- Two senators said Tuesday they have reached a bipartisan agreement to continue making the cost-sharing reduction (CSR) payments to payers that President Donald Trump confirmed late Thursday he would end.
- The agreement from Sens. Lamar Alexander (R-La.) and Patty Murray (D-Wash.) also reportedly restores some funding to promote Affordable Care Act open enrollment and tweaks the waiver process states can use to bypass some ACA requirements.
- The details of the agreement are still being worked out, but a number of lawmakers have already said they don't support it.
Action from Congress would be the surest way to continue the CSRs. Legal action is pending, but could take a long time to get resolved. More than a dozen state attorneys general have already sued the administration and payers are expected to follow.
The agreement includes funding the CSRs for the rest of this year and then for two years following that. It also aims to give states more flexibility in seeking ACA waivers and expands the use of catastrophic health plans.
A report from the Congressional Budget Office found eliminating the CSRs would result in premium increases of about 20% next year. The payments have amounted to about $7 billion so far this year. The healthcare industry (payers in particular) has derided Trump's decision to end the payments and pressured Congress to restore the funding promise.
The agreement between Alexander and Murray is a big step toward refinancing the CSR payments, but it is only the first step. No bill text has been officially released and Murray said some details are still being worked out. Reactions to the announcement from members of Congress were mixed, and while Trump seemed to support the deal, others in the White House expressed skepticism.
Trump’s announcement last week ending the CSRs came after the deadline for payers to commit to the ACA exchanges and set premium rates. Some insurers set their rates with the assumption the CSRs would be discontinued, and some states allowed for late or revised rates.
Trump had been threatening to end the CSRs since the beginning of his administration. He said he wanted the individual market to “implode” and push ACA proponents to negotiate a repeal and replace agreement.
In another blow to the ACA last Thursday, Trump signed an executive order rolling back provisions in the law that require plans to cover essential health benefits and protect people with pre-existing conditions.