Health insurers are finally speaking up for Obamacare — but it may be too late

President Trump and congressional Republicans finally goaded the insurance industry into defending the Affordable Care Act this week — sort of. But these companies’ pusillanimous response to the GOP’s direct threat to Obamacare’s survival is a reminder that the industry, which collectively has made hundreds of millions of dollars from the law, has in many ways been its worst enemy.

The health insurers’ rare outspoken defense of the law came via separate letters from the industry’s lobbying arms, America’s Health Insurance Plans and the BlueCross BlueShield Assn., to Trump and to congressional leaders. The letters warn that the Republican determination to undermine the ACA threatens to drive more insurers out of the individual market, push up premiums and other costs, and burden hospitals with more unpaid bills.

But the letters amounted to a less than full-throated defense. For one thing, AHIP and the association sought cover by issuing the warning jointly with six other stakeholders’ groups, including the American Medical Assn. and the American Hospital Assn.

For another, the letters’ focus wasn’t on the ACA generally but on one provision, the law’s so-called cost sharing reductions. These are subsidies offered to households in the individual insurance market with incomes below 250% of the federal poverty level. (This year, that threshold is $61,500 for a family of four.) The subsidies help pay for out-of-pocket expenses such as copays and deductibles, and are paid directly to the insurance carriers.

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