Payer, provider groups press Trump on ACA subsidy funding

Several of the country’s most powerful healthcare industry groups have appealed directly to President Donald Trump to end the uncertainty about whether his administration will continue funding a critical Affordable Care Act subsidy.

Their plea comes amid news that Trump is using funding for cost-sharing reduction (CSR) payments as a bargaining chip to compel Democrats to work with him on healthcare reform.

CSRs are subsidies that the government pays to insurance companies so they can reduce Affordable Care Act exchange customers’ out-of-pocket expenses. They are the subject of a lawsuit in which House Republicans claimed the Obama administration illegally funded them without congressional approval. A federal judge has already ruled in the House’s favor, but the case is on hold while Trump’s administration decides how to handle an appeal of that ruling.

In their letter to Trump on Wednesday, groups including America’s Health Insurance Plans, the American Medical Association, the American Hospital Association, the Blue Cross Blue Shield Association, the American Academy of Family Physicians and the Federation of American Hospitals tell the president in no uncertain terms that CSRs must continue to be funded.

“The most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions,” the groups wrote. Without funding for the subsidies, they said, health plans could exit the marketplaces and premiums could rise, pushing more people out of the marketplaces. That, in turn, could lead to more uninsured individuals and higher rates of uncompensated care for providers.

Trump’s administration has sent mixed messages on its plans for funding CSRs. The New York Times reported earlier this week that funding for them would continue after the Department of Health and Human Services sent a statement saying it would do so “while the lawsuit is being litigated.” But then HHS issued a statement saying the Times report was “inaccurate,” according to The Hill, and said that “the administration is currently deciding its position on this matter.”

That was no accident, Politico reported, as an “incensed” Trump called HHS Secretary Tom Price to order the second statement after reading the Times article and worrying it hurt his negotiating position with Democrats.

Trump confirmed his stance in an interview with The Wall Street Journal, telling the publication that “Obamacare is dead next month if it doesn’t get that money.”

Trump said that he hasn’t made his viewpoint clear yet about what to do about the subsidies, adding, “what I think should happen and will happen is the Democrats will start calling me and negotiating.”