Since last week, when President Trump snuffed out cost-sharing subsidies for millions of Affordable Care Act health plans, insurers and Democrats have warned that massive rate increases are looming — premium spikes that didn’t need to happen.
“It is the reality that state regulators must face and the reason rate increases will be higher than they should be across the country,” Pennsylvania’s acting insurance commissioner, Jessica Altman, said of the canceled cost-sharing reductions, or CSRs.
“We expect that premiums may increase in 2019 as a result of these activities,” said a spokeswoman for North Dakota’s health-care plans.
“CHAOS without cost-sharing,” warned a memo that was distributed to House Republicans after Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) released a bill that would fund the subsidies.
But for the president and for many Senate Republicans, the cost increases are simply one among several reasons to repeal the ACA. Despite polls showing that two-thirds of voters hold the Trump administration responsible for changes in the health-care system, Trump has led his party in blaming the ACA itself, not the cancellation of subsidies, for any higher premiums.
The legal case against the subsidies was launched by House Republicans during Barack Obama’s presidency, as one of many attempts to knock out the law by making it unworkable. Trump, frustrated by his inability to replace the ACA, has taken two contradictory public positions: One that the ACA is already “dead,” and one that he is not responsible for any problem with the law’s continued implementation.
In several short hallway interviews on Tuesday, Republican senators generally agreed with the president. Asked why some insurers were announcing premium hikes, they said that the jury was out.
“I don’t think it’s driving premium increases at all, in a sense that a lot of them already filed their premium increases,” said Sen. Bill Cassidy (R-La.), referring to Trump’s decision. “They had two sets filed, but it wasn’t going to be clear that the payments would be reauthorized. I’ve been told that if Congress reauthorizes them, then they’ll go back to the lower rates — or else, frankly, they shouldn’t get the money.”
Insurers have not said this, warning that it would be difficult to reverse the calculations they made ahead of the new enrollment period after that period is over. But Republicans, who between 2013 and this year pinned premium increases on the Obama administration, did not say that Trump was responsible for any increases now.
“They’ve been going up the last couple years,” said Sen. Jeff Flake (R-Ariz.). “The mandates, the lack of choices — I mean, that’s what always drives up costs.”
Sen. John Barrasso (R-Wyo.), one of the upper chamber’s few medical doctors, took another tack, saying that Trump’s actions so far — including an order to make it easier for associations to form plans that would evade the ACA’s mandates — would lead to lower premiums.
“I appreciate what the president has done in terms of executive orders to get the premiums down,” Barrasso said. “Under Obamacare, we knew that premiums were going to go up again significantly this year, because of the way the law was passed.”