Insurers that sell plans through Healthcare.gov are having a tough time figuring out what to expect in the next year or two of business. President Trump isn't making the guessing game any easier.
Not only does Trump continue to insist that he will repeal and replace the Affordable Care Act, but he is sending mixed signals about whether his administration will continue to provide subsidies that insurers depend on to provide discounted health plans to low-income customers.
At issue are cost-sharing payments that the Obama administration paid to ACA health plans. During the Obama presidency, Congressional Republicans sued over the payments, arguing that the administration lacked the required Congressional authorization to make them.
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A judge sided with the Republicans in a decision nearly a year ago, but did not enforce the decision while the Obama administration appealed. The appeal is still underway, and the Trump administration could simply drop the appeal and stop the payments any day.
Shortly after the failed attempt to repeal the ACA, Republican leaders in Congress said they would support continuing the subsidies, without which the ACA marketplace would likely collapse. On Monday, the Trump administration appeared to follow suit, saying that the payments would continue "while the lawsuit is being litigated."
But insurers and ACA beneficiaries had barely let out a sigh of relief before the infamously unpredictable president appeared to backtrack on Tuesday.
"The report was in reference to the current status of the lawsuit and is not an indication of what will happen in the future," an administration spokesperson told Vox the next day. "No decisions have been made about how the administration will proceed."
The cost-sharing subsidies amount to $7 billion. Their elimination, according to Vox, would lead premiums to increase on the ACA marketplace by 19 percent.
While 19 percent may seem small compared to some of the dramatic premium hikes that have occurred for some ACA plans, the average increase year-over-year has been in the single digits. Furthermore, the poorest customers were largely insulated from the increases because of the cost-sharing subsidies that kept the cost of their plans relatively steady.
The mixed signals from Trump are leading to uncertainty among insurers, some of which have yet to turn a profit on their ACA business but were counting on eventually making it profitable in the long-term. The uncertainty might lead even more insurers to ditch the ACA market entirely, fulfilling the president's prophesy that the system will "explode."
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