Trump health action ‘critical,’ regulators warn as Fla. uninsured grow

Palm Beach Post (FL)

May 20--As Obamacare deadlines loom, insurance regulators are pleading with President Donald Trump's administration and Congress to end a money drama that threatens the "viability and stability" of health markets and could hurt millions of consumers by chasing insurers away and pushing premiums up 25 percent in Florida.

The effort comes as new federal numbers show Florida adults lacking coverage are on the rise in a state with the nation's third highest uninsured rate overall.

A letter from the National Association of Insurance Commissioners implored Trump budget director Mick Mulvaney to provide assurances billions of cost-sharing dollars will continue to help consumers cover co-pays and deductibles.

"On behalf of the nation's state insurance commissioners, the primary regulators of U.S. insurance markets, we write today to urge the Administration to continue full funding for the cost-sharing reduction payments for 2017 and make a commitment that such payments will continue, unless the law is changed," NAIC's May 17 letter said. "Your action is critical to the viability and stability of the individual health insurance markets in a significant number of states across the country."

On Friday, a coalition of insurers, medical and business groups added their voices.

"We urge Congress to take action now to guarantee a steady stream of CSR (cost-sharing reduction) funding through 2018," said a letter from America's Health Insurance Plans and others. "Unless CSRs are funded, a tremendous number of Americans will simply go without coverage and move to the ranks of the uninsured. This threatens not just their own health and financial stability, but also the economic stability of their communities."

Joining the letter were the American Academy of Family Physicians, American Benefits Council, American Hospital Association, American Medical Association, Blue Cross Blue Shield Association, Federation of American Hospitals and the U.S. Chamber of Commerce.

Ironically, withholding the cost-sharing money could actually cost taxpayers 23 percent more because it drives up another kind of subsidy that reduces premium costs, The Palm Beach Post reported.

But whether Trump and Congress ultimately provide the cost-sharing money or not, a key effect already could be happening: scaring insurers off.

Insurers must decide by June 21 whether to file rates for 2018 and what premiums to charge. Faced with uncertainty and potential losses if they make wrong assumptions about subsidies and other factors, some insurers have already begun pulling out in states including Iowa.

As The Post reported in April, the average rate increase to make up for the projected $10 billion in 2018 government payments is 19 percent nationally and 25 percent in Florida, the Kaiser Family Foundation calculated -- if insurers do not exit Affordable Care markets entirely.

Trump backed legislation the House passed on May 4 that rolls back close to $1 trillion in taxes. Congressional Budget Office analysts said the bill could lower costs for healthier, younger and higher-income people. But it is projected to raise costs for older, sicker and lower-income consumers and its original version would push 24 million out of coverage, CBO said.

CBO projections on the final House bill could arrive this coming week, but the legislative battle is in the Senate's hands now.

In addition, a court hearing is expected in a House lawsuit that seeks to block the cost-sharing payments.

New York and 15 other states, not including Florida, said Thursday they filed a motion to intervene in the case.

"We're talking about people's lives -- and for President Trump and the Republicans to use them as pawns in a political game is simply unconscionable," said New York Attorney General Eric Schneiderman.

The suit deals with what branch of government has the authority to make certain payments, but the bottom line is Congress will have the power to fund the cost-sharing subsidies if it chooses, even if the administration's options become constrained.

Trump threatened to withhold the cost-sharing payments in an effort to get Congressional Democrats to commit to paying for a border wall.

"I don't want people to get hurt," Trump said in April. "What I think should happen -- and will happen -- is the Democrats will start calling me and negotiating."

When that failed to work, Trump tweeted on May 7, "Republican Senators will not let the American people down! ObamaCare premiums and deductibles are way up -- it was a lie and it is dead!"

NAIC president Theodore K. Nickel of Wisconsin and colleagues from Tennessee, Maine and South Carolina told the administration Wednesday there's no time to wait to stabilize markets. A similar letter went to Senate leaders.

"The time to act is now," the letter to Mulvaney said. "Carriers are currently developing their rates for 2018 and making the decision whether to participate on the Exchanges, or even off the Exchanges, in 2018. Assurances from the Administration that the cost-sharing reduction payments will continue under current law will go a long way toward stabilizing the individual markets in our states while legislative replacement and reform options are debated in Congress."

An attempt to seek comment from a White House spokeswoman was not successful.

"As you know, there is increasing concern that more carriers will pull out of this market and rates will continue to rise, leaving consumers with fewer and more expensive options, if they have any options at all," the NAIC letter said. "This is not a theoretical argument -- carriers have already left the individual market in several states, and too many counties have only one carrier remaining. The one concern carriers consistently raise as they consider whether to participate and how much to charge in 2018 is the uncertainty surrounding the federal cost-sharing reduction payments."

Meanwhile, new data showed a growing number of Florida adults lack health coverage, a reversal of recent trends.

Among people 18 to 64, the state's uninsured rate climbed to 20 percent, up from 18.7 percent in 2015, according to the U.S. Centers for Disease Control's early release of estimates from the national health interview survey. A year earlier, the number had fallen, from 23 percent in 2014.

The nation's uninsured rate remained essentially unchanged at an all-time low of 9 percent in 2016, but 13.8 percent of Floridians of all ages had no health insurance, the third highest in the country.

Florida rejected Medicaid expansion under the Affordable Care Act, shunning an option that lowered uninsured rates in many other states. State Republican leaders called it too expensive, as the state would have to pay a share of the costs in later years.

A big part of the political calculus heading toward 2018 elections is whether voters blame Democrat-designed Obamacare or GOP stewardship for problems they may experience. Town hall meetings have demonstrated how prickly the issue can get.

Florida's Republican Gov. Rick Scott, urged by Trump to run against Democrat Bill Nelson for a 2018 U.S. Senate seat, responded through a spokeswoman to a request for comment from the Post.

"As someone who grew up without access to health care, Gov. Scott knows firsthand how important improving access is to people across the state," press secretary Lauren Schenone said. "The Governor has not gone line by line on the current bill but he believes Congress cannot give up on getting rid of Obamacare and is encouraged that something is being done."

Scott supported increased flexibility in the House bill to let states have greater control over how they spend federal health dollars. In addition, Florida successfully lobbied the Trump administration for almost $1 billion in increased "Low Income Pool" money to help cover vulnerable people.

Florida's numbers reflect its "coverage gap," said Joseph F. Pennisi, executive director of the Florida Policy Institute, which calls itself a "common-sense" nonprofit think tank promoting general prosperity based in Lake Mary.

"There are more than 500,000 Floridians in this category, because they make too much money to qualify under Florida's extremely restrictive Medicaid income standards (for a family of four, the adults must have an annual income of less than $7,000 to be eligible) but too little to qualify for subsidies in the federal marketplace," Pennisi said by email. "There is a dramatic difference in uninsured rates between states that expanded Medicaid and non-expansion states. Florida could see a major reduction in its uninsured rate if it expands coverage."

He continued, "Florida made some gains in terms of the percentage of insured residents thanks to the ACA. However, that's being threatened now by the American Health Care Act, which would result in millions of people across the U.S. losing coverage."

The Trump administration's Centers for Medicare and Medicaid Services released new information Tuesday that it said would help states seek waivers from requirements in the Affordable Care Act. The ACA already allows some waivers, and more changes could come under proposed legislation.

"CMS is helping to provide guidance to states who want to pursue solutions to help lower costs and increase coverage choices for Americans struggling with unaffordable premiums and reduced competition in the insurance market, brought on by the ACA," the release said.

But supporters of the 2010 Affordable Care Act said the latest numbers highlight the stark choices facing the country now. They show 20 million more Americans gained coverage since the ACA passed. Florida led the nation in people using the federal marketplace to buy policies, more than 1.5 million.

"That means, when Donald Trump was elected, more Americans had health insurance than ever before," said Ben Wakana, former health spokesman in the Obama administration. "There's no reason for us to go backward -- but unfortunately there's a big risk that we will, due to Republicans' relentless repeal drive and Trump's sabotage of the health care system. Your move, Mr. Trump."

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