Moves in D.C. push marketplaces to brink
WASHINGTON — When health-insurance giant Aetna announced this month that it will pull out of the Affordable Care Act’s insurance exchange in Virginia in 2018, President Donald Trump responded on Twitter: “Death spiral!”
When Humana announced it plans to leave all of the health law’s marketplaces next year, the president chimed in, “Obamacare continues to fail.”
Left unremarked on was a big reason for the instability: The Trump administration and Congress are rattling the markets.
The administration’s refusal to guarantee payment of subsidies to health-insurance companies, the murky outlook for the Affordable Care Act in Congress, and doubts about enforcement of the mandate for most people to have insurance are driving up insurance prices for 2018, insurers say in rate requests filed with state officials.
Opponents of President Barack Obama’s signature legislative achievement have made what might be a selffulfilling prophecy: They repeatedly forecast the collapse of the health law, and then push a collapse along.
Frustrated state officials have ideas for stabilizing the individual insurance market, but they say they cannot figure out where to make their case because they have been bounced from one agency to another in the Trump administration.
The Trump administration has sent mixed signals, reflecting an internal debate about whether to stabilize insurance markets or let them deteriorate further. Trump has said he could cut off the subsidies at any time if he wanted to.
The government might clarify its plans in a legal brief to be filed Monday with the U.S. Court of Appeals for the District of Columbia Circuit. Or it could ask the court for a three-month extension, prolonging the uncertainty.
State insurance commissioners have joined insurers, hospitals and congressional Democrats in urging the administration to pay “cost sharing” subsidies, and federal health officials initially indicated that they would do so. But Trump countermanded them, refusing to make any long-term commitment.
On Thursday, 15 Democratic state attorneys general, led by Xavier Becerra of California and Eric T. Schneiderman of New York, filed a motion to intervene in the case, demanding that the payments continue.
In some ways, the Obama administration shares responsibility with the Trump administration for the current mess, which has huge human, legal and political implications. Unable to get an explicit appropriation from Congress, the Obama administration went ahead and paid the subsidies in a way that a federal district judge later found to be unconstitutional. The ambivalence of the Trump administration has further spooked insurers.
The subsidies are paid to insurance companies so they can reduce deductibles and other out-of-pocket costs for low-income consumers — 7 million people this year.
Senate Republicans, well aware of the political risks of a collapse of the marketplaces, are seeking short-term solutions for 2018 and 2019.
“In order to rescue Americans from collapsing Obamacare exchanges, Republicans are likely going to have to temporarily do some things we may not like, including looking at funding the cost-sharing payments,” said Sen. Lamar Alexander, R-Tenn., chairman of the Senate health committee.