Update on CSRs for affordable healthcare

Posted by admin in Daily Dose on November 01, 2017 # Insurance, Advocacy and Policy

Over the past few weeks, you’ve probably heard a lot about the Trump Administration’s decision to end Cost-Sharing Reduction (CSR) payments. These payments go to insurers to reimburse them for discounts that the Affordable Care Act (ACA) requires them to give lower-income customers with health plans through ACA marketplaces. These payments make coverage accessible for many patients and families who otherwise could not afford health insurance or care. President Trump ended these payments earlier this year, and this week a federal judge in California denied a request from 19 attorneys general to force the administration to resume funding CSRs.

Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. The timing is critical as open enrollment begins this week.

Congress has introduced two bills to try to save the marketplaces. One is a bipartisan plan introduced by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA). It includes provisions important to patients such as providing CSR payments for two years, protecting access to quality coverage, maintaining diverse risk pools, and bolstering individual market enrollment outreach and support. The bill also includes provisions to ensure access to quality care by preventing pre-existing conditions and rating restrictions, as well as maintaining diverse risk pools. In addition to having broad bipartisan support in the Senate, the Congressional Budget Office (CBO) estimates it would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance.

However, last week, Republicans introduced a new plan that also claims to stabilize the ACA. The plan, drafted by Senator Orrin Hatch (R-UT) and Representative Kevin Brady (R-TX), would also fund cost-sharing reduction subsidies for two years, but would waive the ACA’s individual mandate for five years, essentially replacing one source of rising premiums with another. The bill also requires that in order to receive CSR payments, insurers must meet certain conditions. The bill is an attempt to placate legislators who argue if they're going to keep the law's cost-sharing payments flowing, they should be able to negotiate regulatory reforms in exchange.

While there is bipartisan consensus that CSRs should be reinstated, the Hatch-Brady proposal includes partisan provisions that make it highly unlikely to be approved by the Senate. The bill would need 60 votes to pass the Senate, and waiving the individual mandate virtually assures that no Democrat would support the bill. The Alexander-Murray proposal, on the other hand, seems to have enough bipartisan support to pass the Senate, but it’s unclear if it could pass the House or if President Trump would sign it. The timing is also unclear; Speaker of the House Paul Ryan (R-WI) said this week "I can't imagine passing a health-care bill this year.”

Thus, even with open enrollment looming, there is more uncertainty about the future of CSRs than ever, and those covered under the Affordable Care Act may find it considerably more difficult to get insured.

While we continue working in Washington to restore CSRs and maintain provisions critical for patients, the 2018 open enrollment period is from November 1, 2017 – December 15, 2017. Many families who rely on the ACA marketplace still qualify for financial help. You can shop for the plan you and your family need and find out if you qualify for financial help by visiting healthcare.gov.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.