Federal Spending Bill Leaves ACA Untouched

Substantial changes not expected until after midterm elections.

Last week, President Donald Trump signed into law a 2,232-page federal spending bill avoiding another government shutdown. In the days leading up to the bill’s passage, it appeared that Congressional leaders were on the verge of including funds which aimed to stabilize the Affordable Care Act (ACA).

Funding for cost-sharing reduction subsidies (CSR subsidies) that was discontinued in 2017 was expected to be restored. Additionally, $30 billion in funds was expected to be allocated toward reinsurance programs that would offset some of the claims expenses incurred by insurance companies for high risk members.

Congressional Republicans who generally oppose the ACA were willing to include these stabilization measures, but they also wanted some additional restrictions for federal funding of abortions.
Congressional Democrats weren’t willing to make that trade. In the end, neither provision was included in the final bill.

Insurance companies will take this into consideration as they set 2019 premiums and decide which markets they want to participate in next year. Rate filings generally need to be submitted to applicable state and federal agencies in May or June, and the absence of CSR subsidy funding and reinsurance funding may yield another round of high rate increases in some markets.

Many people think the federal spending bill was the last opportunity to make changes to the ACA which would be impactful for 2019. With healthcare being such a touchy subject, it seems less and less likely that substantial changes will be made anytime soon since it’s a midterm election year. It would be more likely that substantial healthcare proposals would be taken up after the midterm elections which will be held on November 6, 2018.


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