“Obviously, we’re not doing that,” Ryan said. “That’s not in an appropriation bill. That’s something separate that the administration does.”
House Republicans, however, spent the previous few years suing the Obama administration for giving insurers the subsidies without consent from Congress, as part of their long-standing barrage against the Affordable Care Act. Their lawsuit, which has been upheld by a federal-district court, argues that the administration was overstepping its authority in making the payments, as they didn’t have a permanent appropriation within the health-care law.
That lawsuit now puts them in an awkward position. Republicans control both Congress and the White House, but they have so far failed to replace Obamacare as promised. The public is likely to blame them for problems with the law going forward, including its premium hikes, adding pressure to ensure insurers get the payments.
The subsidies, called cost-sharing reductions, are an obscure but important part of the Affordable Care Act that emerged as a sticking point as Congress negotiates a bill to fund the government past Friday. Last week, President Trump threatened that Republicans wouldn’t fund them if Democrats blocked funding for a border wall.
They are available to the lowest-income enrollees in the law’s insurance marketplaces — those earning 100 to 250 percent of the federal poverty level — to help them afford extra costs beyond their monthly premium, like co-payments and deductibles.
Insurers must offer the discounts, regardless of whether they get reimbursed by the federal government. They’re arguing that without those reimbursements, they’ll be forced to dramatically pump up premiums for everyone to cover the costs. The Kaiser Family Foundation has estimated premiums for mid-level silver plans would rise by 19 percent on average without the payments.
Now that Congress has refused to fund the payments, the only way for insurers to get them next year is if the Trump administration pays them out anyway. The administration hasn’t said whether it will do so, or whether it will appeal a district-court ruling upholding the House lawsuit, reflecting the high political stakes at play.
If insurers don’t get the payments and hike premiums as a result, resulting in Americans dropping their health coverage, it could create a backlash against Republicans. Moderates who are vulnerable in 2018 are particularly worried about this outcome. And leading Republicans in Congress, including Energy and Commerce Chairman Greg Walden, have said the payments must be made.
But should his administration award the subsidies, Trump would appear to be propping up the health-care law that he had sharply criticized on the campaign trail.
Were Republicans moving forward on a sure path toward repealing and replacing big parts of the Affordable Care Act, Trump could argue he was protecting consumers in the interim. But that measure is currently in a holding pattern as Republicans have clashed over its aspects.
And if the Trump administration awards the subsidies — and House Republicans don’t criticize the move — they risk looking hypocritical, since that’s what they blasted President Barack Obama for doing.