Phil Scott
Gov. Phil Scott. File photo by Bob LoCicero/VTDigger

(This story was updated Oct. 19 at 9:40 p.m. with reporting from Washington by Elizabeth Hewitt.)

[G]ov. Phil Scott is urging Congress to continue federal health insurance subsidies that President Donald Trump ordered cut off.

Scott is one of 10 governors who sent a letter Thursday asking congressional leaders to take that step to stabilize the health insurance markets created under the Affordable Care Act. The markets largely serve people who don’t get coverage through an employer.

The bipartisan group of governors wrote in support of continuing cost-sharing reductions — subsidies to insurers that go toward certain coverage bought through Obamacare exchanges like Vermont Health Connect.

The program allows low-income people — who make slightly too much money to qualify for Medicaid — to pay for a low-price health plan but get the same low out-of-pocket costs of an expensive health plan.

Trump announced he would end federal reimbursements to insurance companies for providing the benefit. However, the Affordable Care Act still mandates that insurance companies provide the benefit. That means consumers can continue to enjoy the cheaper rates, but the full cost would fall on insurers.

“With the elimination of federal payments for the cost-sharing reduction program, insurers are faced with significant financial losses, which could force them to withdraw from the marketplace, or, in some states, request significant rate increases,” the letter says.

“The Congressional Budget Office warned that the president’s action would increase premiums by 25 percent by 2020 and leave some Americans without any insurers in the nongroup market — all while driving up the national debt by nearly $200 billion,” the letter says.

Al Gobeille
Secretary of Human Services Al Gobeille. File photo by Mike Dougherty/VTDigger
Al Gobeille, the secretary of the Vermont Agency of Human Services, said in an interview Thursday: “The ACA basically calls for these cost-sharing reductions, and then the federal government doesn’t fund them. That’s not OK. You wrote a law. You need to fund it.”

He added: “We want the populace to understand that a law created something and it wasn’t appropriated, and now, who’s going to pay for it? And our recommendation would be that Congress does.”

Vermont’s attorney general has joined more than a dozen other states in suing Trump to maintain funding for the cost-sharing reduction subsidies. The lawsuit alleges Trump is violating a federal administrative law by acting without a public process.

Two leading U.S. senators reached a bipartisan deal this week that would continue the subsidies for the time being. The governors’ letter urges the leaders of both parties in the House and Senate to hold a vote on that proposal.

The letter also says Trump’s decision has confused consumers who need to buy health insurance.

“The timing of the termination — days before open enrollment begins — is sowing confusion among consumers and leaving states scrambling to develop solutions to stabilize their insurance markets,” the letter says.

Open enrollment is the once-a-year period when customers who get insurance through exchanges such as Vermont Health Connect can change their plan for any reason. Uninsured people also can sign up during this time.

Trump has already cut the open enrollment period in half. In Vermont, open enrollment for Vermont Health Connect will run from Nov. 1 to Dec. 15. In previous years, open enrollment has run six weeks longer, through Jan. 31.

Mike Fisher
Mike Fisher, of Vermont Legal Aid, testifies in front of the Legislature. File photo by Erin Mansfield/VTDigger
Mike Fisher, the chief health care advocate for Vermont Legal Aid, said his office has been receiving phone calls from people wondering if they should cancel their insurance plans or not sign up for 2018.

Because of federal law, eligible customers will still receive their cost-sharing reduction subsidies in 2017 and 2018, Fisher said. That means insurance companies are going to be absorbing the cost of the subsidies, he said, and likely seek drastically larger rate increases for the 2019 plan year.

“We want to make sure that Vermonters know that if they’re eligible for cost-sharing subsidies that those supports are still available to them,” Fisher said.

Additionally, Fisher said customers should know that the other type of subsidy available on Vermont Health Connect — advance premium tax credits, which help people pay their monthly premiums — is not affected by Trump’s decision.

The Office of the Health Care Advocate staffs a hotline for Vermonters who have questions about health insurance. The number is 800-917-7787.

The prospects Thursday for a legislative solution on the subsidies were uncertain.

Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., officially unveiled their bill with a total of 24 sponsors — split evenly along party lines.

The bill would need 60 votes to pass the Senate.

Asked by reporters if there was support to pass the bill in the Senate, Alexander responded, “It’s not my job to count votes.”

Sen. Lindsey Graham, R-S.C., one of the co-sponsors, said he thinks it’s “a good start” and that he hopes it paves the way for Congress to take up an Obamacare repeal measure he developed with Sen. Bill Cassidy, R-La.

“Nobody believes it’s a replacement bill,” Graham said. “It’s trying to create some stability that we can replace Obamacare with Graham-Cassidy.”

To move forward with the compromise, Graham noted, supporters will need to get the House on board, which could be tough. House Speaker Paul Ryan indicated Wednesday he was against it.

The White House has sent mixed signals on the deal. Trump has publicly criticized it multiple times over the last three days, but has also said he’s open to a bipartisan approach.

Alexander, for his part, said on the Senate floor that in four conversations with the president over the last 10 days, Trump showed encouragement for a bipartisan agreement.



Twitter: @erin_vt. Erin Mansfield covers health care and business for VTDigger. From 2013 to 2015, she wrote for the Rutland Herald and Times Argus. Erin holds a B.A. in Economics and Spanish from the...