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Future Of The Affordable Care Act Remains Uncertain


Over the weekend, President Trump tweeted, if a new health care bill is not approved quickly, bailouts for insurance companies and bailouts for members of Congress will end very soon. That's a threat to end subsidies that benefit low-income Americans who are insured through the Affordable Care Act. It's also a threat to end subsidies specific to health plans for members of Congress. Now this tweet, among others, adds more uncertainty about the future of the Affordable Care Act after Friday's failure to repeal and replace it.

Joining me now is Sarah Kliff. She's a senior health care policy correspondent for Vox. Welcome to the program.

SARAH KLIFF: Thank you for having me.

CORNISH: Let's start out with that term bailouts, the payments that the president is threatening to withhold. Tell us more about what he's talking about and whether he could actually do what he's threatening.

KLIFF: Yeah, so he's talking about two things. And I'll tackle the one for insurance companies first, and then we can go from there. So he is talking about these funds that we call cost-sharing reduction payments. This is about $8 billion that the federal government sends to insurance companies to offset the copays and deductibles that low-income patients on the Obamacare marketplaces have.

What the Trump administration is threatening to do and what they could do is say they are going to stop paying those cost-sharing reduction subsidies. That would cause a lot of chaos in the marketplaces. Experts estimate that premiums would rise 15 to 20 percent if that fund went away.

CORNISH: Now, President Trump regularly talks about letting the Affordable Care Act, quote, unquote, "implode." In the meantime, what are the actions the Trump administration has already taken that could effectively undermine the law? What's happened since he's taken office?

KLIFF: A lot of it is just the uncertainty about how he is going to manage the Affordable Care Act. And for insurance companies, they don't like uncertainty. Insurance companies love to know exactly what they're pricing for, who's going to sign up, how much their medical bills are going to be. So you know, it isn't necessarily the case that they've put out specific policies to damage the Affordable Care Act. It's mostly they don't make clear what their policy positions are. And that's actually quite damaging in itself.

CORNISH: But Democrats look at things they're doing like saying withholding the advertising - right? - so people don't know kind of when and where to sign up and say, look; that's an example of sabotage.

KLIFF: Yeah, that's a good point. You certainly do see some ads being pulled off the air in January. Just last week, the Trump administration cut off a grant to 18 cities to do enrollment work. So you're seeing some small amounts of that. But we'll really get a big test when we get into open enrollment in November and see, you know, is the Trump administration letting people know about open enrollment? Is it easy to get through to the call center? Are there lots of people staffing it? Or are there long waits? These are all kind of small, practical details, but they really add up in terms of whether people get health insurance or not.

CORNISH: So far, has there been an actual effect, right? Like, what has been the result of the actions they have taken?

KLIFF: So we did see enrollment go down a little bit at the end of the open enrollment season this year. This was just a few weeks after the Trump administration came into office. It's hard to know how much of that was related to specific actions they took, but it is certainly true that we saw enrollment dip a little bit. And this is after some of the advertising was pulled. The other place we're seeing it right now are where insurance companies say, our premiums are higher because of the way the Trump administration is managing the Affordable Care Act.

CORNISH: Let's say we hear Republicans and Democrats are working together in a bipartisan way to improve the Affordable Care Act. In another part of the program, we're actually talking to some House lawmakers trying to do that. Are there some obvious fixes?

KLIFF: Yeah, there certainly are, and they're being talked about on Capitol Hill right now. One of the biggest is requiring the payment of those cost-sharing reduction subsidies, writing it into law that this money exists, that it goes to insurance companies.

The other thing that comes up that, you know, insurance companies really want is some kind of fund to offset their really expensive patient so that when they get someone with a million dollars in medical bills, that they have some kind of backup fund from the federal government. This is typically called reinsurance. And insurance companies say they would feel more comfortable enrolling Obamacare enrollees if they had that assurance they wouldn't go broke if they get one really expensive patient.

CORNISH: For people listening who do have insurance coverage through an Affordable Care Act or Obamacare exchange, should they expect any changes to their health care or insurance just in the coming months?

KLIFF: A lot of that depends on where you live. I'd say generally the picture nationally is - we are seeing possibly some significant premium increases in 2018 because insurance companies are not sure about those cost-sharing reduction subsidies. The Blue Cross plan in North Carolina, for example, is tacking 14 percent onto their premium rate increase.

But states, particularly those that have done a lot of work to mitigate some of this uncertainty, a place like California, you're not going to see a lot of change. But then you have other places that haven't been as enthusiastic adopters. And I should also mention we right now have 19 counties across the country in Indiana and Nevada with no insurance plans signed up to sell coverage in 2018. If that doesn't get fixed, those people will not be able to purchase an Obamacare plan next year.

CORNISH: Sarah Kliff is senior health care policy correspondent at Vox. Thank you for speaking with us.

KLIFF: Yeah, thank you.