Ongoing uncertainty over cost sharing subsidies hangs over state health benefit exchange marketplace

Insurers are worried the payments could be discontinued, which could throw things into chaos and cause insurers to pull out of the marketplaces. However, Kristine Grow, a spokeswoman for America’s Health Insurance Plans (AHIP), said Thursday that it is not enough for the payments to simply continue during the lawsuit. She said insurers need certainty that the payments will be there throughout 2018, or else they might need to raise premiums for next year to factor in the uncertainty. She said AHIP would like to see Congress appropriate the money for 2018 or provide some other guarantee that the money will be there throughout next year.

Source: Trump administration to continue ObamaCare insurer payments during House lawsuit | TheHill

Litigation over the constitutionality of federal funding of out of pocket cost sharing subsidies for individual plans offered on state health benefit exchanges continues with no clear direction on its ultimate resolution. While the Trump administration states funding for the subsidies available to households earning between 100 and 250 percent of federal poverty levels will continue in the meantime, given the volatile policy situation with a new administration and Congress taking office this year, health plan issuers aren’t taking that assurance at face value. They want more policy certainty given that funding stream will need to be available through 2018 as they develop and price products over the next several weeks.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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