Insurers say Trump must do more to stabilize ‘Obamacare’

“Obamacare” is proving more of a challenge than the Trump administration bargained for.

With the “repeal and replace” effort at an impasse on Capitol Hill, the administration released on Thursday a set of fixes to stabilize the Affordable Care Act’s shaky insurance markets for next year. But the insurance industry quickly said the changes don’t go far enough.

While calling the administration action a step in the right direction, the industry is looking for a guarantee that the government will also keep paying billions in “cost-sharing” subsidies that help consumers with high deductibles. President Donald Trump says he hasn’t made up his mind on that.

Republicans contend that the Affordable Care Act, or ACA, is beyond repair, but their “repeal and replace” slogan hasn’t been easy to put into practice, or politically popular. So the administration is trying to keep the existing system going temporarily as it pursues a total remake.

Many of the changes follow recommendations from insurers, who wanted the government to address shortcomings with HealthCare.gov markets, including complaints that some people are gaming the system by signing up only when they get sick, and then dropping out after being treated.

But the White House remained mum on the biggest concern. Insurers, doctors, hospitals and the business community have asked Trump to preserve ACA cost-sharing subsidies that pare down high deductibles and copayments for consumers with modest incomes. They’re separate from the betterknown premium subsidies that most customers receive.

“There is still too much instability and uncertainty in this market,” Marilyn Tavenner, president of America’s Health Insurance Plans and the industry’s top lobbyist, said in a statement. “Health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted.”

Estimated at $7 billion this year, the subsidies are under a legal cloud. Without the payments, experts say, the government marketplaces that provide private insurance for about 12 million people will be overwhelmed by premium increases and insurer departures.

In a Wall Street Journal interview this week, Trump raised the possibility of shutting off the money if Democrats won’t bargain on health care. But the president also said he hasn’t made up his mind, and that he doesn’t want people to get hurt.

House Democratic leader Nancy Pelosi of California called that an “appalling threat.” Democrats are now demanding that the issue be addressed in a must-pass spending bill due at the end of the month. The new administration has continued to make cost-sharing payments to insurers as it weighs options.