Appeals Court Gives Insurers a CSR Win, but Limits Payout

Health insurers that sued to recoup halted cost-sharing reduction (CSR) payments scored a key victory on Aug. 14 when a federal appeals court confirmed that the government must reimburse them for providing subsidies to low-income Affordable Care Act exchange enrollees. But that win came with a significant catch, as the three-judge panel said insurers can collect only the monetary damages that they didn’t already recoup from silver loading — the process by which they raise benchmark silver-plan premiums to compensate for lost CSR payments.

Health policy experts who spoke to AIS Health say they don’t expect the court’s decisions will cause much to change about CSRs or silver loading, as the current setup is working well for nearly all stakeholders. Still, insurers probably won’t file any more lawsuits seeking CSR reimbursement from the 2018 plan years and beyond, since they aren’t likely to collect any damages.

© 2021 MMIT

Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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