Payers weigh participation in ACA exchanges while mired in partisan politics and legal uncertainty

Executive looking out window
Health insurance leaders are caught in the middle of political fighting and legal uncertainty. (Getty/Tom Merton)

With just about a month to go before health insurers must set rates and signal whether they’ll offer plans on Affordable Care Act insurance exchanges, the 90-day delay of a lawsuit over cost-sharing reduction (CSR) payments and partisan politics has put them in a difficult spot.  

Previously, the administration said it would continue funding CSRs while the lawsuit plays out. The case, brought originally by House Republicans against the Obama administration, argues that Congress never appropriated funding for CSRs, so the payments are unconstitutional. 

RELATED: Insurers get 90-day stay in House lawsuit over cost-sharing reduction payments

But then came reports that President Donald Trump was considering withholding the payments to force Democrats to the bargaining table over the GOP’s proposed ACA replacement, the American Health Care Act (AHCA).

And on the heels of that came reports that Centers for Medicare and Medicaid Services Administrator Seema Verma sought political support from insurance companies for the AHCA by offering a deal to continue funding the CSR payments.

HHS denies the report, which was first published in the Los Angeles Times and cited anonymous sources. Democrats jumped on the story, sending a letter to Verma on Sunday.

RELATED: Legal, political and financial wrangling over healthcare reform and cost-sharing reductions coming to a head

“These efforts to use the American healthcare system—particularly a program to assist low-income Americans who benefit from lower deductibles and co-payments under the ACA—as a bargaining chip are unacceptable,” ranking Democrats on four Congressional committees wrote in the letter (PDF). "Your reported actions suggest you are using the operation of the American healthcare system as a tool to gain leverage in political negotiations."

The letter from Sens. Patty Murray (Washington) and Ron Wyden (Oregon), the ranking members of the Senate Finance and Health, Education, Labor and Pensions committees respectively, as well as Reps. Richard Neal (Massachusetts) and Frank Pallone Jr. (New Jersey), the House Ways and Means and Energy and Commerce committee ranking members, respectively, seeks any notes from the meeting during which the comment was alleged to have been made and other communications related to “any other proposed quid pro quos … in which favorable treatment was offered in exchange for support for the AHCA.”

But as the payments to insurers—worth roughly $7 billion this year—stay tied up in lawsuits and political battles, the health insurance industry is left to gamble on whether they can afford to participate in public healthcare exchanges. 

"The Trump Administration is … creating extreme instability in the insurance markets,” Congresswoman Rosa DeLauro, a Democrat from Connecticut, said in a statement that was echoed by several other Democratic legislators.

“With its latest decision to ask for a 90-day delay in the lawsuit over the cost sharing payments, the Trump Administration is injecting uncertainty into the markets at the exact time insurers are setting rates for the upcoming year.”