If you feel like you’re getting whiplash just from trying to follow the healthcare policy debate in Washington, you’re not alone; the hits in this saga have been coming seemingly nonstop. After saying the federal government would no longer pay certain subsidies that make the insurance marketplace work, President Trump at first seemed to support a bill that would create short-term stability. But that was yesterday. Today, he’s apparently changed his mind and is now against it.
There’s been a lot going on in healthcare policy in recent weeks; it seems like one of the many unrelenting drumbeats of 2017. But the TL;DR of where we stand today with healthcare is:
- September: The Senate tries (again) to pass a bill to repeal and replace the ACA; lacking sufficient support, the bill is scrapped before a vote.
- October 12: Because the Senate did not act, the President signs an executive order undermining several key provisions of the ACA.
- October 12, continued: A few hours after signing the executive order, President Trump suddenly cancels billions of dollars of payments in insurance subsidies that, basically, make the entire marketplace work.
- October 13: At least 19 states sue the Trump administration over the halted payments.
- October 17: Two Senators — Lamar Alexander (TN) and Patty Murray (WA) — introduce an actual bipartisan compromise bill to restore the subsidies for two years.
The payments are a critical part of making the ACA work. The federal government provides cost-sharing subsidies (CSRs) to insurers to offset certain expenses incurred by health plans. Insurers receive those payments to guarantee that co-pays and deductibles for low-income Americans buying coverage on the exchange can stay low.
Cut the CSRs, and the insurers have to make up the money somewhere. And that “somewhere” is the consumer’s pocket. Absent the subsidies, premiums, co-pays, and deductibles all shoot upwards — with the effect of utterly destabilizing the individual marketplace.
And that brings us to today, when two things at once are going on.
The White House Suddenly Hates Bipartisan Bill
Trying to figure out the White House’s strategy at any given moment in 2017 is, well… let’s be diplomatic and call it a challenge.
The day the Alexander-Murray proposal was announced, the President seemed to be in favor of it. He told reporters, “Yes, we have been involved,” adding:
Lamar [Alexander] has been working very, very hard with the Democratic, his colleagues on the other side. And Patty Murray is one of them in particular.
And they are coming up and they are fairly close to a short-term solution. The solution will be for about a year or two years. And it will get us over this intermediate hump, because we have, as you probably know — we have — either have the votes or we are very close to having the votes. And we will get the votes for having really the potential of having great health care in our country.
So they are indeed working, but it is a short-term solution, so that we don’t have this very dangerous little period.
However, President Trump this morning on Twitter made very clear his personal opinion of the bill has shifted, saying that although he is “supportive of [Sen.] Lamar [Alexander] as a person & also of the process,” he cannot support “bailing out” insurance companies who have “made a fortune” under the ACA.
That’s a pretty significant shift, and it even surprised the Senators involved.
“Trump completely engineered the plan that we announced yesterday,” Alexander told Axios about the bill. “He wanted a bipartisan bill for the short term.”
Heading to Court
Meanwhile, the coalition of attorneys general who are suing the administration have also asked the courts to intervene.
New York Attorney General Eric Schneiderman and California Attorney General Xavier Becerra both announced today that the coalition was seeking an injunction to put Trump’s policy change on hold and make the payments continue.
In the petition [PDF], the attorneys general asked the court “to enter a nationwide temporary restraining order and preliminary injunction requiring [the federal government] to continue making the cost-sharing reduction payments required by the [ACA] pending judicial resolution of this action.”
In other words, the AGs are asking the court to maintain the current status quo — where the payments exist — until such time as the lawsuits are decided one way or the other, which can take years.
“This is no longer about a campaign promise or a punchline. The Trump Administration is willingly breaking the law by refusing to make required payments that keep healthcare affordable for millions of Americans. It is taking active steps to sabotage the Affordable Care Act,” Becerra said in a statement.
Scheiderman echoed the sentiment, saying, “President Trump’s abrupt move to cut these subsidies is reckless, dangerous, – and illegal.”
He added, “We won’t stand for it – and we’re moving to block these dangerous cuts before they do any more harm.”
Senate Traffic Jam
There are a heap of other healthcare proposals also floating around in the Senate as we speak.
There’s the single-payer, Medicare-for-all proposal co-signed by nearly two dozen Democrats out for consideration. Democratic Sens. Tim Kaine (VA) and Michael Bennet (CO) also just introduced a bill proposing to add a public option that consumers could buy into through the marketplace.
But Senate Majority Leader Mitch McConnell has the privilege of setting the chamber’s agenda. So even if a bill actually has enough bipartisan support to move through a committee and pass a vote, it won’t see the light of day if leadership doesn’t want to let it.
The Washington Post reports that the Alexander-Murray proposal stalled out in the Senate almost immediately, with “discord” swiftly “casting the plans’ viability into serious doubt.”
House Speaker Paul Ryan joined Trump in his criticism of the proposal, Politico notes, which further limits its odds of success (a bill has to pass both the House and the Senate to become law).
With Congress either unwilling or unable to take action, that leaves the ball in the court’s court, to either approve or deny the states’ request for an injunction as a next move.