Looming filing deadlines, ACA exchange uncertainty put insurers in tough spot

Health insurance, pen and stethoscope
Health insurers see April 30 as a key deadline for a decision on cost-sharing reduction payment funding. Image: Getty/Minerva Studio

With 2018 rate filing deadlines coming up fast, health insurers that offer plans on the Affordable Care Act exchanges are struggling to make business decisions absent the clarity they’ve requested from policymakers and the Trump administration.

Industry representatives, including America’s Health Insurance Plans (AHIP) CEO Marilyn Tavenner, are set to meet with Centers for Medicare & Medicaid Services Administrator Seema Verma on Tuesday to discuss their concerns, according to Bloomberg.

One of the industry’s chief concerns is funding for cost-sharing reduction (CSR) payments, an ACA subsidy at the center of a lawsuit brought by House Republicans. AHIP and other major healthcare trade groups have urged the Trump administration to commit to continue funding the subsidies even after the case concludes, saying the marketplaces would collapse otherwise.

But the Department of Health and Human Services’ most recent statement is that “the administration is currently deciding its position on this matter,” FierceHealthcare has reported.

That puts insurers in a difficult spot, as they see April 30 as a key deadline for a decision on CSR funding, Bloomberg notes. While the federal deadline for qualified health plan applications has been moved from May 3 to June 21, some plans will have to start informing state regulators as early as May whether they will participate in the exchanges next year.

For Sanford Health Plan, which operates in the North and South Dakota individual exchanges, its leaders have been combing through media reports and social media for clues about what’s going on, The Wall Street Journal reports. “It’s a struggle to keep up,” said the company’s executive vice president, Kirk Zimmer.

Minuteman Health CEO Tom Policelli echoed his frustration, telling the WSJ that the nonprofit insurer from New England is likely to propose high rates next year if the uncertainty continues.

For the larger insurers, the picture is no clearer. When contacted, Anthem, Cigna, Aetna and Health Care Service Corp. all declined to commit to selling ACA plans next year, per the Bloomberg article.

A recent report from Jefferies indicated, though, that Anthem appears poised for a major pullback from the marketplaces. Humana has already said it will pull out of the exchanges next year.