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Alice Ollstein

Alice Ollstein is a reporter at Talking Points Memo, covering national politics. She graduated from Oberlin College in 2010 and has been reporting in DC ever since, covering the Supreme Court, Congress and national elections for TV, radio, print, and online outlets. Her work has aired on Free Speech Radio News, All Things Considered, Channel News Asia, and Telesur, and her writing has been published by The Atlantic, La Opinión, and The Hill Rag. She was elected in 2016 as an at-large board member of the DC Chapter of the Society of Professional Journalists. Alice grew up in Santa Monica, California and began working for local newspapers in her early teens.

Articles by Alice

Less than an hour after Sen. Lamar Alexander (R-TN) told a room full of reporters that President Trump had called him Wednesday morning to offer encouragement for Alexander’s bipartisan deal to stabilize Obamacare’s individual market, the mercurial president took to Twitter and seemingly reversed his position.

A few hours later, he flipped again, telling reporters: “Lamar Alexander’s working on it very hard. If something can happen, that’s fine.”

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Tierney Sneed contributed reporting.

President Donald Trump’s decision last week to terminate billions in subsidies to insurance companies that are required under the Affordable Care Act, lit a new fire under some members of Congress who have been working for months to guarantee the subsidy payments and protect the individual market from the White House’s whims.

On Tuesday, Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) announced a deal that would fund the cost-sharing reduction payments for two years, make it easier for states to waive some health care regulations, and restore the budget for open enrollment outreach Trump gutted earlier this fall.

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A report released Thursday by the health care consulting firm Avalere dives into the impact of President Donald Trump’s move Friday to cut off cost-sharing reduction (CSR) payments to health insurance companies weeks before the start of the crucial open enrollment period.

Because the companies are obligated by law to lower the cost of coverage for low-income patients with severe health needs, and can’t raise their rates until next year, Avalere calculates that the insurers will have to eat a $1 billion loss between now and January.

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President Donald Trump’s decision last week to pull the trigger on his oft-repeated threat to cut off subsidies to health insurance companies is having widespread fallout, with many states scrambling to approve higher insurance rates for 2018 to make up for the loss and keep insurers from fleeing the market altogether.

Because the insurance companies are required by law to cover everyone regardless of their health status and lower the cost of care for low-income patients, and because many had assumed the government would keep making the cost sharing reduction (CSR) payments, Trump’s move has thrown them into turmoil.

The vast majority either had raised their rates already in anticipation of the CSR cut or are filing for emergency rate hikes now. And while these rate hikes will not impact the more than 80 percent of individual market enrollees who get government tax credits, they will cost the government billions of dollars as those tax credits creep upward to cover the difference. The rate increases will also slam the millions of middle class Americans whose individual health plans are unsubsidized.

The timing of the announcement—mere weeks before the start of open enrollment period for 2018 and just after insurers had already signed contracts for participating  —could not have been worse.

“Potentially the biggest effect of all this is just to create confusion,” warned Larry Levitt, the vice president of the Kaiser Family Foundation. “It would be quite understandable if consumers are perplexed about whether subsidies are still available for them, which they are.”

Rates on the rise

Across the country, the non-partisan Congressional Budget Office has predicted about a 25 percent increase in insurance rates over two years solely due to the subsidy cuts. Already, in markets where insurance companies did not originally price for the yanking of the CSRs, that prediction is coming true.

On Friday, Oregon’s Department of Consumer and Business Services ordered health insurance companies on the state’s individual market to hike their 2018 rates by 7.1 percent, “in order to ensure carriers can continue to offer coverage in Oregon.”

“This increase will affect plans both on and off HealthCare.gov, and will compensate for the $49 million worth of cost-sharing reduction payments that the federal government will no longer be making to Oregon insurance companies in 2018.”

Alaska ordered a similar rate increase of 5 to 6 percent. In Arkansas, where insurers submitted two sets of rates—one assuming Trump continued funding CSRs and one assuming last week’s cutoff—the state approved the much higher rate, leading to a 25 percent jump in costs for some non-subsidized residents. In Pennsylvania, the increase will be near 30 percent, and in Florida, patients will pay between 26 and 72 percent more next year.

Many states are only hiking the rate of their silver-tier plans to cover the cost of the lost subsidies, but others, like Indiana, are raising rates across board. According to an AP analysis, Republican-controlled states that did not expand Medicaid, and that voted for Trump, will be the hardest hit.

“Middle class consumers will get hurt, but that’s not what’s happening in most places,” Levitt explained. “It’s really hitting tax payers, because the added cost of the increased tax credits will exceed the federal savings from cutting CSRs.”

Courtrooms and chaos

On Friday, nearly 20 state attorneys general sued the Trump administration over the abrupt subsidy withdrawal, arguing the move violated the text of the Affordable Care Act and the Administrative Procedure Act. The states aim to force the White House to make its October payment via a temporary restraining order while the case is heard, and other legal actions could be close behind.

Because Trump ordered the payments to cease immediately and the rate hikes don’t go into effect until 2018, insurance companies have to eat the loss of tens of millions of dollars between now and the end of December.

“I’ve heard of insurers exploring their options to get this money back through legal action,” Levitt told TPM. “Under the law they still seem to be owed this money.”

Yet not only have insurers not filed lawsuits yet, they have not fled the markets en masse as many predicted.

Though some individual insurers, most vocally in Montana, have threatened to drop out of the marketplace if their rate increases are not approved by regulators, the vast majority are gritting their teeth and staying put.

“For the most part, insurers had a sense this could be coming,” Levitt said. “Those that didn’t feel they could manage it had already left. But because this was just one of several actions the Trump administration has taken to undermine the marketplace, the question on insurers’ minds is: what might come next?”

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After blowing past a self-imposed September deadline for passing a bill to stabilize the Affordable Care Act’s volatile individual market and prevent massive rate hikes from hitting people across the country, the negotiations around that bill are on life support, languishing without the backing of Republican leaders.

“We don’t have an agreement yet,” Sen. Lamar Alexander (R-TN), the chair of the Health, Education, Labor and Pensions Committee told reporters Tuesday. “We’ll keep talking.”

Asked if Senate Republican leadership is encouraging him to continue the negotiations, Alexander laughed. “I’m telling them that I am continuing the talks,” he quipped. “My hope would be that they would want to put it on the floor.”

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A group of Obama administration alumni, celebrities, and health insurance industry leaders is launching this week an outreach campaign to spread the word about this November’s Obamacare open enrollment period.

Josh Peck, the former chief marketing officer for the Department of Health and Human Services, says the effort is meant to help mitigate the damage of the Trump administration’s gutting of Affordable Care Act outreach, severing of outreach partnerships, and shortening of the open enrollment period.

“We’re of the mind that if the administration makes it clear they won’t take open enrollment seriously, we have to step up and get the word out,” he told TPM. “There’s a huge chasm between what we’re able to do and what should be done, and what was done last year. But [the Department of Health and Human Services] has set the bar so unbelievably low this year for outreach that even a relatively small organization can move the needle and have an outsized impact.”

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Late Monday night, House Republicans unveiled a plan for reauthorizing the Children’s Health Insurance Program (CHIP), which Congress allowed to lapse this past weekend.

Like its Senate counterpart, the bill lays out five years of CHIP funding, but reduces the amount of federal money going to help states cover low-income children and pregnant women after two years. Unlike the Senate bill, the entire package is funded by cuts to Medicare and the Affordable Care Act’s prevention and public health fund.

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Over the weekend, Congress allowed funding for the Children’s Health Insurance Program (CHIP), which covers nearly 9 million children in low-income families, to lapse—failing to pass a reauthorization by Saturday’s deadline after spending most of the year attempting to repeal the Affordable Care Act.

The expiration of the program will not affect all states equally. Some are already scrambling to move money around to make sure no child sees their coverage lapse while others have a healthy amount in reserves that will last them well into next year if Congress does not act.

Though the Senate will hold a markup on the reauthorization on Wednesday, its passage remains uncertain. The House has not yet unveiled its version of the bill, and a House Democratic aide told TPM that while negotiations are ongoing, the parties are still fighting over whether to maintain the same level of the federal funding match for CHIP and whether to require cuts to other parts of the federal budget to offset CHIP’s cost.

“We have yet to reach an agreement,” the aide said. “It’s pretty upsetting that the time tradeoff has been an effort to repeal the Affordable Care Act.”

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Cameron Joseph contributed reporting.

Congress may have failed spectacularly to meet Saturday’s deadline for passing a bill to repeal Obamacare with only 50 votes, but Republicans are promising to keep the zombie effort lurching along into 2018—allowing it to cling to future reconciliation bills that GOP leaders had wanted to use as a vehicle for tax cuts. 

Though the Senate budget unveiled Friday does not include provisions to allow for another Obamacare repeal vote, it would allow the Senate to continue to chip away at pieces of the law, such as the individual mandate.

Rank-and-file lawmakers are insisting, meanwhile, that more votes on full repeal are possible next year.

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In a letter to the embattled Health and Human Services Secretary Tom Price on Friday afternoon, Democrats in the House and Senate who work on health care policy demanded answers about a host of recent HHS decisions—including an abrupt order to all 10 regional offices to stop participating in local open enrollment events.

“We urge you to immediately reconsider and reverse this harmful directive to HHS Regional Offices,” the Democratic committee leaders wrote. “The Trump Administration’s latest effort to sabotage health care will likely lead to additional confusion, creating unnecessary barriers for patients and families seeking to purchase insurance.”

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