If Republicans really want to see individual major medical coverage for sale in 2018, they need to renew funding for the Affordable Care Act cost-sharing reduction subsidy program.

Joseph Swedish, the chairman of Indianapolis-based Anthem Inc., gave that message to two House Republican committee leaders in a letter about the American Health Care Act budget measure.

Related: GOP ACA change bill may favor commercial health

Swedish welcomed four major provisions in the AHCA measure:

          • The creation of a grant program that could help states support their commercial health insurance markets.

          • The repeal of an ACA tax on health insurers.

          • A provision that would let consumers use federal premium tax credit subsidies to pay for off-exchange individual major medical coverage as well as on-exchange coverage.

          • A provision that would continue funding for the ACA cost-sharing reduction subsidy program until the end of 2019.

But Swedish said health insurers also need to see Congress appropriate the cash to fund the cost-sharing reduction subsidy program for 2018 and 2019.

“Currently, we are in the process of formulating our rates and making decisions on market participation for the individual market in our 14 states for 2018,” Swedish wrote in the letter, which he sent to Rep. Greg Walden, R-Ore., the chairman of the House Energy & Commerce Committee, and Rep. Kevin Brady, R-Texas, chairman of the House Ways & Means Committee.

“While we have performed better than many of our competitors, it is increasingly difficult to remain in the exchange market under its current structure,” Swedish said.

Anthem is the parent of a Blue Cross carrier, a Blue Shield carrier, or both a Blue Cross and a Blue Shield carrier in 14 states. It is the only insurer now offering health plans through ACA public exchange programs in about one-third of the counties it serves, Swedish said.

Swedish sent the letter to Rep. Greg Walden, R-Ore., the chairman of the House Energy & Commerce Committee, and Rep. Kevin Brady, R-Texas, chairman of the House Ways & Means Committee. Both committees marked up the AHCA measure last week and forwarded it to the House Budget Committee.

The House has been suing to block cost-sharing reduction subsidy funding, but it put the suit on hold in February. (Photo: John Kroetch/Thinkstock)

The House has been suing to block cost-sharing reduction subsidy funding, but it put the suit on hold in February. (Photo: John Kroetch/Thinkstock)

Court battle

The Budget Committee is preparing to review the measure at a markup at 10 a.m. EDT Thursday. The committee will stream video of the AHCA markup live on the web.

The cost-sharing reduction program helps ACA public exchange plan users with income under 250 percent of the federal poverty level pay their deductibles, co-payments and coinsurance amounts. The program spent $4.9 billion on 5.2 million people, or $948 per enrollee, in 2015, according to an analysis Paul Houchens and Zachary Fohl of Milliman prepared for the Association for Community Affiliated Plans.

House Republican leaders have been fighting in federal court to keep the U.S. Department of Health and Human Services from making cost-sharing reduction subsidy program payments.

House Republicans argued in court that Obama’s HHS lacked an appropriation from Congress to make the payments.

The ACA text includes a permanent appropriation for the premium tax credit subsidy program. The Obama administration said the appropriation provision also applies to the cost-sharing reduction subsidy program, because both programs are really part of the same program.

In May 2016, a judge in the U.S. District Court for the District of Columbia ruled in favor of the House.

Related: Court ruling threatens $5 billion in PPACA insurer subsidy payments

The Obama administration appealed to the U.S. Court of Appeals for the District of Columbia.

In February, the House and the Trump administration’s HHS agreed to put the case on hold. They are supposed to file status reports on the appeal every three months starting May 22.

Related:

Trump courts governors, health insurer CEOs

Feds try to ease ACA subsidy program data agony

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