House Speaker Paul Ryan (R-Wis.) dismissed the idea of Congress funding extra Obamacare subsidies, called cost-sharing reductions, on April 25. "Obviously, CSRs, we're not doing that," Ryan said. "That's something separate that the administration does." (The Washington Post)

THE MORNING PLUM:

We now have our first clear evidence that President Trump’s threats to blow up Obamacare — whether or not he actually intends to make good on them — are going to hurt a lot of people here in the real world. In Trump’s mind, these threats are supposed to force Democrats to make a deal on repeal, but minimal logic reveals that this is extremely far-fetched — meaning the only impact his threats will likely have is a destructive one, for no evident purpose whatsoever.

Blue Cross Blue Shield of North Carolina has announced that it intends to try to raise premiums by 22.9 percent next year. The company says it would have tried to raise them by only 8.8 percent, but it is going for the larger increase because the Trump administration has not said whether it will continue paying the law’s so-called “cost-sharing reductions” (CSRs) to insurance companies, which subsidize out-of-pocket costs for lower-income people who get insurance on the individual markets. Democrats in Congress want to appropriate money to cover these subsidies, but Republicans have not done so.

In an interview with me this morning, Brad Wilson, the president and chief executive of Blue Cross Blue Shield North Carolina, said flat-out that the failure of the Trump administration and Congress to guarantee that these subsidies will continue is why rates are going to soar for hundreds of thousands of people in his state.

“The failure of the administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower,” Wilson told me. “That will impact hundreds of thousands of North Carolinians.” The company says it has approximately half a million customers getting individual insurance via Obamacare.

“We filed a 22.9 rate increase for 2018 based on the assumption that the CSRs will not be in place,” Wilson also said. “The rate increase would be 8.8 percent if the CSRs were guaranteed for 2018. Because they are not, the rate is 22.9 percent.”

Trump has repeatedly threatened to cut off the CSRs. Doing so could cause many insurers to exit the market, potentially costing millions their insurance, while causing others to dramatically hike premiums. The administration paid them for May, but officials continue to refuse to say whether the payments will continue after that. The CSRs are tied up in court: House Republicans sued to stop them under Barack Obama, whose administration appealed the decision, and the payments continued pending the appeal, but the Trump administration has not said whether it will continue the appeal (dropping it would cause the payments to halt) and recently asked for a 90-day delay from the court while it mulls their fate. But this has only injected further uncertainty, and while some congressional Republicans have said they think the funds must be appropriated to stabilize the situation, there’s no sign whether they actually will.

But it must be stressed that Trump’s own stated rationale for threatening to cut off the payments is just nonsense. The threat appears rooted in pique over the failure to secure the “win” of repeal. Trump has repeatedly said the threat will force Democrats to the table to make a deal on Obamacare’s future. But Republicans are currently pursuing a repeal-and-replace plan that would do a lot more damage to the law than ending the payments would, so it’s unclear why any Democrats would join them in that effort, in response to a threat to do relatively less (though still severe) damage. The only conceivable way Democrats could make a deal with Trump is if he were open to fixing, rather than repealing, the law, which he isn’t.

Thus, the only thing Trump’s threat is really accomplishing is to drive up premiums for people. Even worse, the news out of North Carolina previews what could happen with other insurers in other states if Trump actually goes through with the threat to cut off the CSRs, and congressional Republicans don’t appropriate the money. The key point is that Blue Cross Blue Shield North Carolina is acting on the assumption that the CSRs will not be there. And in that scenario, the company has decided, massive premium hikes are necessary. So, if it comes to pass that the CSRs actually aren’t there, you will see similar premium hikes across the country.

“The effect will be the same across the country,” Wilson predicted. “Rates will be materially higher if CSRs aren’t funded.” Indeed, a recent Kaiser Family Foundation study found that insurers would likely boost premiums on average nationally by 19 percent on some plans to compensate for it if the CSRs are halted.

One last point: This whole dynamic shows that one of the leading GOP health care talking points is also complete nonsense. Paul Ryan loves to say that Republicans are performing a “rescue mission” by stepping in to save people from the allegedly collapsing ACA by replacing it, and that they don’t want any people to be hurt in the transition. As it is, their “rescue mission” would result in 23 million people losing insurance over 10 years, and in soaring premiums for sick people, with many priced out of the market. But that aside, if their own stated goal is to avoid hurting people during the transition, it’s unclear why they would not fund the CSRs, since the failure to do so is going to hurt untold numbers of them.

* THE CSR DEBATE, IN ONE CHART: Here is a chart supplied by Blue Cross Blue Shield North Carolina that explains its decision:


Seems clear enough.

* TRUMP WILL TAKE TRAVEL BAN TO SUPREME COURT: Now that the block on Trump’s immigration ban has been upheld by the 4th Circuit, his administration will take the fight to the Supreme Court, the Associated Press reports:

Administration lawyers could … seek the justices’ approval to put the travel policy in place on an emergency basis, even as the court weighs what to do with the larger dispute. If that happens, the justices’ vote on an emergency motion would signal whether the government is likely to win in the end. It takes a majority of the court, five votes, to put a hold on a lower court ruling. If at least five justices vote to let the travel ban take effect, there’s a good chance they also would uphold the policy later on.

So the travel ban is certainly not dead yet, because it’s anyone’s guess what will happen when this Supreme Court gets its hands on it.

* GIANFORTE WINS SPECIAL ELECTION: Republican Greg Gianforte, who was just charged with assaulting a reporter, won last night’s special election in Montana, by 51-44. During his victory speech, The Post reports, this happened:

Some in the crowd laughed at the mention of the incident. “I made a mistake,” said Gianforte.

“Not in our minds!” yelled a supporter.

Remember, the Gianforte campaign claimed it raised nearly $100,000 in the wake of the alleged assault.

* GIANFORTE WON BY A RELATIVELY TIGHT MARGIN: Gianforte’s win, by 51-44, should be evaluated in light of the Cook Political Report’s metric for measuring a district’s partisan lean. According to that metric, Democrats should expect a vote share of 39 percent.

That means Democrat Rob Quist overperformed that metric by five points — not a bad sign for 2018.

* THE BRIGHT SPOT FOR DEMS: NBC’s First Read crew runs through recent special elections to show the pattern, i.e., that Democrats are overperforming in them relative to the 2016 House spreads and the Trump-Clinton results:

  • KS-4 in 2016: Mike Pompeo 61%, Daniel Giroux 30% (R+31)
  • KS-4 in 2016 (presidential results): Trump 60%, Clinton 33% (R+27)
  • KS-4 in 2017: Ron Estes 53%, James Thompson 46% (R+7)
  • GA-6 in 2016: Tom Price 62%, Rodney Stooksbury 38% (R+24)
  • GA-6 in 2016 (presidential results): Trump 48%, Clinton 47% (R+1)
  • GA-6 in 2017 (initial round): John Ossoff 48%, Karen Handel 20%, Bob Gray 11%, Dan Moody 9%, Judson Hill 9%.
  • MT-AL in 2016: Ryan Zinke 56%, Denise Juneau 40% (R+16)
  • MT in 2016 (presidential results): Trump 57%, Clinton 36% (R+21)
  • MT-AL in 2017: Gianforte 50%, Quist 44% — with 98% reporting (R+6)

As First Read notes about the Montana outcome, “the silver lining for Democrats last night is that they have continued the trend.”

* COULD THE OPIOID CRISIS SAVE OBAMACARE? Jennifer Steinhauer and Robert Pear report that the Obamacare repeal effort is bogged down in a major way in the Senate, and here’s one notable reason:

The law also has provisions to help drug addicts, and the opioid crisis sweeping many states with Republican senators has been a key motivator. “The opioid issue definitely plays a role,” said Senator Susan Collins, Republican of Maine. “A lot of the young population that is being insured under Medicaid has problems with substance abuse or mental illness.”

One study found that the crisis is concentrated in Trump counties. Also remember that 20 GOP senators come from states that opted into the Medicaid expansion, which may be helping victims.

* FAMILIES HIT BY OPIOID CRISIS FEEL BETRAYED BY TRUMP: The Associated Press reports that many families of victims of the opioid crisis feel betrayed by Trump’s proposed savage cuts to programs such as Medicaid, which helps such patients. For example:

“I didn’t see this coming,” said Paul Kusiak, of Beverly, Massachusetts, who shared with Trump the story of his two sons’ successful battle with opioid addiction during a New Hampshire roundtable discussion eight days before the election. “I’m trying desperately to have hope and take the president at his word.”

Mr. Kusiak, allow me to suggest that at this point, hoping the president will honor “his word” is probably a bad idea.

* AND TRUMP VOTERS GOT SCAMMED, BIGLY: Paul Krugman runs through the data showing how Trump’s health-care plan and budget would ravage West Virginians who depend on safety-net protections, and notes:

What would happen to West Virginia if all these Trump policies went into effect? Basically, it would be apocalyptic: Hundreds of thousands would lose health insurance; medical debt and untreated conditions would surge; and there would be an explosion in extreme poverty, including a lot of outright hunger … So many of the people who voted for Donald Trump were the victims of an epic scam by a man who has built his life around scamming.

As I’ve detailed, there is plenty of other data showing that many Trump voters would be directly harmed by his policies, and the scam may prove doubly cruel to those who also believed that he would bring them jobs (if they never materialize).