San Francisco Chronicle - Trump Delay Driving Insurers to Raise Affordable Care Act Premiums

Op-Ed

By Diane Feinstein and Kamala Harris

It's the height of irresponsibility to purposely increase health care costs to both consumers and taxpayers, while knowingly creating instability in the insurance market. But that's exactly what the Trump administration and congressional Republicans are doing.

The Trump administration recently petitioned the U.S. Court of Appeals in Washington for a three-month delay in a federal case that will have a significant effect on the future of the Affordable Care Act. It could undermine the stability of individual health insurance markets nationwide.

The case rests on a technicality, but at stake is whether the federal government will continue to make $7 billion in payments that reduce co-pays for 7 million low-income families who purchase insurance through online marketplaces nationwide.

Federal law requires insurance companies to reduce co-pays for families who qualify regardless of whether or not the government reimburses them.

The uncertainty surrounding these cost-sharing reduction payments, in conjunction with the Trump administration's indication that it may not enforce the individual mandate to have health insurance, is driving some insurers across the country to request significant rate increases for 2018 or consider dropping out of the market all together.

In California, insurers have been instructed to file rate estimates in two ways: one with the expectation that the federal government won't fulfill its commitment to make these payments, and one that assumes it will. The uncertainty with this and other actions, such as not enforcing the requirement to have coverage if it's affordable, has created unnecessary volatility in the market.

There's simply no sugarcoating the fact that President Trump and congressional Republicans are actively sabotaging the Affordable Care Act in an attempt to score political points and build support for their effort to repeal the law. The only way to make clear they care about health care for millions of American families is to enforce the law.

Despite our state's commitment to making the law work, the effects of this ongoing sabotage campaign are unavoidable. The Affordable Care Act was constructed as a partnership between the states and the federal government. States can't make the law work if the federal government refuses to fulfill its end of the bargain.

An analysis by Covered California shows that premiums could increase by up to 49 percent if the Trump administration fails to make payments to reduce co-pays and enforce the individual mandate, hurting families in both cities and rural communities.

To mitigate this effect, Covered California has asked insurance companies to structure the portion of the increase related to the cost-sharing requirement so it can be offset by the premium tax credits.

Those in the individual market who receive financial help through federal tax credits -- about 90 percent of total Covered California enrollees -- would see the assistance they receive increase to offset the skyrocketing cost of their plans.

Any premium increase would hit hardest those in the individual market who don't currently receive financial assistance. They would pay the full cost of the increase.

Ironically, the Trump administration and congressional Republicans would unnecessarily increase federal spending -- wasting taxpayer dollars -- by increasing uncertainty in the individual markets. The Kaiser Family Foundation estimates it would cost the federal government $31 billion more over 10 years to end the cost-sharing reduction payments because of the increased cost of the help the federal government provides people.

While the effects of sabotage are real and consequential, it's also important to make clear that the Affordable Care Act is not "dead" or "imploding" as President Trump and congressional Republicans often falsely state.

The law can, and certainly should, be improved, but Covered California functions well. Enrollments have been stable, and there has been a steady stream of new signups during each open-enrollment period.

Covered California has also maintained a balance between healthy and sick enrollees. Healthy enrollees have not left the market in large numbers. Maintaining this balance is critical to keeping premiums from spiking.

As public servants, our job is to solve problems, not make them worse. It is outrageous that the Trump administration would consider hurting Americans by sabotaging the individual health insurance market nationwide just to advance a political argument.

In the coming months, if Californians receive notices about sizable rate increases, they should know that they could have been easily prevented if the president would simply follow the law on the books.

Dianne Feinstein and Kamala Harris represent California in the U.S. Senate. Diana S. Dooley is California's health and human services secretary and board chair for Covered California.

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