A Dozen Things To Know About The Trump Healthcare Executive Order and Elimination of CSR Payments
by
Clive Riddle, October 13, 2017
1.
Attorney General Jeff Sessions
issued a legal opinion to HHS and the Treasury Department that that
money appropriated to HHS “cannot be used to fund” Cost Sharing
Reduction (CSR) payments.
2.
The Trump administration has
filed notice to the U.S. Court of Appeals for the D.C. Circuit,
“that the Department of Health & Human Services (HHS) has directed that
cost-sharing reduction payments be stopped because it has determined
that those payments are not funded by the permanent appropriation for
‘refunding internal revenue collections.” they were not formally
appropriated by Congress.
3.
Health Plans still
have to provide marketplace subsidized discounts to low-income
customers. Without CSR reimbursement, one must assume participating
plans will raise premiums as soon as feasible.
4.
A CBO report indicates the decision to
end CSR payment payments is
likely to cost the federal government more than making the payments
due to ACA required subsidies to cover anticipated premium increases
5.
The health plans most impacted by the CSR
elimination include
mostly Blue Cross and Blue Shield companies and insurers focused on
Medicaid, such as CenteneCorp. and Molina Healthcare Inc.
6.
CSR lawsuits are likely. Impacted health
plans may sue.
The Hill reports attorneys general from California and New York say
they are prepared to sue the Trump administration to protect health-care
subsidies that the White House said would be cut off.
7.
As
Sam Baker, Axios
healthcare editor posts, “Congress can solve this. University of
Michigan law professor Nicholas Bagley, an expert on this issue, told me
that if Congress appropriates the money for these subsidies, they would
begin flowing again immediately.”
8.
The
Trump Executive Order does not equate to immediate changes. As
healthcare policy
expert Timothy Jost posts in Health Affairs, the Executive Order “is
a direction to draft rules. Under the Administrative Procedures Act
these agencies will first have to publish proposed rules and then
receive and respond to public comments before publishing the rules in
final form. The fact sheet accompanying the order acknowledges that
regulations will proceed through notice and comment rulemaking. This
will likely take months. Indeed, rulemaking will likely be proceeded by
studies by the affected departments, and any proposed and final rules
will likely have to be reviewed by the Office of Management and Budget.
Therefore, changes are unlikely to affect plans beginning on January 1
of 2018, although some changes may take effect mid-year.”
9.
The executive order instructs the
Department of Labor to expand the availability of association health
plans under the Employee Retirement Income Security Act of 1974 (ERISA).
10.
The executive order instructs the
Departments of Labor and HHS to pursue expanded Availability of
Short-Term, Limited‑Duration
Insurance
11.
The executive order instructs the
Departments of Labor, Treasury and HHS to increase the usability of
HRAs, to expand employers' ability to offer HRAs to their employees, and
to allow HRAs to be used in conjunction with nongroup coverage.
12.
As
Timothy Jost notes in another Health Affairs post, small employers
already received expanded ability regarding HRAs in 2016, when “Congress
adopted in Title XVIII of the [21st Century] Cures Act a new type of
arrangement, the Qualified Small Employer HRA (QSEHRA), that is
effectively an exception to the HRA prohibition, but only for small
employers — employers that have fewer than 50 full-time equivalent
employees and therefore are not subject to the large employer mandates.
These employers may pay or reimburse employees through a QSEHRA for
premiums for health insurance that qualify as minimum essential
coverage.” Thus the Executive Order would have more impact on larger
employers. |
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