Skip to main content

Cost Share Reduction (CSR) Subsidy Has Uncertain Future Under Trump

One of the features of ObamaCare is the Cost Share Reduction Subsidy.  This is separate from the Premium Tax Credit Subsidy and applies in California to those with incomes between 138% and 250% of the Federal Poverty Level (100%-250% in states that did not expand Medicaid).

The CSR is used to reduce expenses under Silver Tier health plans for those who qualify. 

138%-150% are eligible for Silver 94
150-200% are eligible for Silver 87
200%-250% are eligible for Silver 73 

As an example of the CSR at work, here are the primary care office visit co-pays for four Silver plans...

Silver 70 (standard no CSR)    $45
Silver 73 with CSR                   $40
Silver 87 with CSR                   $15
Silver 94 with CSR                   $ 3

The cost share reduction is an important benefit for those with lower incomes.  Whether it will continue to be funded is uncertain at the moment.

President Trump may try to use the funding of CSR as a bargaining chip to get Democratic support for TrumpCare reform.  From California Health Underwriters this week...

There were conflicting administration statements regarding the Cost Sharing Reduction program, with HHS indicating that they will be funded but then backing off that to say that a final decision had not been made. President Trump may wish to use the CSR funding as a bargaining chip with Democrats, but Democrats have indicated that they will not negotiate CSR funding and wanted the funding included in permanent mandatory spending. This is tied to the House v. Price court case, which the Obama administration filed challenging a ruling Federal District court that the program was not properly funded. The Trump administration asked the court for more time to review the case, but if the Trump administration withdraws the challenge, private insurers will be left with approximately $7 billion in payments to individuals, resulting in many carriers exiting the market. Major industry groups and top healthcare officials have sent letters to the administration urging continuation of CSR funding.

As I understand it with regard to House v. Price, so long as the Trump administration maintains the appeal, CSR remains.  If the administration withdraws the appeal, the original federal court decision would be enforced (removing CSR).

This is definitely something I will keep an eye on.  

Dave
www.davefluker.com





Comments

Popular posts from this blog

Anthem Blue Cross (CA) Adding SilverSneakers® Fitness Program

Anthem Blue Cross (CA) announced this morning that they will be adding the SilverSneakers Fitness Program to California Medicare Supplement Plans A, F, and N.  The added benefit will begin on January 1st, 2017. 

Once approved for release into the market, more states have been added to the list as existing and new members in our marketed plans will enjoy the value-added benefits of the SilverSneakers Fitness program at no additional cost! Effective January 1, 2017, California members in our marketed plans will enjoy SilverSneakers, too.  The program offers members their choice of paths to better health. For those who enjoy a traditional workout setting, SilverSneakers offers access to more than 13,000 fitness locations across the country, including use of classes and guidance from a Program AdvisorTM. In addition, for those who can’t get to a fitness center, SilverSneakers Steps® kits focus on at-home or on-the-go general fitness, walking, strength training or yoga. And if that is not …

How Will Donald TRUMP ObamaCare?

With the election of Donald Trump as the next US President, healthcare reform and ObamaCare are on the chopping block.  There is media speculation that a transformation away from the current ObamaCare system will be rather immediate once Donald Trump is sworn into office in January.  


While changes are certainly coming, I would not expect a wholesale changeover immediately, but rather over the course of 2017.  My hope is to see an open market available at any time during the year (like it used to be) instead of an abbreviated Open Enrollment Period.  

Below are some key points to a Donald Trump-Care system and a link to his Healthcare Reform Paper which goes into more detail...



 1. Completely repeal Obamacare. 2. Modify existing law that inhibits the sale of health insurance across state lines. 3. Allow individuals to fully deduct health insurance premium payments 4. Allow individuals to use Health Savings Accounts (HSAs). 5. Require price transparency from all healthcare providers.6. Bl…

2016 Open Enrollment Has Begun

Here to kickoff the 2016 open enrollment period which will run from November 1, 2015 to January 31, 2016.  

It is important to remember that during the open enrollment period all rules regarding SEP (special election period) enrollment dates for loss of employer coverage are off of the tablle. Than means no retroactive start dates on the Covered California health exchange.

Remember during open enrollment you may sign up for any available health insurance plan either off- or on-exchange with no medical underwriting.

My site features live free instant quotes and online applications for off-exchange subscribers.

For Covered California exchange subscribers, I can take your information over the phone and set up your account on Covered CA for you.  You would need to log in with a special code I would provide upon submission of the application and select your plan/pay the initial premium via Covered CA.  

Carrier for 2016 include:

*Anthem Blue Cross PPO, Tiered PPO and HMO
*Blue Shield of Californi…