Dir mulvaney joint csr letter final 051917


May 19, 2017


On Friday, May 19, the Chamber, along with 7 additional trade associations representing insurers, hospitals, physicians and employers, sent a letter to Office of Management and Budget Director Mick Mulvaney. The letter outlines serious concerns about the continued uncertainty around funding for cost-sharing reduction (CSR) payments and the negative impacts uncertainty will have on millions of Americans if it is not addressed.

May 19, 2017

The Honorable Mick Mulvaney


Office of Management and Budget

725 17th Street, Nw

Washington, DC 20503

Dear Director Mulvaney:

As providers of healthcare and coverage to hundreds of millions of Americans, we are writing again to you to express our serious concerns about the continued uncertainty around funding for cost-sharing reduction (CSR) payments. There now is clear evidence that this uncertainty is undermining the individual insurance market for 2018 and stands to negatively impact millions of people.

Action is need now to guarantee a steady stream of CSR funding through 2018. Such action would represent a strong, positive step for all consumers who buy their own insurance by eliminating the single most destabilizing factor causing double-digit premium increases for 2018.

Millions of Americans do not receive health insurance through an employer, Medicare or Medicaid. The individual market is their only option for getting coverage. Unless CSRs are funded, a tremendous number of Americans will simply go without coverage and move to the ranks of the uninsured. This threatens not just their own health and financial stability, but also the economic stability of their communities.

We recognize and understand the Senate is working on legislation that includes provisions intended to promote short-term stability in the individual market. However, in light of 2018 filing deadlines, most of which fall on or before the June 21st deadline for federally facilitated marketplaces, health plans have only a few more weeks to decide whether and how to participate in this market. In several states, the deadline to file products and initial rates has already passed.

Earlier this week, the National Association of Insurance Commissioners (NAIC) again expressed grave concerns to you about the impact of CSR funding uncertainty. Simply put, continued uncertainty, particularly the lack of clarity around CSR payments, has led several insurers to conclude that they cannot participate for 2018. Those who will participate are responding to the market uncertainty with premium requests that are as much as 60 percent higher than last year.

Millions of American consumers and taxpayers will soon feel the impact:

  • Consumers who purchase their own insurance will have few, if any, coverage choices. As a result, millions of people will become uninsured.
  • With more uninsured, providers will experience more uncompensated care which will further strain their ability to meet the needs of their communities and will raise costs for everyone, including employers who sponsor group health plans for their employees.
  • Taxpayers will pay billions of extra dollars in costs due to higher premium subsidies—in fact, recent studies have found overall federal costs will be 23 percent higher.

Action is needed now to fund CSR payments. At this point, only clear action with a commitment to CSR funding can help consumers. We remain committed to working with you toward immediate stability and longer-term, effective, market-based solutions that best serve the American people.


America’s Health Insurance Plans

American Academy of Family Physicians

American Benefits Council

American Hospital Association

American Medical Association

Blue Cross Blue Shield Association

Federation of American Hospitals

U.S. Chamber of Commerce

Dir mulvaney joint csr letter final 051917