Benefits, Cost-Sharing (Reductions), Health Care Reform

What Is Happening with Health Care Reform & CSRs?

A lot has happened since October 12th when President Trump & the Dept. of HHS issued separate Announcements  halting reimbursements to insurance companies for the cost-sharing reduction (CSR) subsidies they are required by law to provide to low-income enrollees on the Exchange.  Earlier that same day the President also issued an Executive Order directing regulatory agencies to take whatever regulatory actions they could to expand use of HSAs, association health plans and short-term limited duration  insurance (STLDI) policies.  (Click here for recent article on this website.)  Here is a short summary of developments since October 12th:

  1. The Senate HELP Committee proposed a bipartisan bill to extend CSR reimbursements for two years to stabilize the individual markets, and also to give states flexibility with some ACA requirements. (Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash.)  President Trump initially supported the bill but quickly changed his mind and said he would not approve it unless it also included repeal of the individual and employer mandates and expansion of other coverage options such as the ones he proposed in his Executive Order October 12th.  Senate Majority Leader Mitch McConnell, R-Ky., said he would not bring the HELP committee bill to the floor for a vote unless he knew that President Trump would sign it.
  2. A bipartisan group of 10 governors sent a letter to Senate and House leaders (October 18th ) urging them to pass the Senate HELP Committee/Alexander-Murray bill.  Signatories of the letter were Governors John Kasich, R-Ohio, John Hickenlooper, D-Colo., Steve Bullock, D-Mont., Bill Walker, I-Alaska, Tom Wolf, D-Pa., Brian Sandoval, R-Nev., Terry McAuliffe, D-Va., John Bel Edwards, D-La., Charlie Baker, R-Mass., and Phil Scott, R-Vt.
  3. On October 13th the attorneys general of 18 states and the District of Columbia filed a lawsuit (State of California, et al., v. Donald J. Trump, et al.), in response to President Trump’s Oct. 12th announcement he would end CSR reimbursements to insurers.  The lawsuit seeks a temporary restraining order and a nationwide injunction to compel the Trump administration to continue making CSR payments until this lawsuit is resolved. The states argue that Congress has appropriated funds to cover the CSR reimbursements and that the ACA language appropriating funds for the premium tax credits also applies for the CSR payments. Although a lower court rejected this argument in the House v Price lawsuit, that court’s decision is not binding on any other federal court. The lawsuit also argues that the President’s Order to immediately halt CSR payments was “arbitrary and capricious” and violates the Administrative Procedures Act. The brief quotes from many of President Trump’s tweets as evidence of his motives and lack of legal basis in issuing the Order.The states joining California in the lawsuit are: Connecticut, Delaware, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia and Washington, as well as the District of Columbia.
  4.  Hospital groups filed a friend-of-the-court (amicus curiae) brief  in support of the attorneys general in State of California v. Trump.  Hospital groups include: the American Hospital Association, Federation of American Hospitals, Catholic Health Association of the United States and Association of American Medical Colleges. “
  5. On Monday, October 23rd, a federal district judge in San Francisco heard arguments in State of California v Trump and questioned why he should order CSR payments to resume. Judge Vince Chhabria said that consumers in California and some other states do not face an immediate threat of higher costs if the President’s Order remains in effect because California and other states have already taken steps to prevent consumers from being hurt by it. In anticipation of this possible move by President Trump, some states told insurers to submit two rates—one if the CSR payments continued and one if they did not—and only allowed insurers to apply the rate increases attributable to no CSR payments to those exchange plans for which premium tax credits would apply (i.e., the second-lowest- cost silver plans on the exchange). Judge Chhabria did not issue a ruling yet.

Stay tuned!  Who knows what will happen next?

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