Understand how we got here — and how to move forward.


September 20, 2017

Trump will make September CSR payment—but 'no final decisions' on future payments

Daily Briefing

A White House spokesperson on Tuesday confirmed that the federal government will make this month's cost-sharing reduction (CSR) payments to insurers, but—as in previous months—the administration did not say whether it will continue to make payments in the future, the Wall Street Journal reports.

In a state of reform: Profiles of innovative state-level health care transformation

The spokesperson said, "The September payment will be made." However, the spokesperson said "no final decisions" have been made regarding future CSR payments, stating, "We are weighing our options and still evaluating the issues."

About the payments

House lawmakers have challenged the CSR payments in court, saying that although the Affordable Care Act (ACA) authorized the payments, Congress never actually appropriated funding for them. The case has yet to be resolved. President Trump separately has threatened to cut off the payments, though since taking office his administration has made the payments each month.

Even if the administration stops making the payments, insurers still would be required to give out-of-pocket cost discounts to certain low-income exchange enrollees under the ACA. Some insurers have said they would scale back or withdraw from the exchanges without greater certainty that CSR payments will continue, and others have said the uncertainty could result in larger premium rate increases. Some insurers also have signaled they would file lawsuits if the payments are not made.

The Congressional Budget Office and Joint Committee on Taxation in August estimated premiums for silver-level exchange plans for the 2018 coverage year would increase by about 20 percent if the administration were to step paying insurers CSRs

According to the Journal, Sens. Lamar Alexander (R -Tenn.) and Patty Murray (D -Wash.) in recent weeks have been working on bipartisan legislation to ensure insurers receive the payments for at least a year. Vice President Mike Pence on Tuesday, however, indicated that the White House is not currently willing to back such legislation (Radnofsky, Wall Street Journal, 9/19; Roubein, The Hill, 9/19). 

5 things everyone should know about MACRA (no matter what happens with ACA repeal)

The implementation of MACRA is the most notable change to Medicare physician payment in over a decade. Passed with bipartisan support, MACRA changes the way Medicare pays clinicians.

Check out our infographic to see the no-regrets strategies to prepare your organization for success under MACRA.

Get the Infographic

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.