New Bill to Restore the ACA CSR
Senate Health Committee Chairman Lamar Alexander (R-TN) “Unless they are replaced with something else temporarily, there will be chaos in this country and millions of Americans will be hurt.”
Twelve Republicans and 12 Democrats signed on to the bill, which would continue ObamaCare’s insurer subsidies for two years and give states more flexibility to waive ObamaCare rules.
Senator Alexander is talking about the impact of Trump canceling the CSR which pays for deducible and co-pays directly to insurance companies for the insured between 138% and 250% FPL. And no, neither the CSR or the Risk Corridor Program bailouts for insurance companies. All of these are lies and misconceptions coming from the mouths of Republicans and the President.
Here is what will happen:
– Premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline.
– People with lower incomes who buy insurance on the exchanges get a tax credit (subsidy directly to the insurance company), so their costs remain stable as a share of their income. When premiums rise, those government subsidies rise as well.
– For people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits (subsidies offsetting premium increases to the insurance company).
– For those with incomes between 200 percent and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper. Some Gold plans may be cheaper than the Silver plans. 85 percent of people who bought Obamacare insurance got a tax credit.
Kaiser Family Foundation Vice president Larry Levitt: “The CBO analysis makes it clear. The ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face. Premiums would rise and the government would end up spending more in the end through tax credits that help people pay their premiums.”
The CBO report confirms earlier analyses, including this one by Kaiser and this one from the consulting firm Oliver Wyman suggested eliminating the cost-sharing payments could make policies cheaper for some individuals.
In the end, the elimination of the CSR may cause a cumulative deficit of $194 billion from 2017 through 2026, CBO and JCT estimate. While it may be chaotic in the beginning as people will not know what to do, premium subsidies paid directly to the insurance companies will pickup the difference, and the CBO assumes the chaotic conditions will level out over a period of 2-3 years.
Giving states more control over the ACA in areas such as the 10 essential benefits or cheaper than Bronze plans would spell the end for the ACA and we would be back to garbage healthcare polices.
If you are prone to do so, it would be helpful to write your sponsoring Senator and tell them you are opposed to this bill by Senator Alexander. The Democratic co-sponsors include Sens. Jeanne Shaheen (D-NH), Joe Donnelly (D-IN), Amy Klobuchar (D-MN.), Heidi Heitkamp (D-ND), Al Franken (D-MN), Joe Manchin (D-WVA.), Tom Carper (D-DE.), Tammy Baldwin (D-WI.), Claire McCaskill (D-MS), and Maggie Hassan (D-NH).
There will be issues; but, the greater issue is with Republicans and states tampering with the ACA offerings.
run75441 (Bill H)
run, if they don’t pass this bill and, indeed, don’t pass anything, what will happen?
Healthcare policy premiums will pick up the difference for everyone not on Medicaid up to 400% FPL. It will create a deficit of ~$194 billion between 2017 and 2026. I believe the ACA would be eligible to sunset in 2027 due to a deficit which goes against Reconciliation rules (same as the 2001/2003 Bush Tax Cuts) and to which parts of the ACA were passed.
There is going to be some chaos as people will not know what to do and the Republicans/Trump have made it more difficult to sign up. They will also not have the information to know they can get a better plan for less money than the Silver plan or a free Bronze Plan.
Senator Alexander’s Plan opens up the door for State tampering with plans such as eliminating the 10 essential benefits. Democrats are stupid to go down that path as they will again own it after Republicans screwed with it. There are some pundits on other blogs making things up about the results of this if we do nothing. They are wrong other than the chaos created by Trump and Republicans and they are not talking about it.
Another scam backdoor attempt and “repealing Obamacare”. Not much will happen. Trump and de Rothschild are scamming you again.
Days:
Not everything involves the Jews.
You don’t think failure to pay the subsidies will cause companies to withdraw from the market as was already starting to occur?
Insurance companies will get the subsidy directly anyway unless Senator Alexander messes with it and changes it to going to the insured first. That would drive more companies out of the healthcare exchanges.
It seems to me that the ACA already mandates Federal payment of the costs of CSRs to insurance companies.
I quote the ACA US Code Title 42 › Chapter 157 › Subchapter IV › Part A › § 18071
https://www.law.cornell.edu/uscode/text/42/18071
“(3) Methods for reducing cost-sharing
(A) In general
An issuer of a qualified health plan making reductions under this subsection shall notify the Secretary of such reductions and the Secretary shall make periodic and timely payments to the issuer equal to the value of the reductions.”
I’m not a lawyer, and I can see that the ACA doesn’t include the appropriate “appropriated” for appropriation of funds. But I can’t imagine that a court will let the Secretary refuse to do that which the law very specifically and clearly mandates.
For some reason few people mention this. I learned it from Mark Joseph Stern
http://www.slate.com/articles/news_and_politics/jurisprudence/2017/10/trump_s_plan_to_kill_obamacare_is_likely_to_fail_in_the_courts.html
Almost everyone acts as if the GOP law suit and judge Collyer’s decision are unambiguously correct as a matter of law and constitutional interpretation. I think she is a W Bush appointed hack & the law is very clear and the Constitution has long been interpreted as allowing disbursement of fund “appropriated by law” even if the law doesn’t include the word “appropriated”.
I am not a lawyer, but I don’t see any ambiguity.
Now Lawyers are arguing for the administration that neither the executive nor the courts can order the spending. It seems to me that they are plainly lying about what Congress did and did not do. How is this not contempt of court ? I don’t see how anyone can claim the funds are not appropriated without addressing the mandate that they be paid. I don’t think that anyone defending Trump’s decision in court can claim not to have noticed the passage I quoted or to have dismissed it as irrelevant.
Robert:
First and foremost, laws are always open to interpretation. They are not ironclad like rules are. When many courts disagree on interpretation, the case is usually taken up by the next level of courts or the COA. In this case, it was requested that the District of Columbia COA would rule. The House asked for a stay and the COA granted under the pretense there would be a political shift and the next administration (Trump) may think differently. This has nothing to do with legality, right or wrong, or the Slate author’s interpretation. The lower court’s opinion/interpretation (Collyer) stands until a higher court over rules it which will happen when someone who has standing (states?) asks the District of Columbia to do so.
Similar to this issue is the Risk Corridor Program which was stopped because funds could only be appropriated by Congress as determined by the GAO in a letter to Senator Sessions who sent it to the Obama Administration HHS. I am assuming this is of similar ilk. Other funds could have been transferred in from other programs ; but, Upton and Kingston stopped that with Section 227 of the 2015 Appropriations Act (dated December 16, 2014) which escaped notice. In the 2015 Appropriations Act, the sentence inserted said no “other” funds in this bill could be used for Risk Corridor payments.
Partial GAO Letter to Senator Jeff Sessions:
September 30, 2014: Discussion; “At issue here is whether appropriations are available to the Secretary of HHS to make the payments specified in section 1342(b)(1). Agencies may incur obligations and make expenditures only as permitted by an appropriation. U.S. Const., art. I, § 9, cl. 7; 31 U.S.C. § 1341(a)(1); B-300192, Nov. 13, 2002, at 5. Appropriations may be provided through annual appropriations acts as well as through permanent legislation. See, e.g., 63 Comp. Gen. 331 (1984). The making of an appropriation must be expressly stated in law. 31 U.S.C. § 1301(d). It is not enough for a statute to simply require an agency to make a payment. B-114808, Aug. 7, 1979. Section 1342, by its terms, did not enact an appropriation to make the payments specified in section 1342(b)(1). In such cases, we next determine whether there are other appropriations available to an agency for this purpose.”
as taken from here: Risk Corridor Program, Premiums, etc. and the Actual Letter: GAO Letter
It does not matter if you or I sees ambiguity. Not being mean. The court also decides who is in contempt of court and what is relevant. Having gone through 10 years of being locked in battle with a state in state courts and the federal courts up to SCOTUS, I can tell you judges are little “Hitlers” in black robes sitting at a higher altitude in the court than you or I. To overturn them can take years. Maybe the State’s AGs (18) will win in federal court as they may have standing there if the court decides such.
Meanwhile, the damage is done. Trump, Republicans, naysayers, and pundits who have always gotten off on critiquing the ACA in as negative a manner as possible (as seen on other sites who will go unnamed) with context (you can keep your insurance, etc.), lies, and misconceptions do not care as to the damage potentially wrought upon millions of citizens.
Democrats need to get the information out of the issues and also the interpretation by the CBO, Kaiser, etc. Informing the public is critical.
Sorry for the initial brevity and now this length.
Run,
I am confused about the CSR and the tax credits. Currently, are both available? If so, do people get both or do they choose which one they get? If not, why are tax credits kicking in? Are the tax credits actually credits or are the tax deductions?
Jerry:
Best to read here: https://www.healthinsurance.org/obamacare/will-you-receive-an-obamacare-premium-subsidy/ and yes they were eligible for a premium subsidy paid directly to the insurance company and also an out of pock subsidy paid directly to the insurance company.