The more urgent concern driving the industry out of rural Nevada’s health exchange

          In the movie version the saboteur was wrongly accused. But only in the movie version.

Area news coverage, as well as statements from Nevada Democrats, on the departure of the insurance industry from rural Nevada’s ACA exchange primarily point to the chaos promised by Trumpcare. But, as many of you know, the arguably more urgent uncertainty driving the industry’s decision is, at least technically, separate from ACA repeal.

I refer of course to the Trump administration’s repeated threats to stop funding subsidies. That is, the administration has repeatedly said it intends to stop reimbursing insurance companies for cost sharing reductions that allow people to buy coverage at reduced rates, based on their income. Even if the Senate ultimately fails to pass a Trumpcare bill, “uncertainty” over the cost sharing reductions is going to continue — or worse, become a certainty. This is the sabotage of which you have heard — and of which the industry has frequently if not always publicly complained.

In a statement on its withdrawal from the rural Nevada market, Anthem cited “continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage” (emphasis mine).

The Center for Budget Policy and Priorities has a decent chronology, with links, of the administration’s stalling over funding the cost sharing reductions, as well as the repeated threats over several months from Trump and HHS Secretary Tom Price to just cold not fund them at all.

I never liked Obamacare’s reliance on the insurance industry. That the Trump administration evidently has legal leeway to unilaterally strangle the program may reflect sloppy bill-writing as much as anything. But the ease by which an administration renowned for ineptitude can destabilize the ACA also underscores the systemic bankruptcy of the whole “market-based” reform model that Obama cribbed from Romney and the Heritage Foundation.

Anyway, I haven’t seen this piece of it explicitly highlighted in the Nevada reaction to the industry’s exit, or not highlighted as much as it probably should be, so I wanted to do that. Someone in the media should probably ask Heller about this. But Heller presumably will be astride his beloved horse in countless parades over the next several days, so unfortunately he won’t have time to explain how he plans to fight an underhanded attack from his party and his president that is deliberately designed to deprive rural Nevadans of affordable health care coverage.