Health insurers are baffled, and more than a bit annoyed, that government plans on whether or not to keep paying them subsidies for their participation in the ACA are up in the air.
Insurers say they need a strong statement of intent to help them decide whether to participate in the individual ACA market exchanges next year.
While the Department of Health and Human Services recently said it hasn’t changed the precedent which would see the government agency continue to pay for the Affordable Care Act’s cost-sharing reduction payments to health insurers while a lawsuit about the subsidies continues, insurers are still unsettled.
“You can’t run a multimillion dollar health plan on a nice statement,” says Ceci Connolly, the president and CEO of The Alliance of Community Health Plans.
Current legislations requires many insurers to file their 2018 premium rate requests by June 21, but insurers are focused on two main dates: the first, April 28, marks the date government funding is set to expire, and the second, May 22 when the House of Representatives and the Trump administration are set to update the status of a U.S. Court of Appeals lawsuit over such payments.
House Speaker Paul Ryan says that lawsuit will remain on the books as Republicans seek to clarify the wider issue of whether or not the White House has the power to make subsidy payments without specific appropriations from Congress. Some House Republicans are saying they have a plan on the table which would guarantee those appropriations to allow insurers to continue receiving the subsidy payments.
“While the lawsuit is being litigated, then the administration funds these benefits. That’s how they’ve been doing it and I don’t see any change in that,” Ryan said last month.
House Republicans filed the suit during the previous administration over “cost-sharing reductions,” or CSRs, aimed at reimbursing insurers for providing discounted deductibles to low-income ACA enrollees.
Insurers are worried the payments could be discontinued, which could throw the market into chaos and cause insurers to pull out of the marketplaces.
Ryan indicated that the administration will continue funding the payments while the lawsuit runs its course.
Kristine Grow, the senior vice president of communications for America’s Health Insurance Plans, says the lack of information will hurt insurers ability to serve consumers.
“Plans need more certainty. As plans make decisions for 2018, they do so with a view of wanting to serve consumers in the market for the full year. That’s why it’s so important to know what will happen with CSRs long term,” Grow says.
According to a Kaiser Family Foundation analysis, the average premium for a silver plan sold on the ACA marketplace would require a 19 percent increase in for insurers to make up for the lost funding if the federal government fails to provide the subsidy payments.
“It’s been clear to us for a while, based on public and private conversations, that the administration and leaders in Congress understand how important the cost-sharing reductions are,” Connolly says. “That’s very positive. But we continue to look for certainty because businesses need to make rational decisions about products and pricing.”