Insurer groups say they still need more clarity from GOP about funding for subsidies

Speaker Paul Ryan said this week that the House won't drop a lawsuit that challenges the legality of a certain type of Affordable Care Act subsidy. Image: Gage Skidmore/CC BY-SA 2.0

Though top Republican lawmakers now say they expect cost-sharing reduction payments to continue through this year, that may not be enough to ease health insurers’ concerns about the Affordable Care Act exchanges.

Cost-sharing reduction (CSR) payments are subsidies the government pays to insurers that they then pass on to ACA exchange customers to reduce their out-of-pocket costs. They are also the subject of a lawsuit brought by House Republicans that argues the funding for those subsidies were never appropriated by Congress. A judge ruled in the plaintiffs’ favor last May, but the Obama administration’s appeal is on hold while the Trump administration decides how it wants to handle the case.

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Health insurers and their various trade groups have been adamant that continuing to fund CSRs is vital, as without those subsidies both insurers and consumers would likely flee the individual marketplaces. America’s Health Insurance Plans, therefore, has requested they be funded through at least 2018.

At his weekly press conference, House Speaker Paul Ryan said the House won’t drop the lawsuit because it makes an important point about the need for Congress to retain its “lawmaking power.”

However, he also said that the Trump administration will continue funding for CSRs while the case is being litigated.

“That’s how they’ve been doing it and I don’t see any change in that,” he said.

House Energy and Commerce Committee Chairman Greg Walden made a similar point, telling reporters Thursday that “I will do everything I can to make sure the cost-sharing reduction payments get made, especially this year where they were promised by the federal government under the contracts,” Bloomberg reported.  

Yet two health insurance trade groups don’t seem to be all that reassured by the Republican lawmakers’ words.

“Continued CSRs are essential to market stability in 2018,” AHIP spokeswoman Kristine Grow wrote in an emailed statement. “Health plans need assurances those payments will continue as they determine whether to participate in exchanges for 2018, and what their premiums would be.”

Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said her group was “pleased Republican leaders appear to understand the importance of cost-sharing reductions,” but added that consumers and insurers alike need more certainty that the funding will continue in the future.

That’s especially important for health plans deciding whether to participate in the exchanges next year, as “filing deadlines are coming up fast and there are still too many unknowns to make responsible business decisions,” she added in an emailed statement.

Crucially, the Trump administration has not yet said what it plans to do about CSRs or the lawsuit that could cut off their funding. During a House subcommittee hearing this week, Department of Health and Human Services Secretary Tom Price said he couldn’t comment on whether the subsidies would continue, citing the fact that he is now named as the defendant in the House’s lawsuit.