Without cost-sharing reduction payments for insurers, safety net health plans that operate on limited margins would be forced to stop offering coverage in the Affordable Care Act marketplace, said four healthcare organizations that have added their voices to those urging Congress to fund CSRs.
Insurers are currently determining their rates for 2018 and need the certainty of the federal funding for cost-sharing reduction payments, they said. The federal deadline to file rates is June 21.
Without the subsidized funds that insurers use to reduce costs for beneficiaries, ACA premiums will rise, said safety net organizations America's Essential Hospitals, the Association for Community Affiliated Plans, the Association of Clinicians for the Underserved and the National Association of Community Health Centers in an April 20 letter to House Speaker Paul Ryan, Majority Leader Mitch McConnell, Minority Leaders Nancy Pelosi and Democratic Leader Chuck Schumer.
Insurers would have to raise consumer premiums by an average of 20 percent and up to 30 percent, they said.
"Many individuals will be unable to afford coverage if premiums rise drastically, leading them to drop coverage altogether," they said. "The resulting impact is an increase in the uncompensated care burden for hospitals, community health centers, and other safety-net providers in particular."
The funding is key to giving low-income consumers access to affordable care, as close to six million people, or about 56 percent of marketplace enrollees, each received the benefit of an estimated $1,000 in offset healthcare costs through the CSRs paid to insurers.
"Contrary to popular belief, eliminating federal CSR funding would actually increase taxpayer spending, not decrease it," they said. "Advanced premium tax credits for marketplace plans, which are federally funded, would increase, as they are based on the cost of coverage."
Increases to APTC would cost the federal government more than funding the CSRs by at least $2 billion more annually, they said.
The organizations, as other healthcare groups have recently done, asked Congress to work with the Trump administration to stabilize the individual market by taking swift action to fund CSRs in the upcoming budget resolution.