Tag Archives: subsidies

Judge says U.S. is on the hook for Obamacare subsidies for insurers

The federal government had a clear obligation to reimburse insurers for assistance provided to low-income people under the Affordable Care Act, a federal judge says.
By ROBERT PEAR / The New York Times
A federal court ruled this month that a Montana insurer is entitled to federal compensation for subsidy payments under the Affordable Care Act (ACA) that President Donald Trump abruptly ended in October, a ruling that could reverberate through insurance markets and cost the government hundreds of millions of dollars.
At issue are payments for cost-sharing reductions, discounts that enhance the value of health-insurance policies purchased from the ACA’s marketplaces by reducing deductibles, co-payments and other out-of-pocket costs for low-income consumers. Trump ended the payments in October, one of a series of executive actions intended to undo President Barack Obama’s signature domestic achievement.
But Judge Elaine Kaplan of the U.S. Court of Federal Claims ruled this month that Trump’s actions violated a government promise to insurance companies participating in the health law. Although Congress never explicitly provided money for the subsidies, the court said, the government had a legal obligation to pay them.
The decision could have broad ramifications for health insurers. Several similar cases are pending in the Court of Federal Claims, a specialized tribunal that handles a wide range of monetary claims against the government. In April, another judge, Margaret Sweeney, certified a class action that allows insurers as a group to sue the government over Trump’s termination of the cost-sharing payments.

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.

Changes to ObamaCare made by President

In the last 24 hours, President Trump has signed executive orders changing a number of things about “ObamaCare” – some which will popular, and others which won’t… depending on who you are.  This is not a political conversation, at least not on my blog.

The first change is to allow Associations and business organizations to offer insurance through their organizations again.  When I first started in this industry this was common, but that turned with NY’s change to “Community Rated Plans” in 1993 under Governor Cuomo.  This will most likely be coupled with “the ability to sell across state lines.”  It is an intriguing idea fraught with many technical issues.

In theory it would allow plans that don’t meet the “minimum essential benefit” rules – which if you are a 25 year old male not needing maternity coverage is a good thing for your rates.  Of course if you need a benefit down the line that you did not buy you would have to change plans.


It also allows Short Term Medical Plans to expand – the Federal Government under President Obama eliminated these plans for any time frame more than 90 days.

NOTHING in the executive orders has any affect on pre-existing conditions, although there has been much speculation in social media about that.

More troubling is the removal of subsidies for “low-income people.”  It is unclear based on what I have been able to read this morning exactly what that means, typical for politics.  Does this mean the Medicaid expansion is unfunded?  It appears to target only the “cost-sharing payments” that lower deductibles and costs for those under 250% of the Federal Poverty level, but does it also affect all subsidies?  Not clear.

SUMMARY-  Executive orders have no force of law.  The Affordable Care Act (ObamaCare) is the law of the land.  The association, and across state lines pieces, will probably take a year or more to have any affect.  It is likely that there will be a series of court appearances designed to stop the Trump administration from eliminating subsidies.  The problem is – Open Enrollment begins in 18 days!  How will people be able to make intelligent decisions about health care choices during this years open enrollment period is a huge concern for our office.

As always, we will be here to help you through this mess.  We expect a number of twists and turns.


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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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