NCMS Statement on Trump’s Recent Health Policy Actions

Last week, President Trump issued two health policy directives that will likely affect how some of your patients are insured.  The first was an Executive Order signed Wednesday night that begins the process of expanding several insurance options for employers and employees. This order simply instructs various federal departments to begin the process of considering and drafting new regulations. Get the details on the Executive Order.  

Our partners at the NCMS Employee Benefit Plan have told us that the executive order does not affect the plan’s 2018 benefits, which have already been filed for review by the North Carolina Department of Insurance.

In his second action, which will have a more immediate impact on the insurance market and your patients, Trump announced late Thursday that his administration would stop paying the cost-sharing reduction (CSR) subsidies to insurance companies. These insurers are required to provide reduced-price deductibles for lower income patients receiving coverage through the Affordable Care Act’s Marketplace. To put the impact of this change in context, according to the Kaiser Family Foundation as of February 2017, the number of people with household income between 100 and 250 percent of the federal poverty level and receiving cost sharing reductions in North Carolina, is 300,255. Learn more about the Foundation’s numbers.

Since last week, Senators Lamar Alexander (R-La.) and Patty Murray (D-Wash.) have reached a bipartisan agreement, which would continue to fund the CSR subsidies. Their proposal also would tweak the waiver process for states wanting to bypass some Affordable Care Act requirements, and allocate additional money to promote ACA Marketplace enrollment. The details are still being worked out with the Senate remaining divided on the provisions of the Alexander-Murray proposal.

Repeated Administration threats to stop these payments and delays in Congressional efforts to specifically authorize and fund the CSRs prompted many insurers to increase their 2018 Marketplace premiums to offset the potential loss of these funds, including Blue Cross and Blue Shield of North Carolina, which is the only insurer in all 100 counties in the state. Whether plans will decide to withdraw from the ACA Marketplace in the future is not yet known.

Impact of the Executive Order on

The North Carolina Medical Society (NCMS) remains steadfast in its support of greater access to affordable health care for the citizens of North Carolina. Removing these subsidies will likely raise the cost of insurance coverage prompting many to forego needed care. While we understand the financial burden these subsidies place on the Federal government, and that current health care costs are unsustainable, we endorse bipartisan efforts to address the weaknesses of the Affordable Care Act while providing a gradual transition to any new plan. We seek a thoughtful and comprehensive approach to improved access to our health care system.

Here are several well-balanced articles explaining the potential impact of these actions.

This Raleigh News & Observer article, published Friday afternoon (10-13-17) outlines what this latest federal move means for the Marketplace insurers in North Carolina.

Who is Going to Be Hurt By Trump’s New Attack on Obamacare? The Real World Consequences of Ending the Cost Sharing Reduction Subsidies, VOX, 10-13-17.

Administration’s Ending of Cost Sharing Reduction Payments Likely To Roil Individual Markets, Health Affairs blog, 10-13-17.


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  • Rafael E Negron

    One of the options presented by the administration is opening the interstate restrictions to selling health insurance. Can somebody explain how is going to work. How is the credentialing process is going to work? I just started a solo practice and it was a difficult process. I haven’t heard any one explaining this. Thank

  • Elaine Ellis

    The decision on the legality of the CSRs is still under appeal. This Health Affairs article offers a comprehensive overview of the case.

  • Joseph Guarino, MD

    There is no mention in the above article that the subsidies currently are illegal, and have been struck down in court.