Insurers Push for ACA Subsidy Payments in Meeting With Verma

AHIP President and CEO Marilyn Tavenner and others "reiterated their concerns." (Victoria Sgarro/Morning Consult)

A meeting with a top U.S. health official did not appear to give health insurers greater confidence about whether the government plans to make key payments under the Affordable Care Act.

Insurance executives, as well as the head of the trade group America’s Health Insurance Plans, met with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, on Tuesday. Insurers have been pressuring administration officials and lawmakers to fund the ACA’s cost-sharing reduction payments.

Kristine Grow, a spokeswoman for AHIP, said in a statement that insurers “reiterated our most pressing concern: the instability in the individual market created by the uncertainty of funding for the cost-sharing reduction program.”

The CSR payments, which help lower-income Obamacare enrollees afford out-of-pocket costs, are at the center of a lawsuit brought against the Obama administration by House Republicans. A federal judge ruled that the payments were unconstitutional because they were made without a specific appropriation by Congress.

The Obama administration appealed the ruling, but the case is currently on hold. Insurers want the administration to commit to funding the payments — or for Congress to appropriate funding for them.

Others who attended the meeting, which also touched on Medicare and Medicaid, included Blue Cross Blue Shield Association CEO and President Scott Serota and Mario Molina, president and CEO of Molina Healthcare.

“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 after the meeting. “And we will work closely with CMS and the administration so that we can continue to fulfill our mission of providing quality care to people receiving government assistance.”

Insurance companies have struggled to adjust to the individual marketplaces since the ACA created the exchanges. The law’s uncertain political future has only added to the questions they face as they approach the June 21 deadline for filing their 2018 premium rate requests. That will be the first indication of how the individual exchanges fare next year, although insurers can still make changes to those requests through the summer.

But a recent survey suggests most insurers are undeterred by the uncertainty, with 94 percent of payers planning to remain in the exchanges in 2018. Of those that intend to participate, 70 percent said they would not make a major strategy shift for next year, according to the survey from consulting firm Oliver Wyman.

Insurers responding to the survey said it was too early for them to set their rate proposals for next year as they need to do more analysis on this year’s performance and risk pools. The fate of the cost-sharing subsidies is also likely to affect their proposals.

Senior Democrats have called the payments a top priority in negotiations for a spending bill, which Congress must pass by the end of next week to avoid a government shutdown.

Senate Minority Leader Chuck Schumer said Tuesday that negotiations “seem to be going well.” The New York Democrat declined to go into details, but said party leaders were hopeful the subsidies would be appropriated in the spending bill.

Morning Consult