Some influential Republicans in Congress don’t want a fight President Trump is threatening to pick over extra Obamacare payments to insurers.
Trump suggested this week that as Congress seeks to fund the government beyond April, Republicans should refuse to pay for cost-sharing subsidies provided through the Affordable Care Act to low-income Americans. There’s widespread agreement that without the subsidies, insurers would be forced to hike premiums next year, worsening conditions in the Obamacare insurance marketplaces.
The president told the Wall Street Journal on Wednesday that not only would such a move cause Obamacare to “die,” it could also be used to force Democrats to negotiate on repealing the health-care law altogether. “Without the payments, Obamacare is gone, just gone,” Trump said.
Many Republicans are well aware that the public is likely to blame them for premium increases, now that they control both Congress and the White House and have so far failed to agree on a health-care replacement plan. And Democrats are keenly aware of the shifting dynamics, seizing every opportunity they can to insist Republicans now own the health-care law.
The Democratic leadership in Congress says it will hold up the government funding bill that expires on April 28 in order to secure the payments if Trump decides to withhold them. But Republicans are unlikely to want to shut down the government — or for Trump to withhold the payments in the first place.
“I don’t think Democrats will let this happen, but I frankly don’t think the Republicans want it to happen either,” said Timothy Jost, a health-law professor at Washington and Lee University.
Rep. Greg Walden (R-Ore.), who, as chairman of the House Energy and Commerce Committee, helped craft the GOP health-care plan, told constituents this week that the subsidies need to be funded, period.
“It was a commitment made by the government to the insurers and the people,” Walden said Wednesday at a town hall in his district. “That needs to happen.”
Rep. Tom Cole (R-Okla.), who chairs the powerful Appropriations subcommittee with jurisdiction over health care, has also said it’s important to fund the payments for insurers, although he stressed it’s a decision that the House leadership would have to make.
“It’s probably the right thing to do, I think,” Cole told The Washington Post last month. “Otherwise you’re going to have insurance companies exiting the market.”
Other top Republicans are remaining quiet about how to handle the subsidies, letting the White House lead the way. Ways and Means Chairman Kevin Brady (R-Tex.) isn’t taking a position. A Brady spokeswoman said Friday that the congressman “believes the administration is taking important steps to stabilize Obamacare’s collapsing marketplace.”
The Trump administration must decide whether it will continue pursuing a GOP lawsuit to block the subsidies. The House sued the Obama administration for awarding the subsidies without a clear congressional appropriation and won in federal court last year. The Obama administration appealed the decision.
Now the GOP has the White House on its side — and a new concern that Republicans will bear the public blame for problems with Obamacare. Trump’s victory created a tricky new situation that House Republicans surely didn’t envision when they filed the lawsuit, said Bill Pierce, a health policy expert at APCO Worldwide.
“It is a situation entirely of their own doing,” Pierce said.
Republicans have said they were fighting the awarding of insurer payments without permission from Congress — not the subsidies themselves. House Speaker Paul D. Ryan (R-Wis.) hasn’t said whether he wants to fund the subsidies in a spending bill later this month, and his office didn’t respond Friday to a query about the issue.
“We believe in Congress retaining its lawmaking power, but this lawsuit hasn’t run its course,” Ryan said late last month. “While the lawsuit is running its course, the administration is exercising their discretion with respect to the [cost-sharing reductions].”
The health-care law requires marketplace insurers to discount extra insurance costs beyond the monthly premium — such as deductibles and co-payments — for people earning less than 250 percent of the poverty level. Without federal payments to cover those discounts, it’s estimated that insurers would hike premiums by an average of 19 percent.
That reality is leading lawmakers such as Walden and Cole to back the subsidies, even if they want to get rid of the underlying law. The cost-sharing reductions would cost an estimated $7 billion or $8 billion in the next year, but with that cost already built in, Congress wouldn’t have to come up with extra money to fund them.
If Trump pushes for withholding the payments, it could fuel a clash between these lawmakers and conservatives who want to damage Obamacare in any way they can.
“I’m not alone in my party in [wanting to fund the cost-sharing reductions], but there are a lot in my party that don’t think that,” Walden said.
Insurers are watching the situation with trepidation, with rapidly approaching deadlines for announcing whether they will continue selling plans on the insurance marketplaces next year. Kristine Grow, a spokeswoman for the trade association America’s Health Insurance Plans, said more plans will likely exit without the cost-sharing reductions.
“A lot of plans are very likely to drop out of the market because of continued instability,” Grow said.