Cost-Sharing Reduction Subsidies & the “Death Spiral”
In addition to legislative activity to repeal the ACA, supporters of the health care law are also keeping a close eye on administrative activities that could undermine the law. Cost-sharing reduction (CSR) subsidies, which help insurers pay medical bills for low-income customers, are now the center of debate as the Administration has the authority to continue or discontinue these payments. A coalition of insurers, providers, hospitals, and businesses sent a letter to President Trump this week, urging the administration to remove uncertainty about CSRs, which help 7 million people, 60 percent of people who purchase insurance on the exchanges. Without the $7 billion of cost-sharing reductions, the ACA marketplace could collapse. In an interview with the Wall Street Journal, President Trump indicated that he would use the subsidies as negotiating leverage with Democrats.
A popular Republican sentiment says the ACA is in a death spiral and that if left alone, the law would “explode.” However, a new Standard & Poor’s report says the health law’s marketplaces are actually becoming more stable and may even church out profits for some participating health insurers by 2018.
Final “Market Stabilization” Rule Issued
The Trump administration issued its final rule on “market stabilization” this week. NCCS commented on the proposed rule in February and expressed concern that the proposal would increase cost and burden for consumers and may not have the desired intent to stabilize the market. Julie Appleby of Kaiser Health News summarized the changes: “The final rule upholds much of what was proposed by the administration in February, including a shorter enrollment window, tighter vetting of people who sign up outside of those open periods and efforts to require some consumers to show proof of prior insurance coverage.” Tim Jost also provides a detailed analysis of the final rule in Health Affairs.
Key for cancer survivors who purchase insurance on the ACA exchanges will be a short enrollment period, November 1 through December 15, half the length of the previous enrollment periods. Additionally, anyone with a lapse in premiums will be required to repay past-due premiums before enrolling. As NCCS said in our comments:
What You Can Do
With Members of Congress at home in their districts for recess, it is critical to continue to show support for the ACA and the protections it has provided for cancer patients and survivors.
Call, meet with, or attend a town hall event with your Member and share your story. NCCS is here to help; visit our Protect Our Care page for more or contact our Public Policy Manager, Lindsay Houff, at firstname.lastname@example.org with any questions.