- Carolyn Y. Johnson The Washington Post
Health insurance executives seeking certainty on the future of federal funds that help lower-income Americans with their out-of-pocket health care costs got no commitment that they would be paid next year in an hour-long meeting with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, according to two insurance industry officials with knowledge of the meeting.
A CMS official confirmed that Verma "did not comment" on the payments, called cost-sharing reductions, at the meeting and told those gathered that it was a decision to be made by Congress.
Cost-sharing reductions are federal payments to insurers that help defray deductibles and co-pays for more than 7 million Americans who buy insurance through the Affordable Care Act marketplaces. In a lawsuit that has dragged on for years, the way the payments are funded has been successfully challenged in court by House Republicans. The decision was appealed by the Obama administration and the case has now been inherited by the Trump administration. The case was put on hold while Republicans tried to pass health reform, and payments are being made while the lawsuit proceeds.
It has remained unclear how the issue will be resolved, and President Donald Trump only increased the uncertainty last week when he suggested that withholding the funds, which are projected to add up to $10 billion in 2018, could be a way to bring Democrats to the table to work together on health reform in an interview with the Wall Street Journal. One possible way for the payments to be made would be for them to be funded in the continuing resolution that must be passed by April 28.
Trump told the Journal he and Congress would both have to approve the payments.
"Otherwise, those payments don't get made and Obamacare is gone, just gone," Trump said.
Insurers weighing whether to participate in the Affordable Care Act marketplaces next year have said that if the funds aren't going to be available, they will have to decide whether to leave the marketplaces altogether or hike premiums by at least 15 percent, on average. The payments are continuing to be made while the lawsuit proceeds.
Verma urged chief executives to lobby Congress directly, according to the industry officials, who requested anonymity in order to speak frankly.
Insurers have been stressing the importance of the payments, with growing urgency, as they begin to face deadlines to decide whether to participate in the insurance marketplaces next year and how to set their rates.
The meeting included representatives of the major lobbying groups, America's Health Insurance Plans and the Blue Cross Blue Shield Association and executives from Molina Healthcare, Oscar Health, Kaiser Permanente, Geisinger Health Plan and Tufts Health Plan.
We "reiterated our most pressing concern: the instability in the individual market created by the uncertainty of funding for the cost sharing reduction program," Kristine Grow, a spokeswoman for America's Health Insurance Plans, said in a statement. "We are committed to working with Administrator Verma, the Administration and Congress to ensure CSR funding is addressed quickly to provide clarity for consumers in 2017 and 2018."
J. Mario Molina, chief executive of Molina Healthcare, said in a statement that it was an honor to be invited to the meeting.
"Our objective remains the same-to help millions of Americans access the health insurance they need at an affordable cost," Molina said in a statement.