38 page ruling –
no reimbursements for enhanced silver
this is why unsubsizized Silver is less premium outside of Covered CA
38 page ruling

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President Obama overstepped his authority in funding the

Extra Benefits of Enhance Silver 94, 87 & 73 – Cost Sharing Reductions. (CSR)


A Federal Judge Ruled that President Obama overstepped his authority in funding the Extra Benefits of Enhance Silver 94, 87 & 73 – Cost Sharing Reductions. (CSR) (§1402 of PPACA). There can be no more reimbursements to the Insurance Companies for Enhanced Silver’s extra benefits – see chart until Congress appropriates the $$$.L.A.Care Health Plan, which was awarded nearly $6 million on Feb. 14 by Judge Thomas C. Wheeler of the Court of Federal Claims. Observing that the money was promised by the ACA and that Trump had no right to stiff the insurers, Wheeler wrote that “L.A. Care should not be left ‘holding the bag’ for taking our Government at its word.” LA Times *

The ruling is stayed, until the time for appeal, which seems likely – see video from the White House at right. On the other hand, with Donald Care coming, the appeal could be dropped on his innagurtation 1.20.2017 – click here for analysis by the Commonweatlh Fund 1.21.2016. * CA Healthline 8.2.2017 States can file lawsuits… * Actual Court Order * NPR 11.9.2016 * Health Affairs.org

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President Trump just announced that Cost Sharing Subsidies will end!!! Modern Health Care *

Covered CA will wait till 9.30.2017 to deciede on CSR Rates – Surcharge * 8.17.2017 Covered CA Press Release * CBO Report – Effect of Terminating CSR * Marketing Matters * Insure Me Kevin.com *

A federal appeals court has granted House Republicans a delay in their lawsuit seeking to halt certain federal payments to health plans under the Affordable Care Act. That delay buys time for the Trump administration to find a way to avoid throwing the individual insurance market into chaos. Modern Health Care 12.5.2016 * Actual Order * Delayed again – Now House v Price US News 2.21.2017 * Six changes Trump can still make to ACA NPR 3.29.2017 * LA Times Editorial 3.31.2017 * * Video on if there would be an appeal in the first place

Status Conference set for 5.22.2017 The House and the DOJ made the request in a joint motion Tuesday… The motion Tuesday grants the House and the DOJ until May 22 to file a status report with the court and establishes 90-day deadlines after that. US Gateway.com * Lifezette.com

7.19.2017 Trump still threatens to stop Cost Sharing Reductions – Enhanced Silver * Politico 7.19.2017 August payments could stop this Thursday! Bloomberg 7.19.2017

Trump askes for 90 day extension. “Clearly by today’s action and their decision to make the next payment, the White House realizes that eliminating cost sharing reduction payments would cause chaos in the markets, and they would get the blame,” The Hill.com 5.22.2017

CA and 13 other states file lawsuit (173 page motion to intervene) to maintain Cost Sharing Subsidies – Enhanced Silver LA Times 5.19.2017 * Kaiser Health News *

8.16.2017 If President Donald Trump were to follow through on his threats to cut federal cost-sharing subsidies, health insurance premiums for silver plans would soar by an average of 20 percent next year and the federal deficit would rise by $194 billion over the next decade, the nonpartisan Congressional Budget Office said Tuesday 8.15.2016 CA Health Line * CBO Analysis

4.28.2017 Sacramento Bee CA Dept of Insurance (DOI) will allow Insurance Companies to file two sets of rates

One set would reflect the rates that insurance companies project if former President Barack Obama’s health care law remains in effect and is enforced.

The other set would be based on an assumption that President Donald Trump and the Republican Congress follow through on their pledges to repeal the Affordable Care Act, or that the Trump administration declines to enforce the law.

Jones’ office – DOI is expected to begin reviewing proposed 2018 health insurance rates next week. They’ll be released to the public on July 17.

The insurance commissioner can ask for changes to the proposed rates, or pressure companies to lower them by declaring them “unreasonable.”

The rates are finalized in October before open enrollment begins Nov. 1.

4.14.2017 Covered CA analysis CBO predicting rate increases….

Covered CA advises insurance companies to file contingent set of rates CA Health Line 6.2.2017

Some States extending deadlines for Insurance Companies to submit 2018 rates, amid the uncertainty. CA must file this week. Modern Health Care 4.20.2017

San Francisco Chronicale 4.11.2017 status in limbo

CA Insurance Dept. opposes loss of cost sharing reductions – enhanced silver 4.13.2017

Washington Post 5.12.2016 * 12.22.2016 Enhanced Silver could end immediately! * Commonweatlh Fund Analysis 12.21.2016

38 Page Ruling with our Annotations, Links & Bookmarks

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1.20.2017 Trump Executive Order

Budget Reconcilation S. Con Res 3 Section 3001

The 7.7.2016 edition of the New York Times summarizes the 7.2016 Joint Congressional Source of Funding on ACA -CSR – Enhanced Silver report that the Obama administration knowingly spent billions for Enhanced Silver, without proper allocations. See also, The Hill.com.

On the one hand, if the extra cost for enhanced silver isn’t subsidized, then the premium would be higher and so would the subsidy.

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