Meeting with Seema Verma offers little to insurers seeking answers about ACA subsidies

Centers for Medicare & Medicaid Administrator Seema Verma met with health insurance industry leaders Tuesday, but didn't offer them much more clarity about funding for cost-sharing reduction payments. Image: Office of the Vice President

Health insurance leaders hoping to get more insight about the future of a key Affordable Care Act subsidy left a meeting with the Trump administration on Tuesday largely empty-handed.

The meeting took place between Centers for Medicare & Medicaid Services Administrator Seema Verma and representatives from America’s Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association, Molina Healthcare, Oscar Health, Kaiser Permanente, Geisinger Health Plan and Tufts Health Plan, The Washington Post reported.

The major issue at hand was what will happen to cost-sharing reduction (CSR) payments next year and beyond. Indeed, AHIP spokeswoman Kristine Grow wrote in a statement following the meeting that the group told Verma it's biggest concern is “the instability in the individual market created by the uncertainty of funding” for the CSR program.

“We are committed to working with Administrator Verma, the administration and Congress to ensure CSR funding is addressed quickly to provide clarity for consumers in 2017 and 2018,” Grow wrote in her statement.

AHIP and other healthcare industry leaders have urged Congress and the administration to commit to funding CSRs next year, arguing that the subsidies, which are paid to insurers to help them reduce consumers’ out-of-pocket costs, are necessary to ensure a stable marketplace.

But House Republicans mounted a successful legal challenge to the constitutionality of their funding, a ruling that the Obama administration appealed. The case is on hold while the Trump administration decides how to proceed with that appeal.

During Tuesday’s meeting, Verma did not offer any more assurances to the health insurance industry, instead telling those in attendance that it is up to Congress to decide the fate of CSRs, according to The New York Times.

Trump indicated in an interview with The Wall Street Journal last week that he hasn’t taken a position on funding for CSRs in a bid to get Democrats to “start calling me and negotiating,” as FierceHealthcare reported. Those comments led top Democrats to say that CSRs are among their top priorities as they get ready to negotiate an appropriations bill with the GOP.  

For his part, House Speaker Paul Ryan has said that Congress does not intend to drop the lawsuit. Both he and the Trump administration have said funding for the subsidies will continue while the case is being litigated, but insurers have argued that doesn’t help them much when trying to plan their marketplace participation for all of 2018.

Key filing deadlines, during which insurers decide which individual market plans they will sell next year and how to price them, are fast approaching, lending extra urgency to their request for more clarity about CSRs.

Even amid all the uncertainty, newly published research from Oliver Wyman found that the “vast majority” of health insurers remain committed to operating on the ACA exchanges next year. But the firm also noted that “payers may withdraw from the market at any time prior to final agreements with the public exchanges and new information or policy developments could change their assessment of the situation.”

Humana has already decided to exit the marketplaces in 2018, and one analyst report indicated Anthem, a major player on the exchanges, may also be considering a significant pullback. Other large insurers like Aetna, Molina and Cigna are still on the fence about their exchange presence next year.