Trump hands Republicans a new ObamaCare problem


Key Republican members of Congress want to restore the ObamaCare payments, known as cost-sharing reductions (CSRs), that President Trump is ending, fearing the impact his move will have on the individual insurance market and their constituents. But there are obstacles ahead. 

Still, even if Democrats grant concessions, there’s no guarantee a health-care deal can pass Congress. Conservatives warn the payments to insurers are corporate “bailouts,” a message echoed by Trump on Friday.

“The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped,” Trump tweeted.

Trump warned Congress during the months-long debate over legislation to repeal and replace ObamaCare that he would let the system implode if lawmakers failed to pass a bill. He made good on his vow this week.

Senate Republicans made clear before leaving Washington for a weeklong Columbus Day recess that they were not fans of simply letting ObamaCare fall apart.

“I’m not for further complicating the lives of Texans just to make a point,” Senate Majority Whip John Cornyn (R-Texas) said when asked before the recess about the argument from some Republicans that ObamaCare should be allowed to fail.

Cornyn noted that Senate Health Committee Chairman Lamar Alexander (R-Tenn.) was in talks with Sen. Patty Murray (Wash.), the ranking Democrat on the committee, over authorizing insurance market stabilization payments in exchange for market reforms, such as granting states waivers from ObamaCare’s regulatory requirements.

Yet Cornyn also said he wants real concessions from Democrats. Simply giving states more power to waive ObamaCare’s insurance regulations, he said, “seems pretty light.”

A spokesman for Cornyn said Friday that his boss had not yet weighed in on Trump’s decision to end the ObamaCare payments, adding that his previous statement did not necessarily reflect his views of this week’s action.

Congressional Republicans are split on whether they think Congress should act to fund the payments. Some say they want to maintain stability and protect people who are enrolled.

“[Trump] rightfully put the burden where it belongs and that’s in Congress and Congress has to deal with this problem,” Rep. Tom Reed (R-N.Y.) told The Hill on Friday. Reed has proposed a bipartisan package in the House to fund the CSR payments, as well as make right-leaning changes like repealing ObamaCare’s medical device tax.   

“If Congress doesn’t get it done, the people who suffer are the people back home,” Reed added.

Other moderate House Republicans, like Reps. Leonard Lance (R-N.J.) and Carlos Curbelo (R-Fla.), who both face tough reelection races, also called Friday for Congress to fund the payments.

The payments reimburse insurers for giving discounts to low-income ObamaCare enrollees. Without the funds, insurers could drop out of the market or spike premiums, causing chaos.

Some Republicans fear that their party will be blamed for chaos in the market. Strategists warn that if health-care premiums spike as a result of Trump ending the insurance payments, candidates will pay a price at the polls in 2018, when the House could be up for grabs. 

“What political party would want to hold a broken health-care system?” said John Weaver, a political strategist who advised Ohio Gov. John Kasich’s 2016 presidential campaign.

“Trump took the health-care system hostage and shot it, so now Republicans are going to own this moving forward. On top of everything else they’re facing in the midterm [election], it’s an unmitigated political disaster,” he added.

Democrats say Trump’s decision will be “devastating” and predict premiums will increase by 20 to 25 percent. 

On the other side of the debate, conservative Rep. Jim Jordan (R-Ohio) told The Hill that “heck no,” he doesn’t support Congress funding the payments, which he called “a bailout to insurance companies.”

Jordan said the conservative House Freedom Caucus has not yet discussed the issue in depth, but “my guess is most members are going to have real problems with these CSR payments.”

Meanwhile, Alexander and Murray are in the midst of bipartisan negotiations over a bill to stabilize ObamaCare, which would include funding the CSR payments. In exchange, Alexander is pushing for giving states more flexibility through expanding waivers to innovate and change ObamaCare rules.

Murray said Friday she is “optimistic” about the negotiations and believes a deal could be reached “quickly.”

A sticking point has been how much to expand the waivers for states. Alexander has been calling for more flexibility than Democrats, who worry about maintaining protections like minimum standards for what an insurance plan must cover. Republicans say substantive changes to the waivers are needed, not just speeding up the process for states to be approved for a waiver.

Still, Democrats expressed hope that a deal could be announced as soon as next week. Staff-level discussions have been ongoing.

Sen. Mike Rounds (R-S.D.), who worked for years in the insurance business before starting a second career in politics, said before the recess that Congress couldn’t simply let ObamaCare fail without finding ways to protect people from the fallout.

“When this fails, and it will fail, this is going to impact the lives of real people, and I think we should be doing everything we can to find an alternative so real people don’t get hurt,” he told The Hill.

He doubled down on that position Friday.

“President Trump’s decision to end cost-sharing reduction payments has the potential to impact 17,000 South Dakotans directly and to create turbulence in the individual market. That is why I have been working with a bipartisan group of senators to try to resolve this issue,” he said in a statement.

Rounds has been talking to Alexander, Murray and Sen. Angus King (I-Maine) about a deal to authorize the cost-sharing subsidies in exchange for insurance market reforms.

Trump on Thursday also signed an executive order to allow Americans to purchase insurance across state lines, a reform that conservative policy experts have long espoused.

But Rounds, based on his experience selling insurance, doubts that will work in practice. He says people living in New York City, which has high health-care costs, won’t be able to buy relatively cheap plans from a state with lower costs such as South Dakota because it won’t make economic sense for insurance companies.

Democratic leaders are looking for a vehicle to get any potential deal passed. House Democratic Leader Nancy Pelosi (Calif.) on Friday floated attaching the payments to a coming disaster spending bill or the larger government funding bill, known as an omnibus, in December.

“I think we’re going to have a very good opportunity in the omnibus to get this done in a bipartisan way if we can’t get it done sooner,” Senate Democratic Leader Charles Schumer (N.Y.) told reporters Friday. 

Trump has indicated that he sees the payments as a bargaining chip. 

“I will say that the Democrats should come to me; I would even go to them,” Trump said Friday. “Because I’m only interested in one thing: getting great health care for this country.”

Tags Angus King Carlos Curbelo John Cornyn Lamar Alexander Mike Rounds Patty Murray
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