House Republicans seek delay in case to end ACA cost-sharing subsidies

By Harris Meyer
Modern Healthcare, November 21, 2016

To buy President-elect Donald Trump time to craft an Affordable Care Act replacement, House Republicans have asked a federal appellate court to delay considering the Obama administration’s appeal in a case that could end some payments to health plans and throw the individual insurance market into chaos.

The House Republicans’ general counsel filed a motion Thursday to temporarily hold in abeyance all briefings in the appeal of a federal district court’s May ruling in House v. Burwell that the Obama administration illegally compensated insurers for reducing low-income enrollees’ cost-sharing responsibilities. A U.S. District Court judge nominated by President George W. Bush unexpectedly held that the payments were unconstitutional because Congress had not appropriated the money.

If those cost-sharing reduction payments were eliminated, as House Republicans have sought, insurers either would have to sharply raise premiums or exit the ACA exchange markets, since the law requires them to reduce cost-sharing burdens for eligible members in silver plans.

Some Republicans and health policy experts fear that any hasty, drastic moves would crash the individual insurance markets. They warn that ending the cost-sharing reductions without any replacement system might panic insurers by causing them to lose lots of money.


If Republicans Repeal Obamacare, Ryan Has Replacement Blueprint

By Alison Kodjak
NPR, November 21, 2016

The absence of specifics on health care from the president-elect makes the 37-page plan that Speaker of the House Paul Ryan has released the fullest outline of what Republicans would like to replace Obamacare. Some health policy analysts say it looks a bit like Obamacare light.

Republicans repeatedly voted for repeal of the Affordable Care Act (ACA) knowing that the severe adverse consequences would be prevented by serial vetoes by President Obama. They also filed  a lawsuit – House v. Burwell – to prevent the payment of cost-sharing subsidies for exchange plans since the funds were never authorized by Congress. But since, to their surprise, a judge has ruled in favor of the Republicans, they are concerned about being blamed for the ensuing disaster if the judge’s decision were to be upheld.

Since they have never advanced replacement legislation, it is clear that this has only been a game of political chicanery and not a legitimate effort to advance their own concepts of whatever they may truly believe would be a superior health care financing system.

Since winning the election, Trump has posted seven items for action which together would “completely repeal” ACA but would introduce changes that would have only a negligible impact in making insurance more available and affordable. The Republicans clearly do not want to be blamed for taking away the expansions in coverage made possible by ACA, so the Trump proposals are not being taken seriously.

The Republicans have been considering many proposals, and they have been aggregated into a 37 page white paper released by Speaker Paul Ryan. Many of the measures would reduce the effectiveness of insurance plans and shift many of the costs of health care onto the individual patients. But it is clear to the Republicans that there are many policy principles that must be met to have any semblance of a functioning insurance market. When they include these requirements, they end up with a proposal that is very similar to Obamacare, except with less coverage and less regulation. Thus the Republican plan is referred to as “Obamacare light.”

We don’t know yet what will happen, but the Republican effort to halt their own lawsuit against the ACA subsidies indicates that they realize that they will have to come up with an effective proposal before they begin to reverse (and then somewhat surreptitiously reinstate) the reforms in ACA. That will likely be Obamacare light.

The improvements under ACA were not enough and have left us with a terribly deficient health care financing system. Under the Republicans, it will be more of the same, but worse. We cannot let up on our efforts to inform the nation that a single payer, improved Medicare for all would be a vast improvement, but it will not happen unless the people demand it. Although there is support for single payer, their voices are not loud enough yet to move the politicians. We need to change that.