CSRs Out of Final Spending Bill as Collins Reportedly Loses in Fight Between Ryan, McConnell

A pledge made to US Senator Susan Collins (R-ME) to support funding for cost-sharing reductions (CSRs) in exchange for her yes vote on the GOP tax bill fell apart Wednesday, apparently because House Speaker Paul Ryan refused to allow the funding to be included in this year’s spending package, slated to be voted on Friday.

The loss was the result of a feud between Ryan (R-WI) and Senate Majority Leader Mitch McConnell, according to press reports. McConnell (R-KY) made the promise to Collins in order to get her to sign on to the tax bill, celebrated by Republicans Wednesday at the White House. During the GOP gathering, President Trump said, "We have essentially repealed Obamacare."

CSRs help insurers afford the lower prices they charge for those with the lowest incomes under the Affordable Care Act (ACA).

This would be the second blow to the ACA this year. The tax bill headed to President Trump’s desk ends the individual mandate, which required everyone to have health insurance or pay a penalty.

Wednesday afternoon, Collins and US Senator Lamar Alexander (R-TN) released a joint statement, saying, “Rather than considering a broad year-end funding agreement as we expected, it has become clear that Congress will only be able to pass another short-term extension to prevent a government shutdown and to continue a few essential programs.”

“For this reason, we have asked Senator McConnell not to offer this week our legislation which independent analysts Avalere and Oliver-Wyman say would reduce premiums by about 20% for the 9 million Americans who have no government subsidies to help them buy insurance in the individual market. Instead, we will offer it after the first of the year when the Senate will consider the omnibus spending bill, the Children’s Health Insurance Program reauthorization, funding for Community Health Centers, and other legislation that was to have been enacted this week. "

They said they believe that McConnell will "uphold his committment" to bring the Bipartisan Health Care Stabilization Act of 2017, sponsored by Alexander and US Senator Patty Murray, (D-WA), up for a vote.

The ACA requires those whose incomes qualify them for premium tax credits to get subsidized rates, CSRs or not. Amid uncertainty and with few options, regulators in some states had allowed insurers to build a CSR loss into 2018 rates, and to load the premium increase onto the benchmark silver tier, causing the cost of these plans to soar.

Trump spent much of 2017 threatening to end the CSRs, while declaring the ACA a failure and calling for Congress to repeal it. He finally canceled CSRs on October 12.

Under the ACA, subsidies are set as a percentage of the value of a second-lowest cost silver plan.