ROBERT SIEGEL, HOST:
It's that time of year when insurance companies are setting their prices for the health care exchanges for the coming year. That's been hard to do with so much up in the air in Washington. And while lawmakers focus on the repeal and replace debate, insurers are worried about a more immediate issue - whether they'll get reimbursed for discounts that they're required to give to low-income customers.
AUDIE CORNISH, HOST:
Unless Congress explicitly allocates the money for those so-called cost-sharing reductions, their payment is up to the Trump administration. And the president has refused to commit to continuing them. With those payments at risk, insurers are setting prices higher. That's according to Julie McPeak with the National Association of Insurance Commissioners.
JULIE MCPEAK: I was really hopeful that our consumers were going to see much more moderate rate increases for this year. But I think that the uncertainty has caused the rates to be higher than they ordinarily would have been expected to be for 2018.
CORNISH: Reporters at NPR member stations have been compiling some of those numbers. We'll hear from some of them, starting with Ben Allen of WITF in Pennsylvania.
BEN ALLEN, BYLINE: Insurers say they'd raise premiums by an average of 9 percent next year here if nothing changes. But the state insurance department asked companies to file two sets of rates - one accounting for uncertainty from Washington. And if the cost-sharing reductions that help low-income Americans with co-pays and deductibles disappear, rates would increase an average of 20 percent. If the individual mandate goes away, rates could increase by 23 percent. And if both hit, rates could be nearly 40 percent higher, says Pennsylvania Insurance Commissioner Teresa Miller.
TERESA MILLER: The only thing right now keeping everyone on edge is what's going to happen in Washington, D.C. If things calm down in D.C. and if we don't see further changes, then Pennsylvania's market really is stabilizing.
ALLEN: Miller says she's nervous about premiums going up. And she worries that 1 or more of the 5 companies who sell on healthcare.gov here will drop out of the individual market if Republicans make big changes. Insurers can leave any time between now and the fall.
ERIC WHITNEY, BYLINE: I'm Eric Whitney in Montana. Insurance companies here only file one set of rates. But the way they did it reveals that the state's biggest insurer thinks the prices will be significantly higher if the cost-sharing reductions disappear. Right now the Trump administration is doling them out on a month-to-month basis.
Two of the 3 companies selling plans on healthcare.gov in Montana say they calculated next year's prices assuming that the Affordable Care Act and those payments would stay in place. They're planning price increases of 4 percent and 7 percent. But the state's biggest insurer, Blue Cross and Blue Shield of Montana, made the assumption that the cost-sharing reductions for co-pays and deductibles will disappear. Their price increase - just over 23 percent.
ABE ABORAYA, BYLINE: I'm Abe Aboraya with Health News Florida. Insurance companies here filed their 2018 rates, and the state says consumers will see an average increase of 17.8 percent. But Tony Jenkins with Florida's biggest insurer, Florida Blue, says if cost-sharing reductions go away, they'll raise their rates even higher.
TONY JENKINS: If cost-share reductions are not approved, then we know that our rates are going to increase probably 20 percent above whatever our submitted rates are going to be.
ABORAYA: Also new for 2018 - Florida Blue is telling customers that if cost-sharing reductions or premium tax credits go away, consumers could be placed in a different plan and be responsible for the full costs if they keep it. While that's always been true, it's now such an actual risk they want to put it in writing for consumers buying a plan.
SIEGEL: The next cost-sharing payments are scheduled to go to insurers this week. And the administration indicated today that they will go out on time. But insurance industry analysts say that if Congress were to allocate these payments for good, it would go a long way to keeping premiums lower for exchange customers.
CORNISH: And this reporting was part of a partnership with WITF in Harrisburg, Montana Public Radio, Health News Florida and Kaiser Health News.
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