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(Bloomberg) — Several business and health groups are saying a $1.1 trillion bill to keep the U.S. government from shutting down must include payments to health insurers under the Affordable Care Act, creating another hurdle for Republicans to overcome as they try to pass the measure.

On Thursday, the U.S. Chamber of Commerce, America’s Health Insurance Plans, the American Medical Association, the American Hospital Association and other groups issued a statement saying that the spending bill has to include the ACA’s cost-sharing-reduction program payments. The payments are used to help poor people afford health coverage. Health insurers say losing access to the subsidies would force them to pull out of the ACA public exchange system or sharply raise rates.

(Related: Government Shutdown Talks Stall as Trump Balks on ACA Subsidy)

“Funding this critical financial assistance for at least two years is the only way to protect these consumers,” the lobbying groups said in the statement. Their members represent some of Washington’s biggest spenders on lobbying and political contributions. “Clarity and commitment to this funding is needed to eliminate confusion and anxiety for consumers, and to allow health plans to make timely and appropriate decisions about market participation in 2018.”

The demand threatens to upend progress on the spending bill, after President Donald Trump’s administration seemed to agree to keep making the insurer payments without an act of Congress. Trump had previously threatened to hold the payments hostage unless he got funding for a wall on the U.S.-Mexico border.

No Promises

Yet the White House didn’t promise to fund the payments for a certain amount of time. The administration told insurers it will commit only to making the payments through the end of next month, said Kristine Grow, a spokeswoman for America’s Health Insurance Plans, in an email.

An administration aide said a final decision on how long the payments will continue hasn’t been made. Insurers have just weeks to decide whether to participate in Obamacare next year.

Mario Molina, chief executive officer of Molina Healthcare Inc., said Thursday the insurer would drop ACA public exchange plans “immediately” if the CSR payments aren’t funded.“ That would result in about 650,000 to 700,000 people losing insurance coverage in 2017,” Molina wrote House and Senate leaders.

Anthem Inc. would raise premium rates 20% or more, or drop coverage in certain areas, without the payments, CEO Joseph Swedish said Wednesday during a conference call with investors.

(Related: Actuary Sizes Up 2018 Individual Health Picture)

Democrats are hopeful Trump won’t hold the funds hostage.

“I expect they’re going to continue them certainly for a long period of time,” Senate Minority Leader Chuck Schumer, a New York Democrat, said Thursday when asked if he had secured a commitment. “The forces that forced them to do it on their own are still there. They know that if 6 million people lose coverage because premiums go way up, it’s on their backs.” 

— Read Trump Confident of No Federal Shutdown as Agencies Prepare on ThinkAdvisor.

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