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You are here: Home / Anderson On Health Insurance / CSR’s are dead

CSR’s are dead

by David Anderson|  January 24, 20187:57 am| 17 Comments

This post is in: Anderson On Health Insurance

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The Washington Examiner reports that House Republicans still think that they have leverage on Cost Sharing Reduction (CSR) subsidies.

However, Congress did not include the two bills in a Dec. 22 short-term spending deal as the House GOP is largely opposed to the bills, with some calling the Obamacare cost-sharing payments a “bailout.”

That position has not changed, several conservative lawmakers said Monday.

“The CSRs are still something that most of the guys I am talking with are saying I can’t get there,” said Rep. Mark Walker, R-N.C., chairman of the 170-member Republican Study Committee….
“So far the only thing I have seen is additional flexibility at the state level. For me it is not enough,” said Cole. “I want something substantial to justify a vote for that.”

There are two ACA related bills floating in the Senate right now. The first, Collins-Nelson is a two year reinsurance bill. It would allocated $10 billion dollars to eat high cost claims. The second and older bill is Alexander-Murray. It tried to do four things. First it fully appropriated CSR for two years. Secondly, it loosened Section 1332 waiver guidelines in ways that make approvals easier and faster to grant. Next, it allocated outreach money to the states instead of Healthcare.gov and finally it allowed anyone to buy a non-subsidized Catastrophic plan while linking those plans to the common risk pool and shared risk adjustment.

There was some urgency last August and September to pass Alexander-Murray as people feared mass withdrawal from the ACA markets if CSR funding was yanked. That did not happen. Instead, insurers rolled the CSR costs into Silver premiums in most states. This led to much better deals for subsidized buyers and an increase in the number of people buying Gold plans. Funding CSR now makes many subsidized buyers worse off.

Liberals who want broader and better subsidized coverage with low out of pocket expenses will not go to the mats for CSR.

Everything else in the two packages are nice to have from a liberal policy perspective but not have to haves.

No liberal will fight for CSR at the cost of other policy goals. There is no House Republican leverage here. There may be a deal for reinsurance, 1332 guidelines and technical corrections that could get veto proof majorities in both chambers as it would leave everyone slightly happier, but that deal does not need CSR in it.

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Reader Interactions

17Comments

  1. 1.

    rikyrah

    January 24, 2018 at 8:01 am

    Thanks for the update

  2. 2.

    NobodySpecial

    January 24, 2018 at 8:07 am

    Am amazed at this outcome given how important this CSRs were to getting Obamacare off the ground.

  3. 3.

    Baud

    January 24, 2018 at 8:13 am

    @NobodySpecial:

    Life Obamacare … finds a way.

  4. 4.

    Weaselone

    January 24, 2018 at 8:20 am

    Whoa, don’t give away the game here. I think what you meant to say is that CSR payments are huge, blow up the Democratic party if we don’t get them important. Maybe if we get DACA and single payer out of the deal, but otherwise no dice.

  5. 5.

    guachi

    January 24, 2018 at 8:23 am

    CSR payments exist to keep costs to the government down. Since I don’t think Republicans care about government spending I don’t think it’s odd Republicans removed CSR payments. It’s clear the only thing Republicans cared about was hurting Americans, cost be damned.

  6. 6.

    Thoroughly Pizzled

    January 24, 2018 at 8:49 am

    I forget who said this, but it’s ironic that repealing the individual mandate essentially gave us the healthcare plan that Obama proposed way back during the 2008 primary.

  7. 7.

    RealityBites

    January 24, 2018 at 9:01 am

    We have to vote the bastards out.

    And I have a question. After the tax ripoff bill passed, I saw an article about the bill would cause cuts to Medicare. Among other things, the article said Medicare would only pay for one month of physical or vocational therapy instead of the usual two. Now I can’t find this reference. Did I hallucinate? Is this true or not? I have two friends looking at hip replacement surgery and I want to pass on this information if it is accurate.
    Thanks

  8. 8.

    MP

    January 24, 2018 at 9:26 am

    @RealityBites: I believe the cuts to Medicare were required under PayGo rules. PayGo refers to budgetary rules that require spending cuts to offset any spending increases. Congress can -and did- waive PayGo rules for 2018. Had they not done so, deep cuts would have been required to Medicare as well as other government programs. Congress will have to waive PayGo on a yearly basis going forward to avoid being forced to cut other programs to pay for the 2017 Reward Our Donors At All Costs bill.

  9. 9.

    Major Major Major Major

    January 24, 2018 at 9:45 am

    @Thoroughly Pizzled: Well, there’s the small matter of the public option.

    Liberals who want broader and better subsidized coverage with low out of pocket expenses will not go to the mats for CSR… No liberal will fight for CSR at the cost of other policy goals.

    No liberal who understands actual policy and isn’t swayed by Republican talking points, that is–which doesn’t accurately describe every liberal in Congress.

  10. 10.

    dr. bloor

    January 24, 2018 at 9:47 am

    No liberal will fight for CSR at the cost of other policy goals.

    But the whining from the left when the sell-out Democrats walk away from it will be epic.

  11. 11.

    Victor Matheson

    January 24, 2018 at 11:06 am

    Might it even be the case that CSRs would be bad for Dems at this point. They would likely result in a large reduction in the price of insurance on the exchanges for 2019. These premium reductions would be announced right as the election is taking place and it is difficult to tell exactly who the electorate would credit for these premium reductions. Certainly Trump would try to take credit for rescuing the failing ACA.

  12. 12.

    Raoul

    January 24, 2018 at 11:15 am

    So, as a non-subsidized, individual market buyer, it seems I’m likely still screwed in about ’19 or at the latest ’20, though, right? (Not that $550/mo right now feels great).
    The curious backfire of not doing CSRs is that the subsidized market got better, but just above 400% FPL and anything above, the pain gets worse, and I don’t think that has changed. Has it?

  13. 13.

    randy khan

    January 24, 2018 at 11:16 am

    It’s interesting how the end of CSRs has played out in the marketplace so far. A lot of people not named David Anderson wouldn’t have predicted it. (And when I told friends on Facebook that they should look at Gold plans because they might be cheaper this year, some of them were astounded.)

  14. 14.

    Fair Economist

    January 24, 2018 at 11:22 am

    @Raoul:

    The curious backfire of not doing CSRs is that the subsidized market got better, but just above 400% FPL and anything above, the pain gets worse, and I don’t think that has changed. Has it?

    No, that is exactly what happens, although generally unsubsidized buyers can switch to Bronze or Gold where the hit is much smaller than for Silver, although those plans might be less suitable in and of themselves.

    The good thing is that when the Democrats regain control they will probably leave the subsidized buyers in their improved situation and provide relief to the unsubsidized, bringing them to at least where they were before and hopefully better to match up with the subsidized. A particular shift I’m hoping for is removing the income cap on subsidies, so that nobody pays more that 10% of income for a Silver plan. It’s a good policy, and the current cliff edge at the subsidy creates some very strange incentives.

  15. 15.

    cynthia ackerman

    January 24, 2018 at 11:30 am

    At age 57, I’m suddenly off employer-provided coverage and finding my way through individual.

    For the moment I am covered by the Oregon Health Plan, which is superb.

    But as my income improves, Healthcare.gov becomes my reality.

    David, I’m thankful for your commitment to educate on this stuff.

    I’m also appalled to live firsthand through something that is unnecessarily Byzantine and apparently getting more so, all for political BS.

    Thanks Republicans! Looking at you, Greg Walden …

  16. 16.

    David Anderson

    January 24, 2018 at 12:08 pm

    @Raoul: Nope, >400% FPL is SOL

    States have the option of applying for 1332 reinsurance waivers that would bring down non-subsidized prices and several are doing so

  17. 17.

    Kelly

    January 24, 2018 at 1:23 pm

    @Fair Economist: Eliminating the the 400% subsidy cliff strikes me as a worthy goal if the Democrats win the Senate and the House 2018. If Trump vetoes it’s an understandable issue to wave around in 2020. Who knows he might sign it depending on who talks to him last.

    Reinsurance is an interesting tool I’ve only thought about in the last year or so. I can see now that if insurance companies know they’ll never be stuck with a million dollar claim the monthly payments would go down or at least up a lot slower.

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