The Trump administration’s announcement that it will end cost-sharing reduction payments has led to a chorus of calls for Congress to step in—but that effort faces steep obstacles.
“With the administration’s decision to terminate this funding, Congress must take action immediately,” stated a letter (PDF) sent to congressional leaders by America’s Health Insurance Plans, the Blue Cross Blue Shield Association, the U.S. Chamber of Commerce and healthcare provider trade groups.
Without congressional action, “millions will face higher premiums, fewer choices and less access to the medical care they need,” the letter added.
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The American Academy of Actuaries offered a similar message.
“Permanently funding the CSR reimbursements through congressional action is needed to avoid further premium increases and insurer market withdrawals that could lead to a loss of coverage,” said Academy Senior Health Fellow Cori Uccello.
In the Senate, Republican Lamar Alexander and Democrat Patty Murray of the Health, Education, Labor and Pensions Committee have been trying to craft a bipartisan ACA stabilization bill that would including CSR funding for up to two years.
“I continue to be optimistic about our negotiations and believe we can reach a deal quickly—and I urge Republican leaders in Congress to do the right thing for families this time by supporting our work,” Murray said in a statement Friday.
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But she and Alexander will face formidable opposition from the right—where some see the decision to end CSR payments, combined with executive order aiming to relax the Affordable Care Act’s insurance regulations, as the GOP’s best chance to unravel the law.
Rep. Mark Walker, R-N.C., tweeted late on Thursday that Congress must avoid “cutting a check” for insurance company bailouts:
Under no circumstance should Congress attempt to expand Obamacare by cutting a check for President Obama’s bailout of insurance companies. https://t.co/86A86qyBXw
— Rep. Mark Walker (@RepMarkWalker) October 13, 2017
And Budget Director Mick Mulvaney told Politico on Friday that President Donald Trump won’t support a Murray-Alexander bill that continues what he sees as “corporate welfare and bailouts for the insurance companies.”
On Twitter, Trump also bragged about how his decision to end CSR payments affected insurance companies’ stocks:
Health Insurance stocks, which have gone through the roof during the ObamaCare years, plunged yesterday after I ended their Dems windfall!
— Donald J. Trump (@realDonaldTrump) October 14, 2017
That stance could be politically perilous, however. Nearly 70% of those who benefit from CSR payments live in states that Trump won, according to an Associated Press analysis.
Those who qualify will continue getting the subsidies since insurers are obligated to pay them, but the risk for consumers is that lack of federal funding for CSRs could cause premiums to rise and possibly spur insurer exits.
There haven’t been any reports of insurers deciding to leave the individual markets yet, noted a Health Affairs Blog post from Washington and Lee University Professor Tim Jost. Insurers in states that use the federal exchange do have the right to terminate their contracts now that CSRs have ended, but they also must give notice as mandated by individual states. Those that leave the exchanges would also have to transfer their enrollees to off-exchange policies.
In sum, “the ability of insurers to leave the exchanges will vary from state to state, and will not be easy anywhere," Jost wrote.