Any money not used to lower the costs is returned to the federal government. Currently, the roughly $8 billion in payments comes from the White House rather than a congressional appropriation. The payments have been the subject of a lawsuit between the Republican-controlled House and the executive branch dating back to the Obama administration. Trump's recent threatsto cease thepayments have causedinsurers and industry groupsto growincreasingly worried about potential losses andtheir participation in the individual insurance markets. Anthem, one of the big fivepublicinsurance companies, said Wednesday that if CSR payments are not funded, they could either raise premiums in the individual market by as much as 20% or leave them altogether. Anthem CEO Joe Swedish said on the company's earnings call that it wasmaking the assumption that CSR payments would be funded. He said the company'soutlook would change if the payments are pulled. "However, we are notifying to our states that, if we do not have certainty that CSRs will be funded for 2018 by early June, we will need to evaluate appropriate adjustments to our filing," Swedish said. "Such adjustments could include reducing service area participation, requesting additional rate increases, eliminating certain product offerings or exiting certain individual ACA-compliant markets altogether." Other major insurers such as Aetna and Cigna also warned earlier in the year that their participation in the exchanges wouldbe based on the payments.
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