More on Reimbursement

Fate of cost-sharing reduction payments comes into question during spending bill debate

Congress is hammering out premium stabilization measures that may or may not include CSRs or be part of omnibus spending bill.

Susan Morse, Senior Editor

The Trump Administration is sending mixed messages on what it proposes to do with cost-sharing reduction payments for insurers ahead of a two-year government funding bill that is facing a Friday, March 23 deadline.

Both insurers and providers, as well as Sens. Lamar Alexander, Patty Murray and Susan Collins, have called upon Congress to stabilize the individual market by funding the cost-sharing reduction payments as well as the reinsurance program that are part of the Affordable Care Act.

[Also: Insurers, providers call on Congress to reestablish reinsurance, cost-sharing reduction payments]

The CSRs help insurers pay deductibles and other out-of-pocket costs for eligible ACA members.

Alexander, a Republican from Tennessee, and Murray, a Democrat from Washington, who head the Senate Health, Education, Labor and Pensions Committee, have put forward a bill to fund CSRs for two years, in exchange for states getting greater flexibility to waive some ACA requirements. 

But conservative groups are pressuring Congress not to include what they call "taxpayer bailouts," according to the Washington Examiner.

Collins, a Republican from Maine and Senator Bill Nelson, a Democrat from Florida, have also proposed giving states $10 billion for the reinsurance program to help insurers cover the cost of high medical claims, the report said.

President Donald Trump ended CSRs in October, but a stabilization bill aimed at reducing premiums proposes the funds be restored. 

Negotiations are reportedly ongoing, and according to provisions published as part of what's called an Obamacare memo, CSRs are being used as a bargaining tool to get other insurance measures passed.

"Although congressional efforts to provide taxpayer money to prop up the exchanges is understandable, any such efforts must also provide relief to middle-class families harmed by the law and protect life," according to the memo published by The Hill and others.

Lawmakers could potentially use the bill to prevent insurance plans that cover abortion services from receiving CSRs.

Three other policies must be included, the memo said.

First, insurers selling short-term, limited-duration insurance must be able to offer renewals of that coverage without individuals going through health underwriting. 

Secondly, health savings account contribution limits must be upped and be integrated with a broader number of plans. 

Third, premium prices of 5 to 1 must be able to be levied based on age in the individual and small group markets. 

"The president also supports congressional efforts to fund and life-protect Obamacare's cost-sharing reduction (CSR) payments after 2018," the memo states. "This would lower premiums for those who purchase their coverage on the exchanges." 

Insurers have said that the lack of CSRs has increased premiums by about 20 percent, as the ACA mandates that they continue to pay the benefit to qualified members.

Some have sued to get the payments, notably Maine Community Health Options, an ACA co-op.

On March 5, the U.S. Court of Appeals in Washington, D.C., ordered the U.S. House of Representatives and Health and Human Services Secretary Alex Azar file supplemental information on their joint motion for a settlement based on the case that President Barack Obama exceeded his authority by funding over $175 million in CSR subsidies, without Congress's approval.

Twitter: @SusanJMorse
Email the writer:

Show All Comments