Ceci Connolly, president of the Alliance of Community Health Plans, said there is a "real danger" in not addressing CSR payments. "If the CSRs go away and many of those working families decide they can't afford coverage without that help, that has real negative effects on the risk pool, which will in turn have negative effects on health plans, which will in turn have negative effects on the market. It is a fragile assembly of pieces that could fall apart very quickly."
Insurance companies also face the prospect that Trump may sign an executive order soon to allow cross-state insurance sales. Experts have long warned that such a policy would weaken consumer protections and further damage the individual market.
Michael Consedine, CEO of the National Association of Insurance Commissioners, said in a statement that the NAIC "has long been opposed to any attempt to reduce or pre-empt state authority or weaken consumer protections." He noted that insurers already are able to sell plans in multiple states.
Insurance companies are also pressing the Trump administration to continue enforcing the individual mandate, which requires most people to enroll in coverage, and reinstate funding for Obamacare marketing and outreach. HHS announced in August that it would slash the marketing budget, and many plans worry those cuts, coupled with a weakly enforced mandate, will lead to lower enrollment. Now, 10.3 million Americans are enrolled in ACA marketplace coverage.
Providers, insurers and state insurance departments are stepping up their outreach efforts in the wake of the loss of federal funding.
"We have the same mechanisms in place to support enrollment in exchange plans or Medicaid expansion and continue those efforts, notwithstanding the administration's efforts around decreasing funding for navigators," said Dr. Richard Gilfillan, CEO of Catholic-sponsored system Trinity Health, based in Livonia, Mich.
Not-for-profit safety net health plans in the Association for Community Affiliated Plans will also do their own marketing, according to association CEO Margaret Murray. She added that her organization is pushing for reducing the number of plans that don't comply with the ACA, such as grandfathered health plans, which she said help to destabilize the individual market and increase premiums.
Healthcare companies are hopeful a bipartisan solution to stabilize the ACA marketplace can be reached. They are urging Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to revisit their bipartisan talks to shore up the individual insurance marketplaces in time for open enrollment, which begins Nov. 1.
In September, the two senators held a series of hearings before the Health, Education, Labor and Pensions Committee on how to stabilize the market, but the conversation was abandoned when Republicans returned their attention to repealing the ACA.
"I hope that there will be a more bipartisan approach to looking at the kinds of things that can improve market stability," UPMC's Holder said. "When insurance markets are stable or more stable, it allows (insurers) to plan more effectively."