Here's what CSR payment uncertainty looks like to insurers

Senate committee Chairman Lamar Alexander speaks with state health insurance commissioners about CSR payments on Sept. 6. Credit: C-Span

Insurers have faced increasing instability in the Affordable Care Act market going into the start of open enrollment on Nov 1.

Nowhere is this felt more than in the price of premiums, after the federal government on Oct. 12 ended cost-sharing reduction payments to insurers.

The CSR payments flowed through insurers to lower-income consumers enrolled in silver-level plans to help enrollees pay for deductibles and out-of-pocket costs. Without the CSRs, insurers have said, premiums would have to increase by 20 percent for them to follow the ACA law in continuing to pay these subsidies.

Insurers had to submit their rates by Sept. 29, before the end of CSRs. Some submitted two sets of premium rates to account for the possibility of no payments. Other were able to change their rates. In two states, Vermont and North Dakota, according to a Kaiser Family Foundation report, insurers had to stick to their original premium price, leaving them to absorb the cost of paying the subsidies for lower-income consumers on their ACA silver plans.

Some insurers adjusted their rates only for silver-level plans within the marketplace, while others increased premiums for all ACA-compliant products both inside and outside the marketplace, the report said.

Insurers also differed on how they reported premiums without the CSRs.

The result is that premium increases for 2018 silver-tiered plans based on the end of CSRs range from 7.1 to 38 percent. But the average of a 19 percent increase is consistent with KFF projections, the report said.

The report shows by plan and state, how the loss of the payments has added CSR surcharges of 6.1 to 34.29 percent to the price of premiums.

Examples of 2018 Insurer Strategies and Rate Increases Attributed to Cost-Sharing Reduction Payments Ending, by State and Insurer

NOTES: "Not specified" indicates the insurer stated the amount of their overall average rate increase attributed to CSR payments ending but did not explicitly state how the increase was applied. Data for Colorado, Montana, and Pennsylvania were confirmed by state insurance departments.

SOURCE: Kaiser Family Foundation analysis of insurer rate filings to state regulators; state insurance regulators.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com