On October 12, President Trump announced in a filing by the Department of Justice in the ongoing litigation challenging the cost-sharing reduction (CSR) payments that such payments will no longer be made to insurers. CSR payments help offset deductibles and other out-of-pocket expenses for Affordable Health Care Act (ACA) exchange health insurance coverage for approximately seven million individuals earning up to 250 percent of the federal poverty level, about $30,000 for an individual and $61,000 for a family of four. The Congressional Budget Office (CBO) previously reported that if the CSR payments were to end, premiums for silver-level plans would increase by 20 percent in 2018. Some insurers reportedly are seeking permission from state insurance regulators to reset their rates for 2018 in light of the discontinuation of CSR payments. On October 13, eighteen states and the District of Columbia filed suit in the U.S. District Court for the Northern District of California challenging the Trump Administration’s action and asking the court to issue a preliminary injunction mandating the Administration continue to make CSR payments. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) have resumed their CSR/waiver discussions and could introduce legislation calling for continued CSR payments and a liberalization of state waiver restrictions. Senator Ron Johnson (R-WI) reportedly is also preparing legislation providing for the expanded use of Health Savings Accounts and a delay in the employer mandate.

On October 11, the President signed an executive order directing the Department of Labor to promulgate rulemaking enabling the formation of association health plans that would be exempt from certain ACA requirements such as the Essential Health Benefits mandate. The executive order also:  (i) provides for expanded access to short-term health plans that are limited under the ACA; (ii) seeks to expand how workers use employer-funded accounts to purchase their own policies; and (iii) calls for an analysis of ways to limit consolidation within the insurance and health care industries.

On October 11, the U.S. House of Representatives’ Committee on Energy and Commerce Subcommittee on Oversight and Investigations held a hearing entitled “Examining How Covered Entities Utilize the 340B Drug Pricing Program.” The hearing notice, background memorandum, Member statements, and witnesses statements are available here.