CSR Payments Continue in August, HELP Committee Schedules Hearings on Stabilizing Markets

The White House confirmed last week that it will continue to make cost-sharing reduction (CSR) payments for the month of August. The Trump administration has been making decisions on whether to continue to fund CSRs on a monthly basis, and had previously suggested that it might soon put an end to CSRs.

CSR payments, which provide extra financial assistance to help consumers who make from 100% to 250% of the poverty line cover co-payments and deductibles, are paid in the form of subsidies to insurance companies, and are provided for in the Affordable Care Act (ACA). The nonpartisan Congressional Budget Office (CBO) estimated that terminating CSR payments would increase the federal deficit by $194 billion through 2026. Because tax subsidies would increase as premiums for silver plans increase, the average subsidy per person would be greater, and more individuals would receive such subsidies. Additionally, the CBO said that cutting off CSR payments could trigger a withdrawal of insurers from some states because of “substantial uncertainty about the effects of the policy” on individuals purchasing plans.

The Kaiser Family Foundation has indicated that, based upon preliminary insurer rate filings, insurers are already beginning such withdrawals; the Foundation reports that Ohio’s Paulding County is expected to have no insurers in 2018 after Anthem—with its selection of 334 plans—exits. If no other insurer enters the local ACA marketplace, residents of Paulding County will not be able to purchase plans that qualify for federal subsidies.

Fourteen counties in Nevada faced a similar challenge after Anthem’s announcement of its withdrawal from the Nevada ACA market, but, as Inside Health Policy reports, a new insurer has stepped in to provide coverage. Nevada Governor Brian Sandovol (R) said that Centene will cover the 14 counties—which are home to approximately 8000 people—that would have been left without coverage in the wake of Anthem’s exit. Centene had previously planned to expand into 3 of the counties.

“It was unacceptable to me to have something like this,” Sandovol said. “It was frustrating and embarrassing for the state of Nevada to not have coverage in those areas.”

As state leaders attempt to secure coverage for their residents, bipartisan efforts to stabilize the ACA markets are underway in the Senate. Senator Lamar Alexander (R-Tennessee), who also led bipartisan efforts to pass the FDA Reauthorization Act of 2017, and Senator Patty Murray (D-Washington) yesterday announced the first 2 hearings before the United States Senate Committee on Health, Education, Labor, and Pensions (HELP) on stabilizing premiums in the ACA insurance market. The meetings, scheduled for September 6 and September 7, will include testimony from state insurance commissioners and governors.

Lamar said, “Any solution that Congress passes for a 2018 stabilization package will have to be small, bipartisan and balanced. It should give states more flexibility in approving insurance policies…as well as fund the [CSR] payments to help stabilize premiums for 2018. I look forward to finishing our work by the end of September in time to have an effect on the health insurance policies sold in 2018.”

Murray added that she hoped “that we can act quickly and in a responsible manner that builds upon our efforts to make health care more affordable, accessible, and higher quality for all.”