The Journal Gazette
Tuesday, June 20, 2017 1:00 am

Health law's future could hinge on subsidy

IU law prof makes case in phone call

BRIAN FRANCISCO | The Journal Gazette

The fate of federal health insurance options might hinge on whether the Republican Congress retains a key subsidy provided by the Affordable Care Act, according to a professor at Indiana University's law school and the state's senior U.S. senator.

David Orentlicher said Monday that nearly half of the roughly 147,000 Hoosiers enrolled in ACA insurance policies depend on what are known as cost-sharing reductions. Under the law, which Republicans are trying to repeal and replace, the federal government pays insurers to reduce deductibles and co-payments for low-income customers.

“Without the cost-sharing payments, Indiana's thriving insurance market will go south,” Orentlicher predicted in a telephone call with news media arranged by the Indianapolis Congregation Action Network, an affiliation of more than 40 faith and community organizations.

Later in the day, Sen. Joe Donnelly, D-Ind., delivered a Senate floor speech in which he said that Congress and President Donald Trump “have created instability and have created chaos in the insurance markets, resulting in significant cost increases for consumers,” by placing cost-sharing reductions in jeopardy.

Nationally, 57 percent of the 10.3 million people enrolled in ACA policies receive cost-saving reductions, the Department of Health and Human Services reported last week. The subsidy will pay insurers an estimated $7 billion during fiscal 2017, according to the Congressional Budget Office.

Orentlicher, also an adjunct medical professor for IU and a former medical ethics director for the American Medical Association, said insurers are projecting double-digit premium increases of up to 40 percent if the industry reimbursements would be eliminated by Trump and Congress. House Republicans – who filed a lawsuit in 2014 over the payments, arguing that lawmakers had not appropriated money – voted to kill the subsidy in the American Health Care Act they passed in May, and Trump reportedly wants to put an end to it as well.

“Low-income Hoosiers who no longer can find an affordable health plan will be left sicker, and those who manage to pay the higher premiums will be left poorer,” said Orentlicher, a former Democratic state lawmaker who ran for Congress last year in southern Indiana's 8th District, losing in the primary election.

Indiana's ACA insurers must submit their 2018 proposed prices to the state by Wednesday. The suggested premiums might reflect how much or little confidence insurers have that cost-sharing reductions will be preserved under the GOP's American Health Care Act, which Senate Republicans have been negotiating in private.

Donnelly said on the Senate floor that insurer CareSource had informed him it would raise its Indiana premiums by 2 percent if cost-sharing reductions are maintained – but by at least 15 percent if they are not. He said insurer Anthem told him that “without certainty of CSR funding,” it was considering increasing premiums, eliminating products and exiting certain markets. Orentlicher had made similar comments in his earlier media call.

In remarks broadcast by C-SPAN, Donnelly said Trump had made “a deliberate choice” to “undermine” the ACA “at the expense of real people.”

“This makes no sense,” Donnelly said. “If your house needs repairs, you don't set the house on fire. You work to fix the issues. If we're serious about improving health care in this country, we can do it, and we can do it working together.”

Like the ACA, the Republicans' health care measure would offer private insurance plans to people who cannot obtain affordable medical coverage through their employers. Senate GOP leaders reportedly want to vote on their version of the bill by the time they leave for their July 4 recess period.

The Rev. Darren Cushman-Wood, pastor of North United Methodist Church in Indianapolis, said during Monday's media call with Orentlicher that any failure to preserve cost-sharing reductions “is going to inflict a great deal of pain on those who are most vulnerable,” including “children, those who are weak and those who are sick.” 

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