Health Affairs October 13, 2020
Insurance companies recently won a narrow victory in the Federal Circuit Court of Appeals. The court held that insurers were entitled to recover unpaid cost-sharing reduction (CSR) payments that the Trump Administration withheld, but only to the extent insurers had not recouped their losses through higher premiums. In this piece, we examine the likely consequences of the decision.
We expect lengthy legal proceedings, at the end of which most insurers will not receive much—if any—compensation for 2018 to the present, since they successfully recouped the costs of CSRs, usually through the approach known as “silver loading.” We further expect both regulators and insurers to conclude that silver loading should continue in the wake of the decision. But since the decision...
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