. A recent Politico report found that spending on charity care at the top seven hospitals in the U.S. dropped from $414 million in 2013 to $272 million in 2015.

Furthermore, a recent Kaiser Family Foundation report said that if the CSR payments are withheld, premiums for silver plans would rise by 19% and more payers will likely leave the marketplaces. Doctors and hospitals are concerned that means millions of patients who have purchased insurance through the ACA exchanges won’t be able to afford their out-of-pocket costs for care.

And they have reason to be concerned, Marc Harrison, M.D., president and CEO of Intermountain Healthcare, which operates nonprofit hospitals and clinics and insures more than 800,000 people in Utah, told NPR. Without the CSR payments, rate increases will likely skyrocket. “We’ll see [the number of] people who are uninsured, or functionally uninsured, go way, way up,” he said.

“The American people need this funding to lower what they pay for coverage and be able to see their doctor,” Kristine Grow, a spokeswoman for America’s Health Insurance Plans told Forbes.

Trump is threatening a move that could make Obamacare implode — here’s which states have the most to lose

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http://www.businessinsider.com/obamacare-cost-sharing-reductions-states-benefit-2017-8

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The Trump administration is threatening a move that could make Obamacare implode.

On Tuesday, the administration is expected to make a decision on whether it will stop payments  to insurers that that help offset healthcare costs. President Donald Trump referred to these payments as “bailouts” in a a tweet on Saturday.

“If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” Trump tweeted.

If the Trump administration does decide to end the payments, known as cost-sharing reductions, it could lead to higher premiums and fewer insurance plan choices in the exchanges. CSRs are paid to insurance companies to help offset the cost of discount health plans they provide to Americans making 200% of the federal poverty limit.

Deadline for 2018 coverage

Insurance companies have until late September to raise rates and finalize their coverage areas for 2018. Not receiving CSRs in 2018 could have a serious impact on what those look like.

Already, the market is in flux. On Wednesday, Anthem, the second-largest insurer in the US, said it might leave more markets in 2018. And on Monday, Ohio said it had managed to find insurers for 19 of the 20 counties that had no insurance plans on the exchanges. Ultimately, without the CSRs, many Americans could lose their health insurance.

GOP lawmakers, Trump at odds over insurance payments

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GOP lawmakers, Trump at odds over insurance payments

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Lawmakers are facing off with President Trump over key ObamaCare payments that are in jeopardy after the collapse of efforts to repeal the healthcare law.

Trump is threatening to cancel the payments, known as cost-sharing reductions (CSRs), as part of his effort to make ObamaCare “implode.”

But he is running into opposition from key Republicans, including Senate Finance Committee Chairman Orrin Hatch (Utah) and House Ways and Means Committee Chairman Kevin Brady (Texas), who say they want to find a way to guarantee the payments, which reimburse insurers for giving discounted deductibles to low-income ObamaCare enrollees.

If the payments were cancelled, insurers have warned they would either have to spike premiums to make up for the lost money, or drop out of the market altogether, limiting people’s options for coverage.

Trump could announce that he is cancelling the payments as early as Tuesday.

Rep. Chris Collins (R-N.Y.), one of Trump’s top supporters on Capitol Hill, told CNN on Monday that he had encouraged Trump to announce the cancellation on Tuesday.

Trump has long warned that he could cancel the payments, though it is unclear if he will follow through.

In addition to a premium spike that experts estimate could reach 20 percent, Democrats warn that there would be a political fallout as well if people blame Trump for the chaos.

A Kaiser Family Foundation poll in May found that 63 percent of the public thinks Trump and congressional Republicans are responsible for problems with the Affordable Care Act going forward.

Senate Democratic Leader Chuck Schumer (N.Y.) on Monday said there would be a “Trump tax” on people’s premiums if he cancelled the payments.

Trump seemed to refer to cancelling CSRs on Saturday when he tweeted: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

Trump has alternated between saying he will simply cause ObamaCare to implode and calling for Congress to repeal the law.

In another tweet on Saturday, Trump called for Congress not to give up on repeal and to vote on it before acting on any other bill.

Many congressional Republicans have called for continuing the CSR payments.

In a statement Friday, Brady warned that “simply letting Obamacare collapse” would cause “even more pain” for people in his district facing high premiums and fewer choices.

“For those trapped in Obamacare, we must continue to look for immediate solutions to deliver relief, stop premiums from soaring even higher, and help people get the health care that’s right for them,” Brady said.

Hatch told Reuters in an interview Monday that he did not want to provide funding for the CSRs, but “I think we’re going to have to do that.”

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, has also called for Congress to act on the payments. His committee will be holding hearings on improving the stability of the ObamaCare markets in the near future, which could lead to bipartisan action.

“I guess I’m hopeful that the administration, the president will keep making them and if he doesn’t then I guess we’ll have to figure out from a congressional standpoint what we do,” Sen. John Thune (R-S.D.), the No. 3 Senate Republican, said on Monday.

Sen. John Cornyn (R-Texas), the No. 2 Republican, noted that Trump would have to sign legislation guaranteeing the payments, making it a “challenge.” He also said that the prospect of action by Congress is a “real live issue.”

A House GOP aide said Monday that Republicans are still looking at different legislative vehicles for temporarily guaranteeing the CSR payments.

Democrats are pushing for Congress to guarantee the payments soon, to reduce uncertainty for insurers ahead of an Aug. 16 deadline for filing their premium rates for next year.

In more momentum for congressional action, a bipartisan group of more than 40 House lawmakers on Monday unveiled a proposal to fix problems with ObamaCare, including guaranteeing funding for the CSRs, which would take the issue out of Trump’s hands.

“Cutting off those payments further destabilizes the individual market and these are real people,” Rep. Tom Reed (R-N.Y.), one of the leaders of the bipartisan effort in the House, told The Hill on Monday.

Reed said that while he still supports repeal of the health law, Republicans should try a different, bipartisan, direction rather than “engage in insanity by doing the same thing over and over again.”

Still, there are other Republicans who are still pressing to repeal and replace ObamaCare.

Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) have both attended meetings at the White House in recent days focused on trying to revive such legislation.

The two senators have written a measure that would convert current ObamaCare spending into a block grant given to states, which is aimed at giving states flexibility. Democrats warn the block grants would be significantly less than current spending levels, leading to cuts.

The proposal faces a steep path to passage, especially given that McConnell indicated he is moving on from repeal efforts for now.

Reed said that he had kept House GOP leaders apprised of the bipartisan group’s work.

“I hope so,” Reed said when asked if leadership is open to bipartisan action on healthcare. “The other path is not working.”

Trump Threatens to End Insurance Payments if No Healthcare Bill

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U.S. President Donald Trump threatened on Saturday to end government payments to health insurers if Congress does not pass a new healthcare bill and goaded them to not abandon their seven-year quest to replace the Obamacare law.

In a Twitter message on Saturday, Trump said “if a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

The tweet came a day after Senate Republicans failed to muster enough votes to repeal parts of the Affordable Care Act, President Barack Obama’s signature healthcare bill commonly known as Obamacare.

The first part of Trump’s tweet appeared to be referring to the approximately $8 billion in cost-sharing reduction subsidies the federal government pays to insurers to lower the price of health coverage for low-income Americans.

The second part appeared to be a threat to end the employer contribution for Congress members and their staffs, who were moved from the normal federal employee healthcare benefits program onto the Obamacare insurance exchanges as part of the 2010 healthcare law.

Trump has previously threatened to suspend the payments to insurers, which are determined by the Department of Health and Human Services. In April, he threatened to end the payments if Democrats refused to negotiate over the healthcare bill.

Responding to Saturday’s tweet, Senate Democratic leader Chuck Schumer said that if the president carried out that threat, “every expert agrees that (insurance) premiums will go up and health care will be more expensive for millions of Americans.”

“The president ought to stop playing politics with people’s lives and health care, start leading and finally begin acting presidential,” Schumer said in a statement.

Trump later urged Senate Republicans to try again on a healthcare vote. The Senate is in session for another week before it is scheduled to begin an August recess.

“Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!” Trump said in a subsequent tweet.

Many insurers have been waiting for an answer from Trump or lawmakers on whether they will continue to fund the annual government subsidies. Without assurances, many plan to raise rates an additional 20 percent by an Aug. 16 deadline for premium prices.

With Republican efforts to dismantle Obamacare in disarray, hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets.

   In response, Trump on Friday again suggested his administration would let the Obamacare program “implode.” He has weakened enforcement of the law’s requirement for individuals to buy insurance, threatened to cut off funding and sought to change plan benefits through regulations.

Meanwhile, some congressional Republicans were still trying to find a way forward on healthcare.

Senator Lindsey Graham said in a statement issued late on Friday that he and two other Republican senators, Dean Heller and Bill Cassidy, had met with Trump after the defeat to discuss Graham’s proposal to take tax money raised by Obamacare and send it back to the states in the form of healthcare block grants.

Graham said the move would end Democrats’ drive for a national single-payer healthcare system by putting states in charge.

“President Trump was optimistic about the Graham-Cassidy-Heller proposal,” Graham added. “I will continue to work with President Trump and his team to move the idea forward.”

However, a majority of Americans are ready to move on from healthcare at this point. According to a Reuters/Ipsos poll released on Saturday, 64 percent of 1,136 people surveyed on Friday and Saturday said they wanted to keep Obamacare, either “entirely as is” or after fixing “problem areas.

When asked what they think Congress should do next, most picked other priorities such as tax reform, foreign relations and infrastructure. Only 29 percent said they wanted Republicans in Congress to “continue working on a new healthcare bill.”

Asked what they think Congress should do next, most respondents picked other priorities such as tax reform, foreign relations and infrastructure. Only 29 percent said they wanted Republicans in Congress to “continue working on a new healthcare bill.”