Maine Insurers, Advocates Decry Trump's Action To End Health Care Subsidies For The Poor

Oct 16, 2017

Insurers and consumer advocates in Maine are denouncing President Donald Trump’s announcement that he will stop payments to insurance companies that help low-income enrollees buy health coverage.

Though Maine consumers who purchase coverage on the Affordable Care Act marketplace likely won’t feel any immediate effects, opponents of the action say it’s an attempt to sabotage the ACA.

Insurance companies that sell on the ACA marketplace are required by law to offer plans to lower-income enrollees with reduced out-of-pocket costs. To help insurance companies afford this, the federal government pays them cost sharing reduction subsidies.

It’s a program designed to increase access to care that Community Health Options CEO Kevin Lewis says is effective.

“Certainly we’re seeing people getting into the doctor’s‘ office at reduced co-payment amounts. There’s lower deductibles. And so that also means less bad debt to providers,” he says.

By ending those subsidies, Lewis says, “it really is now an unfunded mandate.”

But it wasn’t entirely unexpected. Trump has continually threatened to end the cost sharing payments.

Community Health Options and Harvard Pilgrim, the two insurance companies on Maine’s ACA marketplace, submitted rate filings for 2018 with higher premiums to account for a halt in payments. The upshot, says Mitchell Stein, a Portland-based independent health policy consultant, is that Maine enrollees will be shielded from these rate increases.

“The reason for that is the premium subsidy,” he says.

Those are federal subsidies for consumers that are based on the cost of premiums. Since those premiums will now rise, so too will those subsidies. And that, Stein says, will actually cost the federal government more.

“This is definitely the administration further trying to sabotage the law. But in this case, to put it bluntly, they’re really shooting themselves in the foot,” he says.

“You really have to ask, what is the purpose?” says Emily Brostek, executive director of Consumers for Affordable Health Care.

Though Maine consumers won’t feel the effects of Trump’s decision in the short term, she says the long-term effect of ending the cost sharing reduction payments could be that the ACA marketplace is destabilized. Anthem already dropped out of Maine’s marketplace last month and specifically cited the uncertainty around the cost sharing payments as a reason.

“Congress could act next week to put these back into place. They could immediately appropriate the funds to ensure those subsidies are in place and those could start flowing right away. So I think there could be a possible silver lining if this spurs Congress to act,” Brostek says.

Republican U.S. Sen. Susan Collins of Maine criticized Trump’s decision to do away with the subsidy on Friday morning, but her office didn’t respond to a request for details on what actions she might take.

Outside of Congress, at least a dozen attorney generals plan to sue President Trump over the matter. A spokesman for Maine Attorney General Janet Mills said she is not signing onto the suit, but supports the case.

Harvard Pilgrim declined a request for comment on Trump’s decision.

Lewis says the federal action introduces fear and anxiety on the eve of open enrollment, which begins Nov. 1. But he reminds consumers that marketplace plans still offer benefits and protections, and enrollees should carefully evaluate options before choosing.

This story was originally published Oct. 13, 2017 at 12:08 p.m. ET.