Thread: Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again

Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again

By ROBERT PEAR, MAGGIE HABERMAN and REED ABELSON
OCT. 12, 2017

WASHINGTON — President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket 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 — on successive days — 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, Mr. 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.”

Mr. 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.

Mr. 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 Mr. 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,” Representative Ileana Ros-Lehtinen, Republican of Florida, wrote on Twitter. She added that Mr. Trump “promised more access, affordable coverage. This does opposite.”

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

Senator 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. Judge Rosemary M. Collyer of United States District Court in Washington 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 Mr. Trump has made clear that he detests the payments and sees them as a bailout for insurance companies.

This summer, a group of states, including New York and California, were allowed to intervene in the court case over the subsidies. The New York attorney general, Eric T. Schneiderman, said on Thursday night that the coalition of states “stands ready to sue” if Mr. Trump cuts off the subsidies.

“I will not allow President Trump to once again use New York families as political pawns in his dangerous, partisan campaign to eviscerate the Affordable Care Act at any cost,” Mr. Schneiderman said.

The decision to end the subsidy came on the heels of Mr. 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 1,100-word 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 Mr. 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. The 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 Mr. 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.

https://www.nytimes.com/2017/10/12/u...insurance.html

BOOM! BOOM! Double-whammy, cutting subsidies to insurance companies and creating a nationwide interstate traded system at the same time. Good!!! That ought to get someone's attention.

Trump to end key ACA subsidies, a move that will threaten the law’s marketplaces

By Amy Goldstein and Juliet Eilperin October 12 at 11:27 PM

President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision coincides with an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.

The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. Another statement a short time later by top officials at the Health and Human Services Department said the cutoff would be immediate. The subsidies total about $7 billion this year.

Trump has threatened for months to stop the payments, which go to insurers that are required by the laws to help eligible consumers afford their deductibles and other out-of-pocket expenses. But he held off while other administration officials warned him that such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans, according to two individuals briefed on the decision.

Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will open in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to damage the marketplaces — and the law.

Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some states’ regulators directed ACA insurers to add a surcharge in case the payments were not made — but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.

A spokeswoman for America’s Health Insurance Plan, an industry trade group that has been warning for months of adverse effects if the payments ended, immediately denounced the president’s decision. “Millions of Americans rely on these benefits to afford their coverage and care,” Kristine Grow said.

And California Attorney General Xavier Becerra (D), who has been trying to preserve the payments through the courts, said the president’s action “would be sabotage.” Becerra said late Thursday that he was prepared to fight the White House. “We've taken the Trump Administration to court before and won, and we're ready to do it again if necessary,” he said in a statement.

Trump’s move comes even as bipartisan negotiations continue on one Senate Committee on ways to prop up the ACA marketplaces. Both Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have publicly said the payments should not end immediately, though they differ over how long these subsidies should be guaranteed.

The cost-sharing reductions — or CSRs, as they are known — have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established the subsidies does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.

“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

For months, administration officials have debated privately about what to do. The president has consistently pushed to cut them off, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former HHS secretary Tom Price, cautioned that this could exacerbate already escalating premiums on the ACA market, these Republicans said.

But some government lawyers also argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.

While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.

One person familiar with the president’s decision said that HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.

The cost-sharing payments are separate from a different subsidy that provides federal assistance with premiums to more than four-fifths of the 10 million Americans with ACA coverage.

Word of the president’s decision, which was first reported by Politico, came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.

The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House’s announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.

Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.

The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” — a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.

In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.

Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health re*imbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules — another reversal of Obama policy.

In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”

Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”

The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal — giving each state more discretion over matters of insurance.

Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted — his directive will provide “millions of people with Obamacare relief,” he said.

Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers — or refuse to insure them.

The president issued the directive less than three weeks before the Nov. 1 start of the fifth open-enrollment season will begin in ACA marketplaces for people who do not have access to affordable health benefits through a job. Trump noted that about half of the nation’s counties will have just one insurer in their exchange, and he claimed that “many will have none.” However, the most recent canvass shows that there will be no “bare” counties in 2018.

A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.

Even so, with a shortened sign-up period and large cuts in federal funds for advertising and enrollment help already hobbling the marketplaces, “if there’s a lot of hoopla around new options that may be available soon, it could be one more thing that discourages enrollment,” said Larry Levitt, the Kaiser Family Foundation’s senior vice president.

Other aspects of the executive order include commissioning a six-month study, to be led by federal health officials, of ways to limit consolidation within the insurance and hospital industries. Trump also directed agencies to find additional means to increase competition and choice in health care to improve its quality and lower its cost.

The order produced predictable reactions in Congress, with Republican leaders praising the move and Democrats accusing the White House of sabotaging the law.

Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Mike Consedine, chief executive of the National Association of Insurance Commissioners (NAIC) said Thursday that the group has long opposed such plans and is concerned that the administration will allow ones that can bypass state licenses and have such weak financial underpinnings that some will collapse, leaving customers stranded and state insurance regulators “picking up the pieces.”

https://www.washingtonpost.com/natio...=.4fd1c07fc257

The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. Another statement a short time later by top officials at the Health and Human Services Department said the cutoff would be immediate. The subsidies total about $7 billion this year.

Good!! The payments are illegal according to the Courts, because Congress has never appropriated money for them. Trump has thrown the ball right back to Congress again, just like he did with DACA, and just like he's going to do with the Iranian deal tomorrow when he announces decertification because it's not in the national interest, which means DACA is over, ACA is over and the Dumbest Nuke Deal Ever is over.

Congress = File 13.

YIPPEE!!!

Sign an EO to stop issuing US Birth Certificates to illegal aliens and non-citizens coming here giving birth on our soil.

Instruct the Bureau of Vital Statistics to give them a "Certificate of Child Born Abroad"

NO MORE US BIRTH CERTIFICATES TO NON-CITIZENS COMING HERE FROM ALL OVER THE WORLD!

E-verify healthcare...get ILLEGAL aliens and non-citizens OFF our healthcare.

BILLIONS IN COST SAVINGS

THEY HAVE NO RIGHT TO OUR HEALTHCARE SYSTEM...THIS MUST BE TERMINATED.

Originally Posted by Beezer

E-verify healthcare...get ILLEGAL aliens and non-citizens OFF our healthcare.

BILLIONS IN COST SAVINGS

THEY HAVE NO RIGHT TO OUR HEALTHCARE SYSTEM...THIS MUST BE TERMINATED.

And pregnant illegal aliens should be deported ;instead they get free prenatal care, free birth, and 18 years worth of welfare on behalf of the child. Send them home instead, along with their illegal alien family members. Baby needs to arrive in his mother's homeland.

Senators reach deal to save health care subsidies