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CMS Proposal is the Trump Administration’s Latest Act Of Health Care Sabotage

By January 18, 2019No Comments

The Payment Notice Cuts Premium Tax Credits By $1 Billion Annually, Slashes Coverage, Increases Out-Of-Pocket Costs, And Puts People With Pre-existing Conditions At Risk


Last night, the Centers for Medicare & Medicaid Services (CMS) issued the proposed annual Notice of Benefit and Payment Parameters (NBPP) for the 2020 benefit year, which outlines regulatory and financial guidelines applicable to exchange plans. The proposal from CMS would do the following:

  • Cut premium tax credits by $1 billion per year ($900M in 2020 and 2021, $1 billion in 2022 and 2023)
  • Cause 100,000 people to lose marketplace coverage annually starting in 2020
  • Increase annual premiums by $189 for a family of four at 300 percent of poverty
  • Increase the maximum out-of-pocket costs by $400 for a family (from $16,000 without the change to $16,400 with it) and $200 for an individual (from $8,000 annually to $8,200 annually).

“Despite the lessons of the 2018 midterm elections, the Trump administration is continuing its relentless efforts to sabotage health care for millions of Americans,” said Leslie Dach, chair of Protect Our Care. “They want to increase premiums, put protections for people with pre-existing conditions further at risk, and rip affordable coverage from countless Americans. It’s time they start improving our health care and stop ripping it apart.”

Here’s a look at what the Administration’s proposal would mean for people across the country, according to health care experts and CMS itself:

The Payment Notice Means Higher Premiums, Less In Subsides, And A Drop In Enrollment. “The Trump administration estimates that their proposed change to how ACA premium subsidies are calculated would increase consumer premiums by $181 million and decrease marketplace enrollment by 100,000. As a result, the government would save $900 million.” [Larry Levitt, 1/17/19]

The Provisions Of The Payment Notice Would Reduce Americans’ Premium Tax Credits By Roughly $1 Billion Annually, Leading A Family Of Four At 300 Percent Of The Federal Poverty Line To Pay $189 More Annually. As Matt Fielder, Fellow at the USC-Brookings Schaeffer Initiative for Health Policy concludes: “In dollar terms, single person at 300% of FPL would lose $92/year in [premium tax credits]; family of four at 300% of FPL would lose $189/year in [premium tax credits]. Smaller effects at lower income levels and larger effects at higher income levels. In the aggregate, CMS Actuary estimates proposed change would result in $900m less in tax credit payments and 100,000 fewer Marketplace enrollees in 2020.” [Matt Fiedler, 1/17/19]

The Rules Would Also Increase The Maximum Out Of Pocket Costs In All Private Insurance Plans, By $200 For Individuals And $400 For A Family. “A technical change proposed by the Trump administration would result in maximum consumer out-of-pocket costs in all private insurance plans going up to $8,200 per person in 2020 instead of $8,000. To be clear, either amount is out of reach for many people.” The rule would also increase the maximum out of pocket costs for families from $16,000 to $16,400. [Larry Levitt, 1/17/19; Centers on Medicare And Medicaid Services, 1/17/19

100,000 People Would Lose Marketplace Coverage Each Year Beginning In 2020. [CMS, 1/17/19]

The Administration Has Also Invited Public Comment On Two Parameters — Eliminating Silver-Loading And Automatic Reenrollment. “One change the Trump administration is inviting comment on could eliminate automatic renewal of ACA marketplace coverage and premium subsidies. This year 1.8 million people were automatically re-enrolled in states using the federal marketplace. Another change the Trump administration is inviting comment on could eliminate “silver loading,” where insurers increased premiums for silver plans to offset the termination of cost-sharing subsidy payments to those insurers by the administration. Prohibiting “silver loading” of premiums in the ACA marketplace would lower government costs, but it would increase out-of-pocket premiums for many subsidized enrollees and also increase premiums for middle-class consumers not eligible for subsidies.” [Larry Levitt, 1/17/19]

Andy Slavitt, Former Head Of CMS: “Undermining Obamacare Is The Only Conceivable Reason To Dismantle [Auto-reenrollment].” “Auto reenrollment is simple. It means that like most employer coverage, if you forget to sign up for coverage, yours won’t get taken away. With auto-reenrollment, you can still reject coverage by not paying the bill. 1.8 million use it every year to keep continuous coverage. What happens if it’s taken away? You forget to sign up by 12/15. Get a cancer diagnosis in January. Not covered. With auto-[reenrollment], covered. It’s already automated, and how people are used to operating. Undermining Obamacare is the only conceivable reason to dismantle this.” [Andy Slavitt, 1/17/19]

The Payment Notice Allows States To Select An Essential Health Benefits (EHB) Package Used By Another State, Making EHBs More Flexible And Making It Easier For States To Not Cover All Of The Needs Of People With Pre-existing Conditions. “In the 2019 Payment Notice, we finalized options for states to select new EHB benchmark plans starting with the 2020 benefit year. Under 45 CFR 156.111, a state may modify its EHB-benchmark plan by: (1) Selecting the EHB-benchmark plan that another state used for the 2017 plan year; (2) Replacing one or more EHB categories of benefits in its EHB-benchmark plan used for the 2017 plan year with the same categories of benefits from another state’s EHB-benchmark plan used for the 2017 plan year; or (3) Otherwise selecting a set of benefits that would become the state’s EHB-benchmark plan.” [CMS, 1/17/19]

Legislators are calling the changes out for what they are: sabotage.

Sen. Ron Wyden (D-OR), Ranking Member Of Senate Finance Committee: “Today’s Proposed Rule Deliberately And Needlessly Increases Premiums And Will Result In Too Many Americans Losing Coverage.” “Trump’s health care sabotage agenda is defined by higher premiums for families and bureaucratic barriers that make it harder to find health coverage. Today’s proposed rule deliberately and needlessly increases premiums and will result in too many Americans losing access to health coverage. It’s no wonder Americans are so fed up with America’s health care system when the Trump administration continues to fan the flames of uncertainty while families pick up the check.” [Wyden Statement, 1/17/19]

Sen. Patty Murray (D-WA), Ranking Member Of The Senate Health, Education, Labor, And Pensions (HELP) Committee: “Even 27 Days Into The Shutdown He Caused, President Trump Has Somehow Found Time To Further Sabotage Health Care For Patients, Families, And Women.” “Even 27 days into the shutdown he caused, President Trump has somehow found time to further sabotage health care for patients, families, and women — this time by proposing what would amount to a health care tax on patients and families across the country. President Trump is hurting families left and right and Democrats are going to keep holding him accountable.” [Murray Statement, 1/17/19