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The Trump administration asked a federal appeals court on Monday to delay ruling on a lawsuit that could determine whether the government will continue paying subsidies under the Affordable Care Act to health insurance companies for the benefit of low-income people — effectively prolonging uncertainty that is already rattling the health law. The request could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018. (Pear, 5/22)

The two-paragraph filing said that both parties “continue to discuss measures that would obviate the need” for the court to rule — a reference to Republicans’ efforts to abolish most of the ACA and install more conservative health-care policies. ... The cost-sharing subsidies are one of two major types of assistance the law provides to most people who buy private health plans through the marketplaces. The cost-sharing subsidies, focused on lower-income ACA customers, reach nearly 6 in 10 such people. The other assistance helps cover insurance premiums for more than 8 in 10. (Goldstein, 5/22)

The Trump administration could still decide to drop the appeal at any time. According to a spokeswoman for the Department of Health and Human Services, the subsidies have been paid for May, but there have been no promises made about whether the payments will continue. (Wexiel, 5/22)

Insurers say they must know within weeks whether the federal payments will continue next year, since they face a June 21 deadline for deciding whether to participate in the exchanges in 2018. “It’s critical that we have certainty for 2018,” said Justine Handelman, senior vice president at the Blue Cross Blue Shield Association. “Plans are deep in their decision-making for 2018, and if there’s not certainty, you could see a significant impact on premiums, up to 20%, to account for the fact that those cost-sharing payments aren’t there.” (Armour and Radnofsky, 5/22)

"We need swift action and long-term certainty on this critical program,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, the industry lobbying group. “It is the single most destabilizing factor in the individual market, and millions of Americans could soon feel the impact of fewer choices, higher costs, and reduced access to care.” (Mershon, 5/22)

Uncertainty over the future of health care is growing deeper for millions of Americans who buy their own policies. While insurers released a blueprint Monday for stabilizing wobbly markets, the Trump administration is leaving in limbo billions of dollars in federal subsidy payments. ... a major insurer group released a framework for market stability that relies in part on a continuation of subsidies. The BlueCross BlueShield Association represents plans that are the backbone of insurance markets under the Affordable Care Act, or ACA, and would also be the mainstay with a Republican approach. (Alonso-Zaldivar, 5/22)

The dispute began in 2014 when House Republicans sued the Obama administration, saying the payments couldn’t be made without Congress’s approval. House Republicans won the case in district court, and the Obama administration appealed. The Trump administration has threatened to drop the appeal. Attorneys general from New York, California, 13 more states and the District of Columbia last week asked the appellate court for permission to intervene in defense of the payments, interruption of which “would directly subvert the ACA, injuring states, consumers and the entire health-care system,” they said then. (Edney, Tracer and Harris, 5/22)

Some Republicans, such as Sens. Bill Cassidy (R-La.) and Lamar Alexander (R-Tenn.), have said Republicans may need to fund the subsidies in order to maintain a stable insurance marketplace while they work to overhaul the ACA. But President Donald Trump has suggested he could end the payments at any time. (McIntire, 5/22)

Republicans in Washington may not be the only ones who can resolve the ambiguity around who is authorized to fund the CSRs. If states were allowed to intervene in the lawsuit—and 15 states asked to do so last week—that could change the outcome. University of Michigan law professor Nicholas Bagley wrote an analysis Monday that states are betting that the appellate court would disagree with the lower court's finding that the House of Representatives had standing to sue. (Lee, 5/22)