Politics Trump to end key ACA subsidies, a move that will threaten the law’s marketplaces

06:35  13 october  2017
06:35  13 october  2017 Source:   MSN

Trump will pull Obamacare subsidies in another attack on health law

  Trump will pull Obamacare subsidies in another attack on health law The Trump administration has decided to cut off crucial Obamacare subsidies that help reduce health care costs for lower-income Americans, a serious attack on the stability of the health care law’s insurance markets. President Trump has been threatening to end the payments — know as cost-sharing reduction subsidies or CSRs — for months, but is finally following through after Republicans in Congress once again failed to repeal and replace Obamacare late last month.

Trump also appears to be thinking about ending a subsidy that members of Congress receive when they purchase health coverage through the law ’ s marketplaces . The Obama administration allowed a subsidy for members of Congress. Trump appears to threaten to end that.

he wants to end payments of key Obamacare subsidies , a move that could send the health law ' s insurance markets into a tailspin, according to several Lawyers and other administration officials are trying to thread the needle. Trump told aides in a Tuesday Oval Office meeting that he wants to end

A woman walks past a sign advertising © AP Photo/Lynne Sladky A woman walks past a sign advertising "Obamacare", Tuesday, Jan. 31, 2017, in Miami. President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision follows an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.

The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. According to two people briefed on the decision, the cutoff will be as of November. The subsidies total about $7 billion this year.

Trump to halt 'massive' ObamaCare subsidies; legal fight likely

  Trump to halt 'massive' ObamaCare subsidies; legal fight likely President Trump plans to halt payments to insurers under the Affordable Care Act "immediately," in a major blow to ObamaCare that is likely to draw a legal challenge.  The president, though, used the overnight decision to up pressure on Democrats to negotiate a "fix" to the "imploding" health care law. "The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!" he said in a pre-dawn tweet on Friday.

President Donald Trump has told advisers he wants to end payments of key Obamacare subsidies , a move that could send the health law ’ s insurance markets into a tailspin, according to several sources familiar with the conversations.

HHS Secretary Tom Price said Sunday that “no decision’ s been made” on whether to continue key ACA subsidies to health-insurance companies, but that Smarting from the failure of Senate Republicans to pass an Obamacare repeal and replace bill, Trump on Saturday threatened in a tweet to end the

Trump has threatened for months to stop the payments, which help eligible consumers afford their deductibles and other out-of-pocket expenses, but held off while other administration officials warned him that such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans.

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Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will open in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to harm the marketplaces — and the law.

New York, California threaten to sue over health-care subsidies

  New York, California threaten to sue over health-care subsidies Attorneys general from California and New York say they are prepared to sue the Trump administration to protect health-care subsides that the White House said would be cut off. New York Attorney General Eric Schneiderman (D) said in a statement that hundreds of thousands of New York families rely on ObamaCare's subsidies for their health care.

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Trump has called the subsidies a bailout for insurance companies and has threatened to end them as a way get Democrats to agree to overhaul the ACA . "This disastrous law has devastated the middle class, and must be repealed and replaced." Fact check: Trump distorts facts in calling cost-sharing

Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018.

The cost-sharing reductions have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established the subsidies does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.

“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

GOP Rep. breaks with Trump: Cutting health care subsidies does 'opposite' of what he promised

  GOP Rep. breaks with Trump: Cutting health care subsidies does 'opposite' of what he promised A Republican lawmaker slammed President Trump's action on health care Friday.Rep. Ileana Ros-Lehtinen (R-Fla.) said that cutting key payments to ObamaCare insurers will mean more of her constituents will be uninsured.

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Top Democrats sent a letter Wednesday to remind Donald Trump that it' s his obligation under the law to pay Obamacare' s subsidies . Many insurers might react to the end of subsidy payments by exiting the ACA marketplaces .”

For months, administration officials have debated privately about what to do. The president has consistently pushed to cut them off, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former Health and Human Services secretary Tom Price, cautioned that this could exacerbate already escalating premiums on the ACA market, these Republicans said.

But some government lawyers also argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.

While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.

One person familiar with the president’s decision said that HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.

Trump kills key Obamacare subsidies: What it means

  Trump kills key Obamacare subsidies: What it means President Trump will no longer fund Obamacare's cost-sharing subsidies. Here's what that means.The administration announced late Thursday night that it would immediately stop supporting the cost-sharing subsidies that reimburse insurers for reducing the deductibles and co-pays of lower-income Obamacare enrollees. Trump has been paying the subsidies on a month-to-month basis, unnerving many insurers.

Trump Administration Decides to Keep a Key Part of Obamacare in Place . But they are just as critical to the marketplace ' s success. If those subsidies end , insurers would likely leave the ACA exchanges in higher numbers than they already are, making the individual market even more

Trump threatens to withhold CSR payments, Congressional subsidies . White House touts the ACA ’ s demise even as insurers seek help in stabilizing its marketplace More >. Trump tells advisers he wants to end key Obamacare subsidies .

The cost-sharing payments are separate from a different subsidy that provides federal assistance on premiums to more than four-fifths of the 10 million Americans with ACA coverage.

Word of the president’s decision, which was first reported by Politico, came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.

The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House's announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.

Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.

Trump Tweets Approval After Health Care Stocks ‘Plunged’

  Trump Tweets Approval After Health Care Stocks ‘Plunged’ President Trump cut off subsidies to cover insurance costs for low-income people, and some health care stocks fell. He cheered.It is unlike President Trump to cheer when stocks fall, but early on Saturday he did just that.

Trump Administration will attempt to stabilize ACA Marketplaces that they want to repeal. premium and cost-sharing subsidies under the ACA for at least 2-3 years and retain the law ’ s individual A remaining million it allocate to help consumers with acute or life- threatening conditions keep their

The president has threatened to end the payments to insurers before left with huge questions about how key aspects of the law will be handled under the Trump administration as deadlines loom for The Associated Press: UnitedHealth 2Q Profit Surges As ACA Participation Shrinks UnitedHealth

The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” — a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.

In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.

Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health re­imbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules — another reversal of Obama policy.

In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”

Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”

Collins: Trump's healthcare moves hurt 'vulnerable people'

  Collins: Trump's healthcare moves hurt 'vulnerable people' President Donald Trump's recent, aggressive actions on health care will make it harder for people to access care, Maine Republican Sen. Susan Collins warned on Sunday. "What the President is doing is affecting the ability of vulnerable people to receive health care right now," Collins said on CNN's "State of the Union."Trump on Thursday signed an executive order that could dismantle some of the rules around the Obamacare marketplaces, and the administration announced later the same day it would end subsidies geared toward helping low-income people afford care.

The Trump administration late Thursday issued a final rule aimed at stabilizing the health law ’ s insurance marketplace that could have rapid, dramatic The ACA allows people to sign up outside the open enrollment period for a variety of special reasons, such as moving , losing coverage, getting

An evidently frustrated President Donald Trump went on another signature tweetstorm Saturday, threatening to end federal subsidies for health insurance A move of this nature would inject chaos into the insurance markets considering that so many low-income (and even moderate-income)

The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal — giving each state more discretion over matters of insurance.

Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted — his directive will provide “millions of people with Obamacare relief,” he said.

Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers — or refuse to insure them.

The president issued the directive less than three weeks before the Nov. 1 start of the fifth open-enrollment season in ACA marketplaces for people who do not have access to affordable health benefits through a job. Trump noted that about half of the nation’s counties will have just one insurer in their exchange, and he claimed that “many will have none.” However, the most recent canvass shows that there will be no “bare” counties in 2018.

A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.

How the bipartisan health care proposal could affect you

  How the bipartisan health care proposal could affect you WASHINGTON — The roller coaster ride that is Obamacare’s future continued this week with the latest version of a health care proposal, this one a bipartisan effort to make short-term fixes to the insurance marketplaces created by the Affordable Care Act. On Tuesday, Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., said they had reached a deal to shore up Obamacare insurance markets by guaranteeing federal subsidies for low-income insurance customers for two years. For most of the day, it seemed a deal was at hand. But Wednesday morning, President Trump tweeted that he didn't like it, and Republican support began evaporating. At this point the plan is in limbo, though Alexander says he is still pushing to pass it, or some version of it.

Even so, with a shortened sign-up period and large cuts in federal funds for advertising and enrollment help already hobbling the marketplaces, “if there’s a lot of hoopla around new options that may be available soon, it could be one more thing that discourages enrollment,” said Larry Levitt, the Kaiser Family Foundation’s senior vice president.

Other aspects of the executive order include commissioning a six-month study, to be led by federal health officials, of ways to limit consolidation within the insurance and hospital industries. Trump also directed agencies to find additional means to increase competition and choice in health care to improve its quality and lower its cost.

The order produced predictable reactions in Congress, with Republican leaders praising the move and Democrats accusing the White House of sabotaging the law.

Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Mike Consedine, chief executive of the National Association of Insurance Commissioners (NAIC) said Thursday that the group has long opposed such plans and is concerned that the administration will allow ones that can bypass state licenses and have such weak financial underpinnings that some will collapse, leaving customers stranded and state insurance regulators “picking up the pieces.”

Short-term health insurance makes up a tiny fraction of the policies sold, with fewer than 30 companies covering only about 160,000 people nationwide at the end of last year, according to NAIC data.

Experts could not point to figures for how many association health plans exist or how many people they insure. Such arrangements have existed for decades, and scandals have on occasion exposed “multi-employer welfare arrangements” started by unscrupulous operators who took members’ money and either did not have enough reserves to cover hospital bills or absconded with premiums.

The National Federation of Independent Business, a small-business lobby, has pressed Congress to allow use of association plans, arguing that they can be less expensive and give workers more insurance choices. Sen. Rand Paul (R-Ky.) has promoted the idea, and he stood just behind Trump at the morning ceremony. After nearly walking out of the room without signing the order, the president returned to affix his signature to the document and then hand Paul the pen.

Selling health plans from state to state without separate licenses — the idea underlying much of the president’s order — has long been a Republican mantra. It has gained little traction in practice, however.

Half a dozen states — before the ACA was passed in 2010 as well as since then — have passed laws permitting insurers to sell health policies approved by other states. And since last year, the ACA has allowed “compacts” in which groups of states can agree that health plans licensed in any of them could be sold in the others. Under such compacts, federal health officials must make sure the plans offer at least the same benefits and are as affordable as those sold in the ACA marketplaces.

As of this summer, “no state was known to actually offer or sell such policies,” according to a report by the National Conference of State Legislatures. A main reason, experts say, is insurers’ difficulty in arranging networks of doctors and other providers of care far from their home states.

How the bipartisan health care proposal could affect you .
WASHINGTON — The roller coaster ride that is Obamacare’s future continued this week with the latest version of a health care proposal, this one a bipartisan effort to make short-term fixes to the insurance marketplaces created by the Affordable Care Act. On Tuesday, Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., said they had reached a deal to shore up Obamacare insurance markets by guaranteeing federal subsidies for low-income insurance customers for two years. For most of the day, it seemed a deal was at hand. But Wednesday morning, President Trump tweeted that he didn't like it, and Republican support began evaporating. At this point the plan is in limbo, though Alexander says he is still pushing to pass it, or some version of it.

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