If Congress and the Trump administration want consumers in most of the United States to have access to commercial individual health coverage in 2018, they have to come up with the cash to stabilize the market immediately.
The four insurance commissioners who lead the National Association of Insurance Commissioners delivered that warning Wednesday in two letters sent to top policymakers in Washington.
The NAIC officers sent one letter to Mick Mulvaney, the director of the Office of Management and Budget, which is an arm of the White House. They sent the other letter to Senate Majority Leader Mitch McConnell and other Senate leaders.
The NAIC officers, who all represent states with Republican governors, told Mulvaney that the Trump administration needs to continue full funding for the Affordable Care Act cost-sharing reduction subsidy program. Insurers use cash from the subsidy program to cut low-income people's deductibles and other out-of-pocket costs.
The insurance commissioners told Senate leaders that they have to fund the Affordable Care Act cost-sharing reduction subsidy program and also provide extra cash that states can use to shore up their individual markets.
"The time to act is now," the commissioners write in both letters. "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 that insurers will continue to get the cost-sharing reduction subsidies and that states will get extra market stabilization cash could go a long way toward stabilizing the individual market, the commissioners write.
The commissioners who signed the letters are Ted Nickel of Wisconsin, the NAIC's president; Julie Mix McPeak of Tennessee, the president-elect; Eric Cioppa of Maine, the vice president; and Raymond Farmer of South Carolina, the secretary-treasurer.
Analysts at Milliman Inc., an actuarial consulting firm, recently reported that cost-sharing reduction subsidy payments accounted for about $13.4 billion of the $206 bilion in individual major medical insurance revenue U.S. insurers collected from 2014 through 2016.
The insurers also received $16 billion from a temporary Affordable Care Act reinsurance program. That program, which was supposed to help stabilize the individual market, shut down on schedule at the end of 2016.
The cost-sharing reduction subsidy program and the temporary reinsurance program has provided about 15% of the individual coverage issuers' revenue over the past three years.
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