Trump’s threats to end CSR payments may mean hospitals will see a rise in uncompensated care costs

If President Trump decides to withhold or end CSR payments, it could result in disastrous consequences for the individual marketplaces. Doctors and hospitals may see a spike in uncompensated care costs and bad debt.

Hospitals had better brace themselves for a possible rise in uncompensated care costs if President Donald Trump makes good on an implied threat to end cost-sharing reduction payments to health insurers.

Trump indicated on Twitter this weekend that he may end “bailouts” for both insurance companies and Congress. Those bailouts refer to CSR payments, which subsidize the out-of-pocket healthcare costs of low-income Affordable Care Act exchange customers.

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And if he follows through and decides this week to end those payments, the individual marketplaces could see disastrous consequences. And that means doctors and hospitals may see a spike in uncompensated care costs and bad debt, reports Forbes.

Hospitals have seen a drop in uncompensated care costs and bad debt in the years under the ACA. A recent Politico report found that spending on charity care at the top seven hospitals in the U.S. dropped from $414 million in 2013 to $272 million in 2015.

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Furthermore, a recent Kaiser Family Foundation report said that if the CSR payments are withheld, premiums for silver plans would rise by 19% and more payers will likely leave the marketplaces. Doctors and hospitals are concerned that means millions of patients who have purchased insurance through the ACA exchanges won’t be able to afford their out-of-pocket costs for care.

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And they have reason to be concerned, Marc Harrison, M.D., president and CEO of Intermountain Healthcare, which operates nonprofit hospitals and clinics and insures more than 800,000 people in Utah, told NPR. Without the CSR payments, rate increases will likely skyrocket. "We'll see [the number of] people who are uninsured, or functionally uninsured, go way, way up," he said.

“The American people need this funding to lower what they pay for coverage and be able to see their doctor," Kristine Grow, a spokeswoman for America’s Health Insurance Plans told Forbes.