White House proposes reviving CSRs—if conservative policies are attached

The White House is pushing Congress to adopt a series of new healthcare coverage ideas that it feels could lead to lower premiums. Critics argue that costs for many could actually rise if implemented.

In a memo released by the executive branch Tuesday, the White House asked Congress to allow long-term use of short-term plans, increase premiums for older Americans on the insurance exchanges and expand access to health savings accounts.

The Trump administration claimed any congressional efforts to prop up the exchanges was "understandable," but relief also has to be provided to middle-class families.

The memo came as a surprise after the White House ended federal CSR payments last fall. The decision to stop the payments grew out of a lawsuit filed by House Republicans in 2014 alleging the Obama administration was unconstitutionally making payments that were never appropriated by Congress.

The CSRs are paid to insurance companies, who are required by the ACA to lower the out-of-pocket costs, including copayments, coinsurance and deductibles, for people who make up to 250% of the federal poverty level.

The Trump administration's push for expanded access to short-term plans comes weeks after a proposed rule suggested similar changes. The coverage options are not subject to certain Affordable Care Act rules, including requirements that insurance plans must cover 10 essential health benefits and pre-existing conditions without annual or lifetime limits.

The memo's second request is allowing insurers to charge older customers premiums that are five times more than what younger people pay, up from the three times more that's now in effect. The move aims to bring more young people into the individual marketplace.

The final change is expanding access to health savings accounts by raising HSA contribution limits and allowing HSAs to be integrated with a broader number of plans.

On top of this package of policy ideas, Trump is asking that whatever legislative package Congress passes, it should "be properly designed … to ensure all federal dollars are life-protected."

Former acting CMS Administrator Andy Slavitt immediately slammed the proposals on Twitter. "The policies would raise costs for seniors, people with illnesses, women and add unacceptable conservative policies while raising costs for low income population," Slavitt said. "Why choose between sabotage, bad faith and higher costs when you can do all three."

Just under 12 million people signed up for 2018 individual coverage in the ACA marketplaces. Without CSRs, premiums could begin to rise, especially for Obamacare enrollees who earn too much income to qualify for tax credits. It could also limit coverage options if plans exit over financial losses that result from ending the federal payments.