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1 Follow-up about the Budgetary Treatment of Cost-Sharing Reductions 1 (July 20, 2018)

handle is hein.congrec/cboflubtr0001 and id is 1 raw text is: CONGRESSIONAL BUDGET OFFICE Keith Hall, Director U.S. Congress Washington, DC 20515 July 20, 2018 Honorable Mark Meadows U.S. House of Representatives Washington, DC 20515 Re: Follow-Up About the Budgetary Treatment of Cost-Sharing Reductions Dear Congressman: In a July 2, 2018, letter, you asked additional questions following my response to your earlier questions about the budgetary treatment of payments for cost-sharing reductions (CSRs) provided by insurers in the marketplaces established under the Affordable Care Act. I hope this letter answers your remaining questions and addresses any continuing concerns you may have. Background Insurers that participate in the marketplaces established under the Affordable Care Act are required to offer CSRs to eligible people. CSRs reduce deductibles and other out-of-pocket expenses like copayments. Before October 12, 2017, the federal government reimbursed insurers for the costs of CSRs through direct payments. Those payments have now been terminated, and the subsidies for the CSRs are instead being funded through higher premiums and larger tax credits based on those premiums. As discussed in my previous letter, for the spring 2018 baseline, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) project that the entitlement for subsidies for CSRs will continue to be funded that way. 1 The Administration's October 12, 2017, announcement that it would no longer make CSR payments directly to insurers without an appropriation for that purpose caused CBO to consider three related questions: (1) Should reimbursement for the CSRs still be considered an entitlement absent direct payments? 1 See Congressional Budget Office, letter to the Honorable Mark Meadows regarding the budgetary treatment of cost-sharing reductions (June 8, 2018), wwwcbogo/publication/ 53961. www.cbo.gov

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