How Low Can You Go?

Update ahead. In yesterday’s post, Make Some Noise, which is one of several posts I’ve written here about the controversy over payments for Obamacare’s cost sharing reductions (CSRs), I mentioned that there would be a court hearing on Monday relevant to the issue. megaphone The hearing was an appeal in the case of the United States House of Representatives v. Price, which is a lawsuit over the payments that was brought by the House several years ago when Obama was still President.

I won’t rehash the details of the case or of the cost sharing reductions in general, as we’ve talked about those things a bunch of times here before.  If you’re unfamiliar with the issues, or would like a review, this is the most comprehensive post on the topic, explaining what CSRs are, why there’s a controversy over payments, and what the lawsuit is about. I think that post will be really helpful if you’re trying to understand what’s going on right now.

And DC Deciphered’s most recent post, just yesterday talked about the fact that the CSR controversy has been the most underreported issue of the Trump presidency.  It’s an issue of vital importance that had gotten almost no attention from the media or from Democrats until just the last 2 weeks or so.  A confluence of events, discussed in yesterday’s post, have finally brought this crucially important issue some much needed attention.

Anyway, now an update:  I mentioned yesterday that Monday’s hearing could potentially determine the fate of the CSRs, or alternatively, it was possible that the parties would simply ask for the case to be delayed again, as it had been before.  And it turns out, they took the latter option. The case will be delayed for another 90 days.

This is . . . not great news.  In the most narrow, short term sense, it’s a relief because the Trump administration could have notified the court today that it was dropping the appeal (remember, this appeal was originally sought by the Obama administration, in a suit brought by the Republican House.  Now the case awkwardly pits the Trump administration against a Republican House).  That would have been the end of the case, and the cost sharing reduction payments would have stopped immediately, sending the Obamacare markets into chaos (possibly throwing people off of their insurance before year’s end).  So, it’s obviously good that we avoided that.

But beyond that, no progress was made today.  We’re not in any better spot than we were last week or last month. The insurance companies still have no assurances about whether the CSRs will be paid in 2018, which is what they need in order to make their decisions about participating in next year’s markets.  In fact, they still don’t even have any assurances about whether the CSRs will be paid next month.  So that’s very bad news.

This outcome leaves everyone – insurance companies, customers, Democrats – in limbo, the same limbo they’ve been in for months now.  And it means Trump can still decide on a whim to stop making the CSR payments – tomorrow, next week, next month, any moment the feeling grabs him.  And the fact that the Trump administration asked for this delay today, instead of allowing the hearing to proceed, sends a signal to the insurance companies that he will continue putting off making a decision of any sort.  So they took today’s events as a very bad sign.

This means that the effects they’ve been warning about – dramatically increased premiums or exits from the market for 2018 – are still likely to occur. This is especially so because insurers need to submit their final premium rates before this new 90 day delay will be over.  So they will have to make that pricing decision without knowing what the next step in this court case will be. They will have to assume that CSR payments won’t be made and price that into their premium rates.

In more positive news, the Washington Examiner, a conservative leaning site, reports that Congressional Republicans are supposedly trying to work something out – legislatively – to keep the CSR payments going, at least until their Obamacare replacement plan is ready.  They seem to recognize that if millions of people suddenly lose insurance on their watch (including many of their own constituents & supporters), the blowback could hit them quite hard.  However, the article has almost no details about what sort of ideas they might have for accomplishing this, and it contains only one quote, which is from an anonymous source.  So I’m not sure how much we should count on this actually happening.

So the most positive thing I’m taking from today is that the delay at least seemed to galvanize some response out of the Democrats. Let’s hope they keep it going until they can pressure Trump and/or the Republicans to finally fund these payments:

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