Health Care in the News: Keeping Down Costs

  1. Cost-Sharing Reductions: On Thursday, 10/12, the President announced the discontinuation of cost-sharing reduction payments (CSRs) for health insurers that sell plans in the state Health Insurance Marketplaces.
    • For those who choose to buy health insurance coverage through the marketplaces, they may be eligible for 2 types of financial assistance: 1) premium tax credits; and 2) cost-sharing reductions. Premium tax credits reduce your monthly premium payment for whichever plan you choose to buy in the marketplace. Cost-sharing reductions are a requirement in the ACA, that insurance companies lower the cost of deductibles, co-payments, and co-insurance amounts on silver level plans, based on your income level. The cost-sharing reductions are provided by the insurance company, but are reimbursed by the federal government.
    • Since taking office, the President has indicated that he might end the CSRs. His lack of a definitive decision creative uncertainty for insurance companies in determining their rates for plans sold in the marketplace for 2018. This uncertainty actually cause may insurers across the country to choose not to sell plans in the marketplace for 2018, which ultimately reduces competition and increases rates for the plans that are sold in the marketplace. Some companies decided to continue to sell their plans, but increased their rates, to cover the loss of the CSR payments from the federal government.
    • It now falls on Congress to fund the CSR payments for 2018 and beyond. There is currently a proposal being discussed in the Senate to fund the CSR payments for two years, but it includes other changes (see below).
    • On Wednesday, 10/18, eighteen states filed a temporary restraining order to force the President to continue funding the CSR payments.

Alexander-Murray-Keeping-Costs-Down

  1. Alexander-Murray Legislation: On Wednesday, 10/18, in response to the President’s decision to end the CSR payments, U.S. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) reached a bipartisan compromise that is an important first step to stabilize health insurance markets and provide states more flexibility, while maintaining important patient protections.
    • They have proposed bi-partisan legislation, which will likely keep health insurance costs lower for consumers. This legislation is supported by nearly 30 cancer organizations representing patients, physicians, nurses, and social workers, because cancer patients and survivors need access to quality, affordable health insurance. However, there are some political compromises included in this bill.
    • This bill funds the CSR payments through 2019 and restores some of the funding that was previously cut by the President, for outreach and education about open enrollment and health insurance options.
    • This bill also takes some steps to expand access to catastrophic health insurance plans, which could allow more people to afford health insurance, but there is also serious concern about the limited coverage included in these plans. It also allows states flexibility to waive some of the ACA requirements for plans sold through the marketplace. Again, while it may expand access, there are some questions about the coverage included in those plans.
    • At this time, it is unclear if there are enough votes to pass this legislation. If you would like to share your opinion or experience, you can contact your U.S. Senators by calling: 844-257-6227.
  1. Executive Order: On Thursday, 10/12, the President also signed an Executive Order, which allows insurance companies to sell policies across state lines and to sell cheaper policies with less coverage than currently required under the ACA. The challenge with this proposal is that:
    • It allows insurance companies to avoid state health consumer protections.
    • It also creates a situation where people can buy minimal health insurance coverage, but if they are diagnosed with a serious medical condition like cancer, then they find out that those policies don’t cover needed medical care, like chemotherapy.
    • The Executive Order requires federal agencies to draft regulations, share the draft for public comments, and then release final regulations on these changes.

As these events unfold, Triage Cancer will continue to provide updates on these changes and how they may have an impact on the cancer community. Stay tuned.