Senate committee recommends extending cost-sharing reduction payments through 2018
America's Health Insurance Plans, the American Hospital Association and six other organizations want CSR payments through 2019.
Senate committee Chairman Lamar Alexander speaks with state health insurance commissioners on Wednesday. Credit: C-Span
The chairman of a bipartisan Senate committee has suggested the continuation of cost-sharing reduction payments to insurers through the end of 2018.
This is a year short of the 2019 guarantee recommended by eight healthcare organizations in a Sept. 5 letter to the Senate Health, Education, Labor and Pensions Committee.
[Also: CMS extends ACA premium rate filing deadline due to change in CSR risk adjustment methodology]
Committee Chairman Lamar Alexander said Wednesday he wanted members to come to a consensus by the end of next week so that insurers would know the result prior to their Sept. 20 deadline to file their final premium rates and a Sept. 27 date for the rates to be posted on Healthcare.gov.
Insurers need to know whether the cost-sharing reduction payments will continue to avoid a 20 percent increase in premiums for the 2018 ACA market and to ensure the availability of plans, Alexander said.
Alexander also recommended that states be given more flexibility over Affordable Care Act mandates by amending a Section 1332 waiver already in the ACA. This will allow states flexibility over coverage of essential health benefits, while protecting the ACA mandate to cover pre-existing conditions and to allow adults until age 26 to remain on their parents' plans, he said.
Twenty-three states have begun steps towards getting a waiver, seven have applied, and two -- Alaska and Hawaii -- have gotten waivers, he said.
[Also: Providers say replace, payers still waiting for CSR stability, as McConnell scraps Senate bill]
Alexander and Sen. Patty Murray, ranking member of the committee, both stressed the bipartisan effort to come to a consensus without what Alexander called making "political hay" by blaming either Republicans or Democrats.
The committee is holding four hearings this week and next over premium rates. Today members are meeting with state insurance commissioners, and on Thursday with governors. On Tuesday, they will meet with experts on giving states more coverage flexibility and on Sept. 14 they will meet with with healthcare stakeholders.
Those include Marshfield Clinic Health System CEO Susan Turner, MD, and Robert Ruiz-Moss, vice president of the individual market segment for Anthem in Denver.
Earlier this week, eight healthcare organizations urged Alexander and Murray to stabilize insurance coverage by ensuring continued funding for cost-sharing reduction payments for at least two years, through 2019.
America's Health Insurance Plans has long pushed for continued CSR funding. The letter was sent by AHIP, BlueCross BlueShield Association, the American Academy of Family Physicians, the American Medical Association, the American Hospital Association, the Federation of American Hospitals, the American Benefits Council and the U.S. Chamber of Commerce.
"Without two years of CSR funding, uncertainty will persist and the Congress will need to address these same issues early next year," the groups said in the letter. "In addition, without a break in funding for the CSRs, we expect that this provision would not contribute to the federal deficit. By committing to CSR funding for two years, it would go a long way to bring much needed stability to the individual market and promote access to more affordable coverage and choices for millions of Americans."
Ending CSRs would actually increase the federal budget deficit by $194 billion over the next 10 years, the groups said, citing a Congressional Budget Office report. This is due to federal funding for tax credits.
Rosemarie Day, founder of Day Health Strategies and former chief operating officer of the Massachusetts Health Connector, said she learned through her work in Massachusetts that insurers need to be treated as business partners.
"The longer the time horizon you can give, the better it can be for more stabilization," Day said. "Two years are better than one year. If you create uncertainty, you get a real bad partner."
The ripple effect of having consumers uninsured is that hospitals bear the cost of uncompensated care, she said.
The individual market of about 22 million people represents about 7 percent of the health insurance market. Many in this market find coverage unaffordable and need the break in deductibles and out-of-pocket costs insurers provide through CSRs, she said.
While Republicans have tried to repeal and replace the ACA, it's become clear from the pushback to these efforts that people want the ACA fixed, and not repealed, Day said.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
