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Insurers in limbo as Trump delays health care decision

Ricardo Alonso-Zaldivar
Associated Press

Washington — Uncertainty over the future of health care for millions grew deeper Monday as insurers released a blueprint for stabilizing wobbly markets and the Trump administration left in limbo billions of dollars in federal payments.

At the federal courthouse, the administration and House Republicans asked appeals judges for a 90-day extension in a case that involves federal payments to reduce deductibles and copayments for people with modest incomes who buy their own policies. The fate of $7 billion in “cost-sharing subsidies” remains under a cloud as insurers finalize their premium requests for next year.

In requesting the extension, lawyers for the Trump administration and the House said the parties are continuing to work on measures, “including potential legislative action,” to resolve the issue. Requests for extensions are usually granted routinely.

Hours before the filing, a major insurer group released a framework for market stability that relies in part on a continuation of such subsidies.

The BlueCross BlueShield Association represents plans that are the backbone of insurance markets under the Affordable Care Act, or ACA, and would also be the mainstay with a Republican approach.

As the GOP-led Congress works on rolling back major parts of the Obama law, the BlueCross BlueShield plan called for:

■Continued protections for people with pre-existing medical conditions and sustained federal funding to offset the cost of care for the sickest patients.

■More leeway for states to experiment with health insurance benefits, with a basic floor of federal standards.

■Preserving ACA consumer safeguards including no lifetime caps on benefits, no higher premium for women based on gender, and a requirement that insurers spend a minimum of 80 cents of every premium dollar on medical care.

■Penalties such as waiting periods for people who fail to maintain their coverage. Republicans want to repeal the Obama-era tax penalties on uninsured people deemed able to afford coverage.

■Significant federal funding to subsidize premiums and out-of-pocket costs.

“There needs to be sustained federal funding,” said Justine Handelman, policy chief for the insurer group. “It’s critical to ensuring overall affordability.”

About 20 million Americans purchase individual health insurance policies, with more than half using the ACA’s markets, which offer income-based subsidies for premiums and out-of-pocket costs.

The Trump administration has sent mixed signals, and the White House is now saying it needs more time to decide on the cost-sharing money. Without those subsidies, experts say, premiums could jump about 20 percent in 2018. Another round of sharp premium increases and insurer exits seems possible.

The case is on appeal after a lower court ruled that the government lacks constitutional authority to make the payments because Congress failed to specifically approve them in the Obama-era health overhaul legislation.