One state shows the chaos Trump is wreaking on the Obamacare exchanges

Donald Trump and Barack ObamaWin McNamee/Getty ImagesDonald Trump and Barack Obama

Republicans passed their plan to repeal and replace Obamacare through the House this week, but the Affordable Care Act remains the law of the land.

That means that the ACA’s individual insurance markets are still up and running. But under the Trump administration, they haven’t been running very well.

Maryland, which has a state-run exchange instead of using the federal platform, released requested premium increases from the five insurers in its market on Thursday.

The proposed increases are quite stunning.

Of the five insurers, the Kaiser Foundation Health Plan of the Mid-Atlantic States had the lowest average requested increase for their plans, at 18.08%. The highest was CareFirst of Maryland, with an average increase request of 58.80%, which would bring the baseline monthly premium payment for the plans up to $US714.95.

The maximum requested premium increases were similarly striking. The biggest proposed jump came from Cigna, which requested a 150.83% hike for a plan on the high end.

Maryland’s insurance commissioner Al Redmer said in a statement that the proposed rates still have to go through a review process and could be adjusted before they are offered to consumers.

“It’s important to remember that these rates are what companies have requested, and not necessarily what will be approved,” Redmer said. “There will be a thorough review of all the filings. As in years past, we may require changes.”

Also at issue is the uncertainty of whether Obamacare’s cost-sharing reduction (CSR) payments are ceased.

The payments, which help defray the cost of providing low-income Americans with cheaper health insurance plans, are seen as critical to ensure the stabilisation of the ACA’s individual insurance markets.

Currently, the payments are appropriated by the White House rather than Congress, and President Donald Trump has threatened to end the payments. The payments are also subject to an ongoing lawsuit between the House and executive branch questioning the legality of their funding without a congressional appropriation. While the Obama administration defended the case, Trump could drop an appeal of a ruling from 2016 in which a court sided with House Republicans.

The White House has said that it will continue funding for the CSR payments but have not guaranteed they will be in place for 2018.

The uncertainty led Maryland to tell insurers that they would be able to refile their requested increases if the payments are discontinued.

In fact, in California, the insurance commission told insurers that the companies could submit plans that assumed CSRs would be paid and a set of rates assuming they went unpaid.

“I have written President Trump asking that he and his Administration stop undermining the Affordable Care Act and health insurance markets,” read a letter from Dave Jones, the California insurance commissioner, to insurers filing in the state. “Health insurers are legitimately concerned that the President’s actions are undermining the ACA and health insurance markets.”

Most other states have set deadlines for plan submissions in June.

In addition to the uncertainty regarding CSR payments, which some experts said insurers are already baking into the rate projections, Trump’s administration has also issued a number of rules that could cause instability in the individual market.

A variety of insurers have already pulled out of various markets, like Aetna in Iowa and Virginia, in part due to the political uncertainty.

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