Trump gambles with ObamaCare moves


http://thehill.com/policy/healthcare/355390-trump-takes-big-gamble-with-obamacare-moves?rnd=1507929727

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Frustrated by Congress’s inaction on ObamaCare repeal, President Trump is taking a big political risk in using his authority to dismantle the health-care law piece by piece.

Democrats say Trump now owns ObamaCare, bearing responsibility for any problems that arise in the system, including higher premiums and insurer exits.

“Republicans in the House and Senate now own the health-care system in this country from top to bottom,” Senate Minority Leader Charles Schumer (D-N.Y.) said in a press call Friday.

“Their destructive actions and the actions of the president are going to fall on their backs.”

The administration announced late Thursday evening that it wouldn’t continue ObamaCare insurer payments, a decision that could come back to haunt Republicans politically.

Estimates from the nonpartisan Congressional Budget Office released in August indicated that premiums for the most popular ObamaCare plan would be 20 percent higher in 2018 and 25 percent higher by 2020 if the payments were canceled.

The administration had been making the cost-sharing reduction (CSR) payments — which compensate insurers for lowering the out-of-pocket costs for certain ObamaCare enrollees — on a monthly basis. Now, insurers are still on the hook to offer the discounts, but won’t be getting reimbursed for it.

“The claims that Trump had been sabotaging ObamaCare actually are true with this,” a conservative strategist said. “I don’t believe they were true before. I think Democrats were just yelling to yell, but in this particular instance you can actually say that, because this is going to lead to adverse selection, this will cause insurance companies to withdraw from the marketplaces, health insurance premiums will rise and people aren’t going to buy.”

Before Trump’s announcement, insurance carriers had already signed contracts to sell insurance on healthcare.gov in the next enrollment season, which starts Nov. 1.

Some insurers may try to exit markets before open enrollment starts, potentially leaving some counties without any ObamaCare insurers next year.

Still, many insurers had already hiked premiums for next year on the assumption the payments would get canceled. Some states have seen rate increases as high as 50 percent.

“The Trump administration and every Republican in Congress who lets him do this is now responsible for every rate hike people see for the foreseeable future,” said Brad Woodhouse, campaign director for pro-ObamaCare group Protect Our Care.

The decision to end the payments came the same day that Trump signed an executive order lifting restrictions on short-term insurance plans and allowing the expansion of association health plans. The impact will not be immediate, as agencies are directed to issue new regulations or guidance that will go through a comment period.

Experts have warned that order could undermine the stability of the marketplaces if healthier people move away from ObamaCare and into the cheaper, skimpier plans. Such an exodus would leave the ObamaCare markets with sicker, more expensive customers, driving up costs.

But the White House says ObamaCare is “imploding” because the law is simply not workable.

Officials also argued that it’s illegal for the administration to be making the CSR payments because it requires an appropriation from Congress. A court agreed with that assessment, and a case has been on hold in an appeal for months.

“ObamaCare is a broken mess. Piece by piece we will now begin the process of giving America the great HealthCare it deserves!,” Trump tweeted on Friday.

The Trump administration faced accusations that it was sabotaging ObamaCare even before the latest moves.

Health officials cut advertising for ObamaCare by 90 percent and also slashed funding for local and state groups that help enroll people in coverage. If fewer people sign up for ObamaCare this year, it would bolster Trump’s argument that the law is failing and should be repealed. Republicans hope to return to repeal legislation sometime next year.

But a large majority of Americans would rather see Trump make ObamaCare work. Nearly half of Republicans agree, while 43 percent say the White House shouldn’t help the Affordable Care Act (ACA), according to a Kaiser Family Foundation poll released Friday.

An August poll from the organization found that 60 percent of the public agreed that Trump and Republicans in Congress are responsible for any problems with the ACA moving forward.

“President Trump has made himself perfectly clear — he wants to undermine the ACA and doesn’t care who he hurts doing so,” said Sam Berger, a senior policy adviser with the liberal Center for American Progress.

“I don’t think there will any confusion among millions of Americans who is to blame.”

Conservative groups, meanwhile, frustrated with Congress’s inability to repeal ObamaCare, have praised Trump’s actions.

“Obamacare has resulted in fewer choices and massively higher costs for millions of Americans. The president’s actions are necessary to give the law’s victims access to more affordable coverage that better meets their needs,” Nathan Nascimento, vice president of policy at Freedom Partners said in a statement, referring to the executive order.

He continued: “While repealing Obamacare legislatively is the best way to provide relief, the president is right to take action to ease the law’s burden through solutions that don’t waste billions of taxpayer dollars propping up the collapsing law.”

Conservatives are quick to note that ObamaCare is still the law of the land, and that Republicans have not yet kept their promise to change that.

“Although this is a step in the right direction, it is no substitute for Congress keeping its promises to repeal ObamaCare,” Jason Pye, vice president of legislative affairs for FreedomWorks, said in a statement, referring to the executive order.

Other Republicans are unhappy with Trump’s actions and worry about its impact on the insurance markets.

“I will say that I am very concerned about the president’s executive order that was issued yesterday and his decision to do away with an important subsidy that helps very low-income people,” Sen. Susan Collins (R-Maine) said at an event Friday.

Nevada’s Republican Gov. Brian Sandoval called the decision to end the insurer payments “devastating.”

“It’s going to hurt people,” he said in an interview with the Nevada Independent.

“It’s going to hurt kids. It’s going to hurt families. It’s going to hurt individuals. It’s going to hurt people with mental health issues. It’s going to hurt veterans. It’s going to hurt everybody.”

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