White House pushes health plan

But it will take back seat as Congress works to pass spend­ing bill and avoid shut­down.

Star Tribune - - NATION & WORLD - By MATT FLEGENHEIMER and REED ABELSON New York Times

WASH­ING­TON – White House of­fi­cials, des­per­ate to demon­strate progress on Pres­i­dent Don­ald Trump’s prom­ise to re­peal the Af­ford­able Care Act, are push­ing to res­ur­rect a re­vamped ver­sion of a Repub­li­can health care bill be­fore his 100th day in of­fice next week.

Some mem­bers of the pres­i­dent’s team have grown con­sumed by the 100-day mark, wor­ry­ing that pub­lic ap­praisals at this tra­di­tional eval­u­a­tion pe­riod will be bru­tal and hop­ing that a last push might bring a mea­sure of sal­va­tion.

But at the same mo­ment Trump’s 100-day mark is reached on April 29, there is a far more ur­gent dead­line: Much of the fed­eral gov­ern­ment will run out of money. Reach­ing agree­ment on a mea­sure to keep the gov­ern­ment open past mid­night that Fri­day will be the first pri­or­ity of Repub­li­can lead­ers when Congress re­turns Mon­day from a two-week spring re­cess.

“I be­lieve that when we first go back, that’s go­ing to be the thing we’ll ad­dress im­me­di­ately and have to get done by Fri­day,” said Rep. Dan Dono­van, R-N.Y.

Repub­li­can lead­ers and the White House have been search­ing for a health care com­pro­mise that could pla­cate enough mod­er­ates and hard-line con­ser­va­tives to win pas­sage in the House.

The lat­est ver­sion of the pro­posal, pub­lished Thurs­day morn­ing in Politico, would main­tain pop­u­lar ben­e­fits in former Pres­i­dent Barack Obama’s sig­na­ture do­mes­tic achieve­ment, such as guar­an­teed cov­er­age for emer­gency ser­vices and ma­ter­nity care. It would also pre­serve the health law’s ban on in­sur­ers re­ject­ing cus­tomers with pre­ex­ist­ing med­i­cal con­di­tions.

But un­der the com­pro­mise Af­ford­able Care Act re­place­ment, states could seek waivers from many of those man­dates if they could demon­strate that pre­mi­ums would be low­ered. States could re­quest an ex­emp­tion from the ex­ist­ing health law’s “com­mu­nity rat­ing” rule in­tended to en­sure that peo­ple with pre­ex­ist­ing con­di­tions could not be charged pro­hib­i­tive pre­mi­ums — but only if those states es­tab­lish a high-risk in­sur­ance pool where such con­sumers could pur­chase gov­ern­mentsub­si­dized in­sur­ance.

But the com­pli­ca­tions that re­main may be far too dif­fi­cult to fi­nesse at the same time the House and Se­nate press to pass a gi­ant spend­ing bill.

Tus­sles over the spend­ing dead­line — in­clud­ing pos­si­ble de­bates over top ad­min­is­tra­tion pri­or­i­ties such as a bor­der wall and money for im­mi­gra­tion en­force­ment of­fi­cers — are ex­pected to con­sume the Capi­tol. And Democrats will have their own demands, most im­por­tantly bil­lions of dol­lars in sub­si­dies for health in­sur­ance com­pa­nies to lower de­ductibles and other forms of spend­ing for low-in­come Amer­i­cans pur­chas­ing health cov­er­age on the Af­ford­able Care Act’s online mar­ket­places.

Se­nior Repub­li­cans ap­pear un­con­vinced that a re­vised health care bill would as­sure pas­sage in the House. Dono­van, an op­po­nent of the orig­i­nal Repub­li­can health care bill, said the pro­posed amend­ment “re­ally doesn’t ad­dress the con­cerns that I had.”

“We’re in the midst of ne­go­ti­at­ing sort of fin­ish­ing touches,” Speaker Paul Ryan, R-Wis., said this week. “It’s dif­fi­cult to do. We’re very close. It’s ba­si­cally, make good on the prom­ises that were made.”

In re­cent weeks, the in­sur­ance com­pa­nies have been strongly urg­ing the Trump ad­min­is­tra­tion and Congress to com­mit to fund­ing cost­shar­ing re­duc­tions, warn­ing that with­out the money from the gov­ern­ment, the com­pa­nies will have to sharply raise the prices of their plans of­fered through the state mar­ket­places.

The sub­si­dies re­duce the amount some­one has to pay in de­ductibles and co-pay­ments when they buy a plan. At stake is roughly $10 bil­lion in pay­ments ex­pected to be made to the in­sur­ers this year. Some House Repub­li­cans op­pose how the Obama ad­min­is­tra­tion funded them, and they won a court case po­ten­tially block­ing the fund­ing that is now on ap­peal.

Ear­lier this week, in­sur­ance ex­ec­u­tives met with Medi­care of­fi­cials to plead their case. They left that meet­ing with Seema Verma, the new Medi­care head, with no prom­ises. Trump has pub­licly toyed with the idea of with­hold­ing the sub­si­dies as a way to force Democrats to ne­go­ti­ate over the House pro­posal, and Verma told the in­sur­ers they should look to Congress to ap­pro­pri­ate the money.

State in­sur­ance reg­u­la­tors weighed in Wed­nes­day, send­ing a let­ter to Congress urg­ing it to fund the sub­si­dies for this year and next. “Your ac­tion is crit­i­cal to the vi­a­bil­ity and sta­bil­ity of the in­di­vid­ual health in­sur­ance mar­kets in a sig­nif­i­cant num­ber of states across the coun­try,” of­fi­cials from the Na­tional As­so­ci­a­tion of In­sur­ance Com­mis­sion­ers wrote.

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