Cost-sharing reduction payments officially stop on Friday

Cost-sharing reduction payments stop as of Friday, America's Health Insurance Plans has confirmed.

The CSR payments were due on Oct. 20, according to AHIP, which said it has learned they will not be paid.

President Donald Trump has followed through on his October 13 decision to end CSRs despite legal challenges from an estimated 20 state attorneys general and the bipartisan Alexander-Murray bill being released today that restores the CSR  payments for two years.

[Also: Senators strike bipartisan deal to give insurers 2 more years of CSR payments]

Without CSRs, insurers have said premiums for silver-tiered plans would be expected to increase by at an estimated 20 percent.

As insurers face open enrollment starting Nov. 1, some have been granted the flexibility to refile their rates, while others will have to absorb the cost.

[Also: Trump administration ends cost-sharing reduction payments under ACA]

The government required insurers to finalize premium rates on Sept. 29.  Many insurers filed two sets of rates to account for a potential end to CSR payments.

In states where insurers filed one rate, in most cases it appears to be  up to insurance commissioners to decide whether payers can refile.

[Also: Medical, consumer advocacy groups against Trump executive order]

In one known case in Montana, the Centers for Medicare and Medicaid Services gave permission for insurers to refile their rates, according to The Washington Post. But CMS did not respond to a request on whether the agency had given other states this option.

Oregon told insurers to file a 7.1 percent increase on all silver plans on top of their 2018 rates to account for the loss of CSRs, according to the report. Washington also asked insurers to submit higher rates of between 9 and 27 percent.

In certain states, such as North Dakota, insurance commissioners are not allowing insurers to refile.

Blue Cross Blue Shield of North Dakota said the decision means it will have to absorb the cost associated with the lack of CSR funding.  This means paying out-of-pocket to help lower income consumers pay deductibles and their own out-of-pocket expenses.

"We understand the insurance commissioner's decision to deny additional rate requests, as additional increases at this point would cause disruption for consumers in North Dakota," said BCBSND spokeswoman Andrea Dinneen. "We expect that premiums may increase in 2019 as a result of these activities, however the full impact will not be known until we understand our 2018 membership and their utilization of health care services."

In 2016, BCBSND received $4 million in CSR funds from the federal government, Dinneen said.

"In planning for 2018 rates, we expected an increase in CSR payments, however we are not able to share a specific figure," Dinneen said.

Despite not being able to collect higher premiums to make-up for the lack of federal funding, BCBS North Dakota will remain on the federal exchange in 2018, she said.
  
The nation's largest insurer, UnitedHealthcare, which withdrew from many ACA markets, has now about 30,000 people in four states who would be eligible for CSR payments in 2018, CEO David Wichmann said during an earning's call this week. The insurer submitted two rates, one that reflected a continuation of the payments, and another without the CSRs.

"Thus, we expect any impact to be extremely small," Wichmann said.

Trump originally indicated on Monday he supported the bill, saying it represented a short-term fix until Congress crafted healthcare legislation for a vote in early- to mid-2018.

On Wednesday, responding to a reporter's question, White House Press Secretary Sarah Huckabee Sanders said it was correct that the president did not support the bipartisan plan. The president wants a bill that gives relief for all Americans, she said.

Trump tweeted Wednesday that he could never support bailing out insurance companies which "have made a fortune w/O'Care."

To ensure CSRs benefit consumers rather than insurer profits, the  bill requires insurance companies offering plans through the Affordable Care Act marketplace to pay members the subsidies as one-time or monthly rebates to consumers, according to NPR.

AHIP supports the plan.

The bill introduced by Republican Lamar Alexander and Democrat Patty Murray will provide a more stable insurance market for consumers, AHIP said.

"AHIP supports the goal of ensuring that consumers receive the benefit of continuous funding for cost-sharing reduction assistance, which makes it more affordable for low- and middle-income Americans to see their doctor or fill their prescriptions," AHIP said. "Plans would work with states to operationalize any changes required to meet this goal."

The bill supports the Republican goal to give states more flexibility, through additional Section 1332 waivers to the ACA on coverage requirements.

Without CSRs, consumers can still get a break on the price of premiums through tax credits.

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