Sun Sentinel Palm Beach Edition
ACA upended as subsidies ended
Trump’s actions shock health care system, spur suits
WASHINGTON — President Donald Trump’s move late Thursday to cut off critical federal payments to insurers sent shock waves through the health care system Friday, threatening widespread disruption to markets nationwide and igniting new legal and political battles over the Affordable Care Act.
Caught in the middle are millions of Americans likely to see their insurance premiums shoot higher as the administration intensifies its effort to dismantle the 2010 health care law, often called Obamacare.
Insurers have said that markets in some parts of the country could collapse, leaving many consumers who don’t get insurance on the job with no choices for health plans. And state insurance regulators predicted premiums in the individual market nationally would rise by 12 percent to 15 percent next year because of the cutoff.
“These kinds of decisions have real-life consequences,” warned Stacey D. Stewart, president of the March of Dimes. “It is not fair for our leaders to play games with people’s health and their health care.”
The move to cut off the money, known as cost-sharing reduction payments, came after months of indecision by the administration on the issue.
It marked a sudden lurch by Trump back to a hardline approach on health care after a brief period in which the administration had sent mixed signals on whether it might cooperate with bipartisan efforts in Congress to strengthen the Obamacare markets.
The money at issue is roughly $7 billion in annual payments that the federal government makes to insurers to reimburse them for reducing deductibles and co-payments for low-income consumers, something the law requires health plans to do.
Trump’s decision to end those payments paralleled a similar shift this week to embrace a more hard-line position on immigration, with the president demanding that Congress restrict legal immigration and build a wall along the southern border in exchange for White House support for legalizing the status of young people brought to the U.S. illegally as children who are covered under the Deferred Action for Childhood Arrivals program.
In both cases, Trump took more conservative positions supported by many of his core voters although unpopular among Americans at large.
A new survey by the Kaiser Family Foundation, released Friday, found that by better than 2-1, Americans said they would prefer Trump and Congress work to stabilize the marketplaces rather than continue to try to repeal and replace the current law. A majority of Republicans, however, said they preferred to see the focus remain on repealing and replacing the law.
Trump’s steps on both health care and immigration also threatened to blow up bipartisan talks in Congress and to severely disrupt the lives of ordinary Americans — some 700,000 DACA recipients and millions of health plan consumers — as a way of putting pressure on lawmakers.
“If we’re going to do something, we need to get something in return,” the president said during an interview Wednesday with Fox News’ Sean Hannity that now seems to have presaged his moves.
A Twitter message from Trump on Friday morning and a statement by his budget director, Mick Mulvaney, made the approach explicit:
“The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” Trump wrote.
Later, speaking to reporters, Trump said, “If the Democratic leaders could come over to the White House, we’ll negotiate some deal that’s good for everybody.”
Mulvaney, in an interview with Politico, said that Trump would not sign a bipartisan measure to restore the funds unless congressional Democrats went along with his priorities.
He listed the proposed border wall as one of the top priorities the president would consider trading.
“The president fully expects his priorities to be funded,” he said.
That approach drew strong criticism Friday across the health care system, from patient advocates, in state governments and in Congress.
Democratic attorneys general in at least 18 states and the District of Columbia said they would sue to stop the administration’s action.
Senate Democratic leader Chuck Schumer of New York said Democrats would not be “bullied” by Trump.
In a statement, he called Trump’s action a “spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America.”
Ironically, many of the consumers most likely to be hit with higher costs will be in demographic groups that lean strongly Republican — residents of rural areas, where insurance already tends to be more expensive than average, and self-employed people whose income is too high for them to qualify for federal subsidies for their premiums.
That’s one reason that several GOP senators have repeatedly urged Trump not to cut off the payments.
Maine Sen. Susan Collins, a centrist Republican who has opposed several recent GOP bills to repeal the current law, decried the president’s action. “We cannot simply wipe out the Affordable Care Act with a stroke of the pen without having a workable, better alternative in place,” she said in a speech in her home state Friday.