Congress fails to deliver on healthcare

GOP abortion politics killed a rare bipartisan proposal to shore up Obamacare insurance exchanges.

Abipartisan negotiations, the Senate seemed poised last week to reach an agreement on a proposal to inject billions of dollars into the state Obamacare insurance exchanges, holding down premiums for millions of Americans not covered by large employer health plans. But then abortion politics took over, scuttling any chance of attaching the proposal to the $1.3-trillion spending bill President Trump signed Friday. The episode bodes ill for future efforts to shore up the exchanges or take any other steps to build on Obamacare.

Obamacare (formally known as the 2010 Patient Protection and Affordable Care Act) has its problems, but they’ve been exacerbated by congressional Republicans and Trump administration officials eager to see the exchanges collapse — regardless of the damage inflicted on consumers. To that end, they’ve taken a series of steps that push healthier people out of the exchanges and raise costs for insurers, driving premiums even higher than rising medical and prescription drug costs would take them.

The proposal to shore up the exchanges had two main parts. The first would have restored billions of dollars in annual payments to insurers that the Trump administration cut off in mid-2017, arguing that Congress had not explicitly appropriated the money. The loss of those funds — which reimbursed insurers for the discounts Obamacare required them to provide for low-income customers’ deductibles and co-pays — led insurers to raise premiums for some or all customers in the exchange by up to 38%.

Ironically, taxpayers have largely covered the premium increase through the subsidies they provide for the vast majority of people Obamacare insures. Still, the Obamacare consumers who aren’t eligible for subsidies have been hit hard by the premium hikes, and their pain shouldn’t be ignored.

The second part of the proposal would have provided states a total of $10 billion a year for three years to cover some of the most expensive claims faced by insurers in the Obamacare exchanges. This move would have lowered premiums too, although the proposal would have given too much discretion to the administration to decide how much relief to send to which states.

Where it all fell apart, though, was over what should have been a nonissue: federal funding for abortion.

The 2010 healthcare law clearly prohibits federal dollars from being spent on abortions, just as does an executive order issued by President Obama. Instead, private insurers are required to fund abortion coverage separately, through a small surcharge on policyholders — but only where allowed by state law. About half the states don’t permit abortion coverage in Obamacare plans, and in six states that do, no insurers offer it, the Kaiser Family Foundation reports.

Anti-abortion lawmakers weren’t satisfied with that status quo, so they insisted on undoing the Obamacare compromise as part of the proposal to lower premiums in the exchanges. Specifically, they demanded a version of the Hyde Amendment — a longstanding prohibition on federal funding for abortions or abortion coverage — that appeared to ban insurers aided by the proposal from offering abortion coverage unless they did so through entirely separate policies (called “riders”). The language was so vague, however, it left open the possibility that the Trump administration could bar insurers that sold policies in a state Obamacare exchange from covering abortions at all in that state.

That would have put the three states that require insurers to cover abortions — California, Oregon and New York — in a tough spot. It’s conceivable that they could have found a way to honor the federal funding prohibition while still having insurers provide abortion coverage to all their customers, but not without putting the new federal aid in jeopardy. And as Kaiser noted, in states where abortion coverage can be offered only through riders, there is no abortion coverage available.

Again, there was no reason for lawmakers to hit this land mine. Obamacare already complies with the Hyde Amendment’s spirit in barring federal dollars from paying for abortions or abortion coverage. If lawmakers can’t stop litigating this issue, there will be no help coming for the consumers who rely on the state Obamacare exchanges.