October 21, 2018
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Trump creates doubt over deal to shore up Obamacare exchanges

Pablo Martinez Monsivais | AP
Pablo Martinez Monsivais | AP
President Donald Trump applauds members of the audience before speaking at the Heritage Foundation's annual President's Club meeting in Washington, Oct. 17, 2017.

President Donald Trump created doubt and confusion Wednesday about a bipartisan deal to prop up Affordable Care Act exchanges, saying on Twitter that he won’t support “bailing out” insurance companies that have profited from the health-care legislation.

As soon as the deal was announced Tuesday, the Trump administration was sending conflicting signals about the pact reached by Republican Sens. Lamar Alexander of Tennessee and Democrat Patty Murray of Washington, which also faces ambivalence from some Republican senators and outright hostility from many House Republicans.

His Wednesday tweet added to the uncertainty: “I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co’s who have made a fortune w/ O’Care.” He didn’t specifically say whether he opposes the legislation or whether he considers it a bailout of insurers.

Coming days after a decision by Trump to scrap subsidy payments to Affordable Care Act insurers, the deal is likely the only the Affordable Care Act legislation with a chance of passing Congress this year. It could help stem a flight by major insurers out of the individual insurance market in many states, with Americans due to begin signing up for 2018 coverage in two weeks.

But even though a number of Republicans are eager to prevent a collapse of the individual health insurance market, opposition from Trump would likely doom the measure.

Trump has appeared to try to straddle the divide in his party on the Affordable Care Act, both encouraging Alexander to reach a deal with Murray and reveling in dismantling the Affordable Care Act. Alexander said Trump pushed him in phone calls last week to reach a short-term deal to stabilize the Affordable Care Act exchanges. But the president also gloated on Oct. 14 after shares of health insurers fell following his order to end payments to help cover the cost of policies for low-income consumers.

“Health Insurance stocks, which have gone through the roof during the ObamaCare years, plunged yesterday after I ended their Dems windfall!” he said on Twitter.

Alexander said at an Axios event that Trump called him Wednesday morning and said he’ll review the bill and see if there’s anything he wants to add. Senators plan to introduce the bill Thursday, Alexander said.

Trump acknowledged Tuesday that he had encouraged Alexander to reach a deal with Murray, but said he wanted to ultimately see states given blocks of money and be allowed to set up their own programs.

“The solution will be for about a year or two years; it’ll get us over this intermediate hump,” Trump told reporters.

But within an hour of his remarks, White House budget director Mick Mulvaney told Bloomberg TV that “the president wasn’t interested in signing the original version of Alexander-Murray.” He added, “It could be packaged with some type of larger deal.”

Marc Short, the White House legislative director, emerged from a Tuesday lunch meeting where the deal was discussed saying the White House wants bigger concessions, including doing away with the part of the law requiring everyone to have insurance, either through their own policy or their employer.

Later, speaking at the Heritage Foundation’s annual President’s Club meeting, Trump added: “While I commend the bipartisan work done by Senators Alexander and Murray — and I do commend it — I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies.”

Alexander late Tuesday sought to assuage Republicans who may be wary of taking the limited action on a health program they campaigned to end altogether. On the Senate floor, he said the plan should be seen as an incremental move that can be followed later with other actions.

“Once we complete this limited first step we can take a second and a third step. I want to undersell this proposal instead of oversell it,” he said on the Senate floor. “It has significant advantages. But it is only a limited first step.”

The two-year deal would allow crucial subsidies to health insurers to start flowing again, potentially lowering insurance premiums for those in the program next year.

The package would give states new flexibility on how their Affordable Care Act markets are run. It will also encourage states to meld their markets together, and let more people buy low-cost, limited-coverage plans.

The flexibility would allow states to implement the Affordable Care Act in a way that provides customers coverage similar in affordability to plans under the current law. At the same time, states can’t degrade consumer protections the Affordable Care Act requires plans to offer, such as maternity care, mental health services and a ban on discrimination against pre-existing conditions, Murray said on the Senate floor.

The agreement also restores some of the money the Trump administration slashed for outreach regarding open enrollment in Affordable Care Act plans.

“We compromised on the outreach funding and have agreed we will spend about twice as much or more than President Trump wanted to spend but we will do most of that in grants to the states,” Alexander said.

The administration had cut advertising spending by 90 percent down to $10 million for the sign-up period starting at the beginning of November. It also reduced payments by 39 percent to groups that help people choose among their health insurance options.

Perhaps the chief obstacle to the deal being enacted is the wariness of some key Republicans to embrace it.

Last week, House Speaker Paul Ryan of Wisconsin praised Trump for planning to end the payments and he has never encouraged any short-term fix to stabilize the exchanges.

Resistance to the proposal is already building in the House. Rep. Mark Walker, who heads the conservative Republican Study Committee, said that GOP lawmakers should be focused on repealing the Affordable Care Act, not propping it up.

“This bailout is unacceptable,” the North Carolina lawmaker said in a tweet from the group’s account.

But other conservatives sounded more open to the deal, including House Freedom Caucus chairman Mark Meadows of North Carolina, who praised Alexander and Murray and said the deal “is a good start and a welcome expansion from earlier discussions.”

In the Senate, Republican leaders still are recovering from the July collapse of their drive to replace the Affordable Care Act. Alexander told reporters this week that the leadership team was focused now on a tax overhaul and not on his efforts to stabilize the exchanges.

McConnell didn’t commit to putting the compromise plan on the Senate floor after a closed-door meeting Tuesday of all Republicans in the chamber, where Alexander summarized the accord.

“We haven’t had a chance to think about the way forward yet,” McConnell told reporters.

Senate Minority Leader Chuck Schumer said the Alexander-Murray package got “broad support” during Senate Democrats’ weekly lunch at the Capitol.

“We think it’s a good solution,” he said. “I think there’s a consensus that we need short-term stability.”

The payments to the health insurers, known as “cost-sharing reductions,” have been a major factor in the increased premiums plans say they’ll charge next year. The subsidies help lower-income people with co-pays and other costs they face when they see a doctor or pick up a prescription.

A federal court ruled the payments improper because of how the 2010 law was written, and the matter is currently before an appeals court. The Trump administration announced last week that it was cutting them off, leaving health insurers and hospitals wondering what would happen for the rest of this year and for 2018.

Funding the cost-sharing subsidies would spare insurers more than $1 billion in financial losses this year, and could let them lower premiums for 2018. But with rates already set for 2018, it’s not clear whether insurers and state regulators would be able to bring premiums down immediately.

Trump’s tweet on Wednesday left lawmakers uncertain.

Sen. John Thune of South Dakota, the No. 3 Republican leader, said Wednesday he isn’t certain whether Trump opposes the bipartisan deal. “Most of us are still looking at the details,” Thune told Bloomberg Television.

Before the tweet, the senator had said he saw potential for a “short-term bridge” similar to what Alexander and Murray are proposing. Republicans could do that and then later seek deeper changes to the Affordable Care Act, he said.

Thune said if a final stabilization measure gets broad support, it could be attached to another piece of legislation this fall or be considered on its own. The most likely candidate is the year-end spending bill needed to keep the government open after Dec. 8.

GOP Sen. John McCain of Arizona, whose thumbs-down vote doomed an Affordable Care Act replacement in July, praised Alexander and Murray’s “good faith, bipartisan negotiations” in a statement and said he looks forward to voting for the bill.

 


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