Pres­i­dent to scrap health in­sur­ance aid

Tampa Bay Times - - Front Page -

The sub­si­dies help low-in­come peo­ple, and the change could un­ravel Oba­macare.

WASH­ING­TON — Pres­i­dent Trump will scrap sub­si­dies to health in­sur­ance com­pa­nies that help pay out-of­pocket costs of low-in­come peo­ple, the White House said late Thurs­day. His plans were dis­closed hours af­ter the pres­i­dent or­dered po­ten­tially sweep­ing changes in the na­tion’s in­sur­ance sys­tem, in­clud­ing sales of cheaper poli­cies with fewer ben­e­fits and fewer pro­tec­tions for con­sumers.

The twin hits to the Af­ford­able Care Act could un­ravel Pres­i­dent Barack Obama’s sig­na­ture do­mes­tic achieve­ment, send­ing in­sur­ance pre­mi­ums soar­ing and in­sur­ance com­pa­nies flee­ing from the health law’s on­line mar­ket­places. Af­ter Repub­li­cans failed to re­peal the health law in Congress, Trump ap­pears de­ter­mined to dis­man­tle it on his own.

With­out the sub­si­dies, in­sur­ance mar­kets could quickly un­ravel. In­sur­ers have said they

will need much higher pre­mi­ums and may pull out of the in­sur­ance ex­changes cre­ated un­der the Af­ford­able Care Act if the sub­si­dies were cut off.

Known as cost-shar­ing re­duc­tion pay­ments, or CSRs, the sub­si­dies were ex­pected to to­tal $9 bil­lion in the coming year and nearly $100 bil­lion in the coming decade.

“The gov­ern­ment can­not law­fully make the cost-shar­ing re­duc­tion pay­ments,” the White House said in a state­ment.

It con­cluded: “Congress needs to re­peal and re­place the dis­as­trous Oba­macare law and pro­vide real re­lief to the Amer­i­can peo­ple.”

Trump’s de­ci­sion to halt the sub­sidy amounts to a re­buke to mem­bers of Congress from both par­ties who have urged him to con­tinue the pay­ments.

Trump had raised the pos­si­bil­ity of elim­i­nat­ing the sub­sidy with Repub­li­can sen­a­tors at a White House meet­ing sev­eral months ago.

At the time, one sen­a­tor told him that the Repub­li­can Party would ef­fec­tively “own health care” as a po­lit­i­cal is­sue if the pres­i­dent did so.

By late Thurs­day night, a back­lash against Trump — in­clud­ing from fel­low Repub­li­cans — ap­peared im­mi­nent as law­mak­ers voiced con­cern over how end­ing the sub­si­dies would af­fect their con­stituents.

“Cut­ting health care sub­si­dies will mean more unin­sured in my dis­trict,” Rep. Ileana Rosle­hti­nen, a South Florida Repub­li­can of Florida, wrote on Twit­ter. She added that Trump “promised more ac­cess, af­ford­able cov­er­age. This does op­po­site.”

Democrats im­me­di­ately re­acted with out­rage, warn­ing that Trump was in­flict­ing harm on the na­tion’s health care sys­tem.

Sen. Richard J. Durbin, Demo­crat of Illi­nois, wrote on Twit­ter, “The pres­i­dent is de­stroy­ing health care to make a po­lit­i­cal point.”

The fu­ture of the pay­ments has been in doubt be­cause of a law­suit filed in 2014 by House Repub­li­cans, who said the Obama ad­min­is­tra­tion was pay­ing the sub­si­dies il­le­gally. U.S. Dis­trict Judge Rose­mary M. Col­lyer agreed, find­ing that Congress had never ap­pro­pri­ated money for the cost-shar­ing sub­si­dies.

The Obama ad­min­is­tra­tion ap­pealed the rul­ing. The Trump ad­min­is­tra­tion has con­tin­ued the pay­ments from month to month, even though Trump has made clear that he de­tests the pay­ments and sees them as a bailout for in­sur­ance com­pa­nies.

The de­ci­sion to end the sub­sidy came on the heels of Trump’s ex­ec­u­tive or­der, which he signed ear­lier Thurs­day, which in­cludes sales of cheaper poli­cies with fewer ben­e­fits and pro­tec­tions for con­sumers than those man­dated un­der the Af­ford­able Care Act.

The pres­i­dent’s plan, an 1,100word di­rec­tive to fed­eral agen­cies, laid the ground­work for an ex­pand­ing ar­ray of health in­sur­ance prod­ucts, mainly less com­pre­hen­sive plans of­fered through as­so­ci­a­tions of small em­ploy­ers and greater use of short-term med­i­cal cov­er­age.

It was the first time since ef­forts to re­peal the land­mark health law col­lapsed in Congress that Trump has set forth his vi­sion of how to re­make the na­tion’s health care sys­tem us­ing the pow­ers of the ex­ec­u­tive branch. It im­me­di­ately touched off a fu­ri­ous de­bate over whether the move would fa­tally desta­bi­lize the Af­ford­able Care Act mar­ket­places or add wel­come op­tions to con­sumers com­plain­ing of high pre­mi­ums and not enough choice.

In Congress, the move seemed to in­ten­sify the po­lar­iza­tion over health care. Se­nate Ma­jor­ity Leader Mitch McCon­nell of Ken­tucky said the pres­i­dent was of­fer­ing “more af­ford­able health in­sur­ance op­tions” des­per­ately needed by con­sumers.

But the Se­nate Demo­cratic leader, Chuck Schumer of New York, said Trump was “us­ing a wreck­ing ball to sin­gle-hand­edly rip apart our health care sys­tem.”

Most of the changes will not oc­cur un­til fed­eral agen­cies write and adopt reg­u­la­tions im­ple­ment­ing them.

The process, which in­cludes a pe­riod for pub­lic com­ments, could take months. That means the or­der will prob­a­bly not af­fect in­sur­ance cov­er­age next year, but could lead to ma­jor changes in 2019.

Getty Im­ages

Pres­i­dent Don­ald Trump shows his signed ex­ec­u­tive or­der with Sen. Rand Paul, R-Ky., Vice Pres­i­dent Mike Pence, Rep. Vir­ginia Foxx, R-N.C., and Sec­re­tary of La­bor Alexan­der Acosta.

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