Trump presses Democrats on Oba­macare

Seeks talks or may cut off pay­ments

The Washington Times Weekly - - Politics - BY TOM HOW­ELL JR.

Pres­i­dent Trump is threat­en­ing to cut off crit­i­cal Oba­macare pay­ments to in­sur­ers un­less Democrats come to the ta­ble to ne­go­ti­ate a new health care bill, tak­ing a tough ne­go­ti­at­ing stance that could force Demo­cratic lead­ers into a govern­ment shut­down by month’s end.

At stake are “cost shar­ing” pay­ments that Oba­macare back­ers say are sup­posed to be made to in­sur­ance com­pa­nies to cover their losses from low-in­come cus­tomers.

A fed­eral court has in­val­i­dated the pay­ments, say­ing the Obama administration spent the money even though Congress specif­i­cally stripped the funds from its an­nual spend­ing bills.

The govern­ment is still mak­ing the pay­ments pend­ing an ap­peal of the case, but Mr. Trump hinted last week that he would halt the pay­ments him­self, forc­ing Oba­macare into a quick death un­less Democrats agree to ne­go­ti­ate over ma­jor changes to the Af­ford­able Care Act.

“If Congress doesn’t ap­prove it, or if I don’t ap­prove it, that would mean that Oba­macare doesn’t have enough money, so it dies im­me­di­ately as op­posed to over a pe­riod of time,” he told The Wall Street Jour­nal. It’s a risky gambit. Democrats are re­sist­ing changes to Oba­macare and are in­sist­ing that Congress add cost-shar­ing money into a must-pass spend­ing bill later this month. Oth­er­wise, they sig­naled that they would with­hold their sup­port for the spend­ing bill, ig­nit­ing yet an­other govern­ment shut­down show­down.

“Our ar­gu­ment to con­gres­sional Repub­li­cans is: You won. Your ar­gu­ment in this case is that Congress needed to ap­pro­pri­ate these funds. OK, let’s do it,” said an aide to House Mi­nor­ity Leader Nancy Pelosi, Cal­i­for­nia Demo­crat.

Mr. Trump is search­ing for leverage to make an Oba­macare deal af­ter his first ef­fort, which re­lied en­tirely on Repub­li­cans, crum­bled.

The cost-shar­ing pay­ments, which to­taled about $7 bil­lion last year, are crit­i­cal to the sur­vival of Oba­macare. With­out the pay­ments, plans would likely drop out or raise their pre­mi­ums across the board.

Michael Can­non, di­rec­tor of health care pol­icy stud­ies at the lib­er­tar­ian Cato In­sti­tute, said Mr. Trump has a duty to ei­ther stop the pay­ments or keep ap­peal­ing the court’s rul­ing, which isn’t fea­si­ble at this point.

“He needs to an­nounce he is obey­ing the court or­der, the cost-shar­ing re­duc­tion pay­ments will stop and that Democrats are pre­vent­ing Congress from res­cu­ing Oba­macare’s grow­ing num­ber of vic­tims,” Mr. Can­non said.

Democrats, though, said it’s Repub­li­cans who will feel po­lit­i­cal pain if they sab­o­tage Oba­macare now. They pointed to a poll from the Kaiser Fam­ily Foun­da­tion that says 3 in 5 Amer­i­cans will hold Mr. Trump and con­gres­sional Repub­li­cans re­spon­si­ble for what­ever hap­pens to health care, now that they con­trol the levers of po­lit­i­cal power in Wash­ing­ton.

Pol­icy an­a­lysts said Mr. Trump doesn’t ap­pear to have much po­lit­i­cal leverage in the broader fight.

“I prob­a­bly don’t have to tell you that [Mrs.] Pelosi and [Se­nate Mi­nor­ity Leader Charles E.] Schumer are smarter than that and aren’t about to bail him out of the re­peal-and-re­place mess he is in. Par­tic­u­larly since he ap­pears to be threat­en­ing to take Oba­macare all the way down all by him­self,” Robert Laszewski, a health care pol­icy con­sul­tant in Alexan­dria, Vir­ginia, wrote in a memo to his clients last week.

House Speaker Paul D. Ryan, Wis­con­sin Repub­li­can, has said the pay­ments should con­tinue while the law­suit is pend­ing in the ap­pel­late courts, though he hasn’t sig­naled whether they will be funded in this month’s spend­ing bill.

“We con­tinue to work with the Trump administration to eval­u­ate the op­tions in front of us,” Ryan spokes­woman Ash­Lee Strong said.

Josh Black­man, a con­sti­tu­tional law pro­fes­sor at the South Texas Col­lege of Law, said that if Mr. Trump truly wants leverage, then he should can­cel an Obama-era rule that lets mem­bers of Congress and their staff keep their fed­eral health care sub­si­dies, even though they are man­dated by law to use Oba­macare’s ex­changes.

Reg­u­lar Amer­i­cans who buy plans through the ex­changes are re­stricted from hav­ing em­ploy­ers con­trib­ute to their pre­mi­ums, so crit­ics of the carve-out say it of­fered spe­cial treat­ment to Capi­tol Hill in­sid­ers.

“If the cost-shar­ing sub­si­dies are cut, the Amer­i­can peo­ple as a whole will feel it,” Mr. Black­man said. “If the con­gres­sional sub­si­dies are cut, the Amer­i­can peo­ple won’t feel it. In fact, Amer­i­cans may be up­set that mem­bers of Congress are be­gin given spe­cial treat­ment. I think this is­sue plays well in the pub­lic arena.”

For now, in­sur­ers caught in the cross­fire say they tired of get­ting mixed sig­nals from the administration.

Health care plans praised Mr. Trump for steps he took to sta­bi­lize the Oba­macare ex­changes, but they want the administration to guar­an­tee that cost-shar­ing pay­ments will flow through the end of next year.

“If the pay­ments stop midyear, in­sur­ers will face un­ex­pected li­a­bil­ity and pos­si­bly losses for that year,” said Allison Hoffman, a pro­fes­sor at the UCLA School of Law. “Since par­tic­i­pa­tion in the ex­changes is ten­u­ous as is, such losses could de­ter

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