The Washington PostDemocracy Dies in Darkness

Partisan clash on Obamacare raises specter of government shutdown

On Oct. 15, members of both parties had sharp words on the executive order on health-care President Trump signed on Oct. 13 and called for Congressional action. (Video: Meg Kelly/The Washington Post, Photo: Melina Mara/The Washington Post)
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Democrats accused President Trump of trying to sabotage the nation’s health-care system through his decision to halt payments to insurers that are meant to shore up the system, while Republicans countered Sunday that Trump is just pushing for a hard bargain.

Trump’s decision, announced Friday after months of criticizing the payments as an insurance industry bailout, will throw into doubt the private insurance exchanges that are part of the Affordable Care Act. Democrats vowed to use year-end negotiations on the federal agency budgets as a leverage point to reinstate the payments, promising to pin the political blame on Republicans if premiums skyrocket next year.

“This is the equivalent of health-care arson. He is literally setting the entire health-care system on fire just because the president is upset that the United States Congress won’t pass a repeal bill,” Sen. Chris Murphy (D-Conn.) said on “Fox News Sunday.”

But Sen. Lindsey O. Graham (R-S.C.), who has played golf twice with Trump in the past week, said the president called Sen. Lamar Alexander (R-Tenn.) on Saturday and is “encouraging him to get a bipartisan deal that would have some flexibility” from the existing law.

“I hope that we can get a deal between Senator Alexander and Patty Murray that would allow us to continue the payments, but get reform,” Graham said on CBS’s “Face the Nation,” referring to the chairman and the ranking Democrat on the health committee.

[If Trump doesn’t deal on DACA, some Democrats threaten a government shutdown]

The standoff comes as Trump heads to a potentially pivotal meeting Monday with Senate Majority Leader Mitch McConnell (R-Ky.), with whom he has publicly clashed since the Senate’s unsuccessful vote in late July to repeal the ACA. Advisers say the one-on-one talk is meant to get both sides on the same page moving into the critical fall and early winter legislative session as they tackle such as health care, immigration and federal spending, among others.

Alexander and Murray (Wash.) have been in negotiations over ways to stabilize the ACA markets ever since Republicans lost their bid to repeal, almost outright, the 2010 health-care law. The bipartisan duo have signaled that they are close to a deal, but Republicans have been demanding some changes to the ACA and conservatives in the House have grown very wary of the talks, vowing to oppose anything they view as a bailout.

“The president is not going to continue to throw good money after bad, give $7 billion to insurance companies unless something changes about Obamacare that would justify it,” Graham said, trying to explain Trump’s announcement.

But some moderate Republicans, as well as GOP governors who support the ACA, view those payments as critical and contend that without them, millions would lose insurance and that those who do not would pay significantly more for coverage.

“What the president is doing is affecting the ability of vulnerable people to receive health care right now. This is not a bailout of the insurers. What this money is used for is to help low-income people afford their deductibles and their co-pays so that their health care is available to them,” said Sen. Susan Collins (Maine), one of three Republican senators to vote against the July ACA repeal effort.

“These certainly are very disruptive moves that will result in smaller numbers of people being insured, that will make it more difficult for low-income people to afford their out-of-pocket costs, and that will destabilize the insurance market,” she said.

Sen. Bill Cassidy (R-La.), who worked with Graham last month on a last-ditch effort to repeal the ACA, defended Trump’s actions, saying that “the president’s not gutting the Affordable Care Act.”

He noted the ruling of a lower federal court that the subsidies were unconstitutional and should come from the annual spending bills passed by Congress, not an automatic payment. Cassidy said he wants reforms along the lines of his bill with Graham that would have given vast powers to states in administering the health law.

All of this is likely to come to a head in the December negotiations over funding federal agencies, one of several combustible issues that Trump and lawmakers must deal with or else risk shutting down the federal government during the holiday season.

House Minority Leader Nancy Pelosi (D-Calif.) questioned whether Trump fully understands where the Alexander-Murray negotiations stand. “I wonder if he even knows what that path is, because, from what he says, it doesn’t sound like he has knowledge, knows the facts,” she said on ABC’s “This Week With George Stephanopolous.”

Pelosi said the blame for a shutdown would rest with Trump and Republicans who control Congress. “They have the majority in the House and the Senate and the president’s signature. They have the power to keep government open,” she said.