Upon the unveiling of another health insurance “stabilization” measure Tuesday, Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) claimed he did not view it as a repudiation of his own “stability” measure, introduced last week.
“We’ve gone from a position where everyone was saying we can’t do cost sharing [reduction payments] to responsible voices like [Senate Finance Committee Chairman Orrin] Hatch and [House Ways and Means Committee Chairman Kevin] Brady saying we should.”
In the words of Margaret Thatcher, “No. No. No!” Conservatives should reject the premise that Congress must immediately open up the federal piggy bank to replenish the unconstitutional cost-sharing reduction subsidies that the Trump administration cut off earlier this month. Instead, it should first hold insurers—and insurance regulators—accountable for the irresponsible actions that got them to this point.
Insurers Disregarded a Federal Lawsuit
My May article explained how insurers sought to hold Congress hostage over cost-sharing reduction payments. Unless Congress guaranteed the payments for all of calendar year 2018, insurers claimed they would have to raise premiums to reflect “uncertainty” over the payments.
But that “uncertainty” always existed. Insurers just ignored it. They ignored a federal district court judge’s May 2016 ruling striking down the cost-sharing reduction payments as unconstitutional, because the judge stayed her ruling pending an appeal. They ignored warnings that the next presidential administration could easily cut off the payments unilaterally. And they ignored the fact that a presidential election was scheduled for November 2016, and that “come January 2017, the policy landscape for insurers could look far different” than under the Obama administration.
Upon reading my May 2017 article, a former colleague who works for an insurer responded by claiming that no one took the litigation against the cost-sharing reduction payments seriously last year. In other words, it was a risk that he and his colleagues ignored until President Trump started making threats to cut off the payments, and finally did so earlier this month.
A Congress that responds to this type of risky behavior—ignoring for more than a year the risk of cost-sharing reduction payments disappearing—by immediately reinstating the payments would only validate and encourage more risk-taking by insurers in the future.
Regulators Asleep at the Switch?
Likewise, state insurance commissioners largely disregarded until this spring and summer the possibility that cost-sharing reduction payments would disappear. At a Capitol Hill briefing last month, I asked Brian Webb of the National Association of Insurance Commissioners (NAIC) whether his members had considered the prospect of cost-sharing reduction payments disappearing last fall, when regulators examined rates for the current (i.e., 2017) plan year. By last fall, a federal court had already declared the payments unconstitutional, and every state insurance commissioner knew a new administration would take office in January and could stop the payments directly.
Webb’s response? “Under the court decision, they [the cost-sharing reduction payments] are still being paid, pending appeal.… In the meantime, payments are being made.” That is, until three weeks after the briefing in question, when President Trump stopped the payments. Oops.
It does not appear that most regulators even bothered to consider this scenario last year, just like most insurers ignored the prospect of cost-sharing reductions going away. Instead, as with banks who assumed a decade ago that subprime mortgages could never fail, the health insurance industry blindly assumed—despite significant evidence to the contrary—that cost-sharing reduction payments would continue.
Prevent ‘Too Big to Fail’
Therein lies the premise that conservatives should reject: That because an entire industry made a bad bet on a flawed premise, Congress must immediately acquiesce in this flawed premise by restoring the flow of payments.
Yes, the Congressional Budget Office has indicated that cutting off the cost-sharing reduction payments would cost the federal government more in the short-term. That and other facts may give Congress a reason to restore the payments, eventually.
But most importantly, Congress should take action—by exercising its oversight authority, and through legislation if necessary—to end the “too big to fail” mentality that led insurers and their regulators to make a series of bad decisions regarding cost-sharing reductions. To instead give insurers a blank check, paid for by federal taxpayers, could cost far more in the longer term.