The Trump administration and Republicans in the U.S. House asked Monday for a delay in litigation over certain Affordable Care Act subsidies that health insurers say are key to stabilizing markets under the federal health law.
The litigation focuses on "cost-sharing reductions," or CSR payments, that the government has been paying to private health insurers to lower deductibles and out-of-pocket costs for low-income people.
In Minnesota, the CSRs are expected to provide a few million dollars of support this year to individual insurance shoppers, but a much larger sum — in excess of $100 million per year — for the MinnesotaCare health insurance program.
Republicans in the House last year won a court ruling that would block continued funding of the subsidies. But the Obama administration appealed, and the matter has been delayed as Republicans attempt to repeal and replace the Affordable Care Act (ACA).
"The parties continue to discuss measures that would obviate the need for judicial determination of this appeal, including potential legislative action," according to the Republicans' filing Monday in the U.S. Court of Appeals in Washington, D.C.
In March, the court approved an abeyance in the case and set Monday — and at 90-day intervals after that — as the deadline to file a status report. The Republicans' filing asked the court to continue the abeyance.
Earlier this month, Minnesota Attorney General Lori Swanson joined with attorneys general in more than a dozen other states seeking to intervene in the case. Lawyers for the Trump administration and the House on Monday said they would respond separately to the states' request.
Cost-sharing reductions are provided only to those who buy through government-run exchanges like MNsure in Minnesota. In April, about 11,843 people with individual insurance policies in Minnesota were benefiting from CSRs, MNsure says.
In Minnesota, most consumers with incomes that make them eligible for CSR subsidies receive coverage from MinnesotaCare, rather than private insurance. So the value of CSR payments for those consumers is largely directed to the state government's "basic health plan" — another name for MinnesotaCare.
Swanson projects that MinnesotaCare will receive $120 million this year via the subsidies. MinnesotaCare is a state health insurance program that provides coverage to a group often described as the "working poor."
The case is on appeal after a lower court ruled that the government lacks constitutional authority to make the payments because Congress failed to specifically approve them in the Obama-era health overhaul legislation. Democrats argue that is based on a faulty reading of the law.
Both the Obama and Trump administrations have kept making monthly payments while the case is pending.
The subsidies are a big deal for people who buy insurance on their own or have MinnesotaCare coverage, said Jim Schowalter, chief executive of the Minnesota Council of Health Plans, a trade group for insurers. "The federal money in question helps pay medical bills for Minnesotans who make about $7 to $15 an hour," Schowalter said in a statement. "The administration's 'Now you see it, now you don't' approach to these monthly payments makes it very hard for Minnesotans and local insurers to plan."
Tim Jost, an emeritus professor at the Washington and Lee University School of Law, wrote Monday in a blog post for the health policy journal Health Affairs: "Leaving the appeal in abeyance leaves the insurance industry in limbo." Jost wrote that President Trump has suggested he would use continued payment of the CSRs as a bargaining chip to lure Democrats into negotiating ACA changes.
This article includes reporting from the Associated Press.