Because of the uncertainty surrounding the future of cost-sharing reduction payments, Affordable Care Act exchange insurers will now get more time to submit their final rate requests for 2018.
A memo from the Centers for Medicare & Medicaid Services says that insurers will have until Sept. 6 to submit modified rate filings, 3 weeks later than the original deadline of Aug. 16.
The reason for the added flexibility is that CMS intends to make changes to the federal risk adjustment methodology. Those changes, the agency says, will reflect the fact that some states have allowed insurers to increase their silver-plan rates to account for the possible disappearance of CSR payments.
The decision about whether those CSR payments will disappear is in the hands of none other than the Trump administration. It is currently weighing how to handle the previous administration’s appeal of a federal judge’s ruling that the subsides are funded illegally, and thus has not committed to continuing the payments.
The uncertainty over the CSR program’s fate has factored heavily into insurers’ filings for 2018 exchange participation and rates. Citing “continual changes and uncertainty in federal operations, rules and guidance,” Anthem has already said it will exit five states’ exchanges and lessen its footprint in two other states next year.
But while CMS extended the rate-filing deadline to account for that uncertainty, its memo made clear that the issue driving it hasn’t been resolved.
“At this time, there have been no changes regarding HHS’s ability to make cost-sharing reduction payments to issuers,” it states.
In what will likely add more fuel to the debate, the Congressional Budget Office says it plans to release an analysis this week that estimates the effects of terminating CSR payments.
Congress could solve the problem once and for all by enacting a bill to permanently appropriate funding for the CSR program. In fact, one Senate committee plans to hold hearings on the matter—and other fixes for the ACA exchanges—next month.
Over in the House, GOP reps. Tom MacArthur of New Jersey and Mark Meadows of North Carolina are working on an individual market stabilization package that would include making CSR payments to insurers in exchange for “very flexible” language about the role of 1332 waivers under the ACA, Axios reports.
Some members of the House Freedom Caucus, however, are hoping to revive the flat-lined ACA repeal push by forcing a vote on a measure similar to one that recently failed in the Senate, according to The Washington Post. House Speaker Paul Ryan hasn’t publicly addressed that effort, but Rep. Jim Jordan, R-Ohio, told the publication that Ryan “doesn’t think there are the votes there.”