Letter to President Trump - Cost-Sharing Reduction Payments


By: Gwen Moore, Ron Kind, Mark Pocan, Denny Heck, Adam Smith, Pramila Jayapal, Derek Kilmer, Rick Larsen, Suzan DelBene, Peter Welch, Stacey Plaskett, Gerry Connolly, Don Beyer, Jr., Donald McEachin, Bobby Scott, Lloyd Doggett II, Filemon Vela, Jr., Marc Veasey, Henry Cuellar, Joaquin Castro, Sheila Jackson Lee, Beto O'Rourke, Vicente Gonzalez, Al Green, Steve Cohen, Jim Cooper, Jim Clyburn, Jim Langevin, David Cicilline, Matt Cartwright, Mike Doyle, Jr., Brendan Boyle, Dwight Evans, Bob Brady, Kurt Schrader, Peter DeFazio, Earl Blumenauer, Suzanne Bonamici, Tim Ryan, Marcia Fudge, Marcia Kaptur, Joyce Beatty, Brian Higgins, Louise Slaughter, Paul Tonko, Sean Maloney, Nita Lowey, Eliot Engel, José Serrano, Joe Crowley, Adriano Espaillat, Carolyn Maloney, Jerry Nadler, Yvette Clarke, Hakeem Jeffries, Nydia Velázquez, Grace Meng, Gregory Meeks, Kathleen Rice, Thomas Suozzi, Ruben Kihuen, Jacky Rosen, Dina Titus, Michelle Lujan Grisham, Bonnie Watson Coleman, Don Payne, Jr., Bill Pascrell, Jr., Albio Sires, Frank Pallone, Jr., Joshua Gottheimer, Donald Norcross, Ann Kuster, Carol Shea-Porter, Alma Adams, David Price, G.K. Butterfield, Jr., Bennie Thompson, Kilili Sablan, Emanuel Cleaver II, Lacy Clay, Jr., Rick Nolan, Collin Peterson, Keith Ellison, Betty McCollum, Tim Walz, Brenda Lawrence, John Conyers, Jr., Debbie Dingell, Sandy Levin, Dan Kildee, Chellie Pingree, Jamie Raskin, Elijah Cummings, John Delaney, Steny Hoyer, Anthony Brown, John Sarbanes, Dutch Ruppersberger, Bill Keating, Stephen Lynch, Mike Capuano, Seth Moulton, Katherine Clark, Joe Kennedy III, Niki Tsongas, Jim McGovern, Cedric Richmond, John Yarmuth, André Carson, Pete Visclosky, Cheri Bustos, Bill Foster, Brad Schneider, Jan Schakowsky, Raja Krishnamoorthi, Danny Davis, Mike Quigley, Luis Gutiérrez, Dan Lipinski, Robin Kelly, Bobby Rush, Dave Loebsack, Tulsi Gabbard, Colleen Hanabusa, Madeleine Bordallo, David Scott, John Lewis, Hank Johnson, Jr., Sanford Bishop, Jr., Frederica Wilson, Debbie Wasserman Schultz, Ted Deutch, Lois Frankel, Alcee Hastings, Sr., Kathy Castor, Charlie Crist, Jr., Val Demings, Darren Soto, Stephanie Murphy, Al Lawson, Jr., Lisa Blunt Rochester, Eleanor Norton, Elizabeth Esty, Jim Himes, Rosa DeLauro, Joe Courtney, John Larson, Ed Perlmutter, Jared Polis, Diana DeGette, Susan Davis, Scott Peters, Juan Vargas, Alan Lowenthal, Lou Correa, Nanette Barragán, Mark Takano, Lucille Roybal-Allard, Linda Sánchez, Karen Bass, Raul Ruiz, Norma Torres, Ted Lieu, Grace Napolitano, Pete Aguilar, Brad Sherman, Tony Cárdenas, Adam Schiff, Judy Chu, Julia Brownley, Salud Carbajal, Jimmy Panetta, Zoe Lofgren, Anna Eshoo, Ro Khanna, Jim Costa, Eric Swalwell, Jackie Speier, Barbara Lee, Nancy Pelosi, Mark DeSaulnier, Jerry McNerney, Ami Bera, Doris Matsui, Mike Thompson, John Garamendi, Jared Huffman, Kyrsten Sinema, Ruben Gallego, Raul Grijalva, Tom O'Halleran, Terri Sewell, Richard Neal
Date: May 24, 2017
Location: Washington, DC

Dear Mr. President:

The law requires, and it is your obligation under the law, to pay the Affordable Care Act's (ACA) cost-sharing reduction payments. Equivocation on this matter destabilizes the market and hurts American families by directly increasing their health care costs.

Cost-sharing reduction payments help seven million hardworking Americans and their families -- more than half of all Marketplace enrollees for 2017 -- afford their out-of-pocket health care costs. The decision to unilaterally rescind support for these subsidies will cause premiums and out-of-pocket costs to skyrocket and could cause millions of Americans to lose their health insurance coverage.

According to a recent report in Politico, your administration has stated that it will continue to pay these cost-sharing subsidies, for now. However, your public statements continue to raise doubts about the future of these payments and your commitment to enforcing the ACA, the law of the land. You have also stated in the past that, "The best thing politically is to let Obamacare explode" and recently said that "Obamacare is dead."

We strongly disagree. The ACA is not dead; however, your failure to commit to paying these subsidies is destabilizing the Marketplaces, and will directly result in higher costs and fewer consumer choices. Insurers have little time left to finalize their rate filings for 2018, and without certainty as to whether or not cost-sharing subsidies will be paid, they will significantly raise their rates or exit the Marketplaces altogether. According to the American Academy of Actuaries, failure to make cost-sharing subsidy payments "could result in insurer losses and solvency challenges, leading insurers to further consider withdrawing from the market. . . . [S]ignificant market disruption could result, leading to millions of Americans losing their health insurance." In fact, the CEO of Molina Healthcare recently warned that if cost-sharing subsidies are not funded, the company will withdraw from the Marketplaces immediately.

In areas where insurers decide to remain in the Marketplaces, failure to pay these subsidies will increase premiums for all individuals enrolled in the individual market. According to a study by the Kaiser Family Foundation, average ACA Marketplace premiums for silver plans would need to increase by 19 percent to compensate for lack of funding for cost-sharing subsidies. An analysis conducted by Covered California found that 2018 health premiums in the individual market in California could rise by 42-49 percent if the subsidies are not funded and other provisions of the ACA are not enforced. Rising prices and fewer choices will likely hit consumers in rural areas, where health care prices have traditionally been higher, particularly hard. As a result of rising premiums, the federal government would end up spending $31 billion more from 2018-2027.

Working families in every state are relying on you to pay cost-sharing subsidies to help ensure that they can afford the health care they need. The stability of the nation's health care system and the health of millions of Americans now rest in your hands. Their health care coverage is not a bargaining chip.

It is your responsibility to the American people and your obligation under the law to make the cost-sharing reduction payments and to stop other acts of sabotage that undermine Americans' access to affordable, quality health insurance.