The nation's state insurance commissioners urged the Trump administration Wednesday to ensure continued funding for payments to health insurers to cover cost-sharing reductions for low-income exchange plan members.
The National Association of Insurance Commissioners, most of whose members come from Republican-led states, told Office of Management and Budget director Mick Mulvaney in a letter that continuing the cost-sharing reduction payments "is critical to the viability and stability of the individual health insurance markets in a significant number of states across the country."
The NAIC also wrote to Senate leaders Wednesday urging them to take swift action to stabilize the individual insurance markets, including funding the CSR payments and providing sufficient money for reinsurance programs or high-risk pools.
The commissioners warned Mulvaney, a fierce opponent of the Affordable Care Act and critic of the law's CSR payments, that more insurers will exit the markets in 2018 and premiums will spike if carriers don't receive assurance soon that they will receive the approximately $7 billion in federal payments.
Immediate action is needed, they said, because carriers are making decisions now whether to offer plans on the exchanges in 2018 and where to set premiums.
Citing uncertainty over the CSR payments as one big factor, insurers say they'll have to charge much higher rates for next year. Plans in Connecticut have requested increases ranging from 15% to 34%. Maryland rate hikes range from 18% to nearly 60%. Most of Virginia's insurers have requested double-digit jumps.
House Republicans successfully sued to block the ACA-required CSR payments on the grounds that the Obama administration funded them without the money being appropriated by Congress, whose Republican majority refused to approve it. The Obama administration appealed the district court's ruling, but the Trump administration hasn't declared whether it will continue the appeal. A status hearing on the case is scheduled for next week.
Meanwhile, President Donald Trump has sent mixed signals on whether his administration will continue making the payments to insurers beyond this month, recently warning that he was considering cutting them off. Experts say if that happened, some insurers might seek to terminate their 2017 exchange plans.
"As long as the court case, House v. Price, remains unresolved and federal funding is not assured, carriers will be forced to think twice about participating on the Exchanges," the NAIC wrote.
Julie Mix McPeak, the Tennessee insurance commissioner and NAIC president-elect, said in a recent interview that she got nowhere trying to determine who is making the decision whether to continue the CSR payments. "We're interacting with Congress. We're interacting with the Trump administration and you're hearing, 'It's HHS. It's OMB. It's the Department of Justice. It's the president himself.' It's been hard for us."
Leaders of two major healthcare industry groups told Modern Healthcare this week that it appears the decision lies with Trump himself.
Meanwhile, some Senate Republicans are discussing putting together a short-term insurance market stabilization bill including funding for CSR payments to insurers while they work on a broader bill to repeal and replace the Affordable Care Act. But it's far from clear whether they can draw enough Republican and Democratic support to pass such a bill, and whether it would have any chance in the more conservative U.S. House of Representatives.
The administration and congressional Republican leaders could face political peril if they don't act soon on funding the CSR payments and the individual market, which covers nearly 20 million people, unravels. A recent Kaiser Family Foundation poll found that 75% of those surveyed said the administration should do what it can to make the ACA markets work, while 61% said Trump and congressional Republicans are responsible for any future problems.
