Tag Archives: Cost Sharing Subsidies

Maine COOP sues Government over cost sharing subsidies

From HEalth Affairs Online:

 

“On December 28, 2017, Maine Community Health Options (MCHO)—a nonprofit insurer in Maine—filed what is believed to be the first lawsuitagainst the U.S. Department of Health and Human Services (HHS) for failing to reimburse marketplace insurers for cost-sharing reductions (CSRs) for 2017. MCHO seeks an estimated $5.6 million in CSR payments for the 2017 plan year.

“Although much of the damage of CSR nonpayment has been mitigated for 2018 through higher rates, it remains to be seen whether MCHO will be successful and whether other insurers will sue HHS for outstanding CSR payments. ”

 

For the full Article, click here.

So what, exactly, did Trump eliminate on the Subsidies?

The President, in signing an executive order this past week, stopped all payments for Cost-sharing Subsidies.  Now, in a language most of you can understand:

  1.  This does not eliminate subsidies.  The Government is continuing to pay these and apparently will continue
  2. “Cost-sharing Subsidies” are only received by those on Silver plans below 250% of the Federal Poverty Level
  3. The plans are already filed and pre-approved.  Enrollees will continue to receive the same benefits as the contracts are not being changed.
  4. The Insurance company is not being paid their portion of the cost-sharing subsidies.

So in the end this affects the Insurance Carriers but not the enrolled person.  Many Insurance Carriers have already increased their premiums for 2018, based on warnings by the States that this would happen.  So in the end it may not mean much, except we all know the premiums are going up for 2018.

 

MEANWHILE – back in court, Attorney GEnerals in more than a dozen states, led by NY and CA, filed suit to get an injunction and prevent this from happening.  Given the recent rulings by these courts it is likely that they will win, at least temporarily.  It also seems to have stimulated Congress to discuss this, and perhaps even try and fix it.  At the center of the move is the argument that this is an expense that Congress never authorized.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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