CMS Administrator Seema Verma declined to say whether the Trump administration would limit how payers in the Affordable Care Act (ACA) marketplace use government subsidies, the Washington Examiner reported.
The question comes as some ACA payers continue the practice of “silver loading,” which is when an insurer puts all the losses associated with the end of cost-sharing reduction (CSR) payments on only silver plans. HHS Secretary Alex Azar also said recently that he hasn't been involved in discussions about whether to stop silver loading.
Verma also told reporters the agency continues to uphold the ACA despite its well-known opposition to the law.
President Donald Trump ended CSR payments to ACA payers in October. They had been given to insurers for only silver plans, to help contain out-of-pocket costs for lower-income Americans. Silver plans make up more than half of ACA plans.
Without those CSR payments, payers could either increase premiums on silver plans, which is called silver loading, or spread the losses across the four plan levels in the marketplace. Keeping the largest premium increases to the silver plans kicks in other government subsidies and tax credits for lower-income members.
Middle-class and upper-middle-class members still see their premiums skyrocket. Most people with an ACA plan get subsidies to help control the cost, but those who make too much then take the brunt of the premium increase.
Meanwhile, Verma’s comments about the CMS following ACA law in its decisions was evident when the agency recently rejected Idaho’s request to sidestep ACA regulations in the marketplace. CMS went against Idaho’s plan because the state wouldn't be enforcing the ACA rules.
That said, Verma also suggested at the time that Idaho could achieve its goals by expanding short-term catastrophic plans. The Trump administration supports transforming short-term plans from three-month plans for which few people are eligible to 12-month plans with the option to extend the plan for another 12 months. The administration’s proposal would also open up the plans to everyone.