The CBO predicts Trump's move to end ObamaCare subsidies will hike premiums, uninsured rate, deficits
On Thursday night, the Trump administration formally decided to end cost-sharing subsidies that the Health and Human Services Department has been paying insurers to lower premiums for millions of lower-income customers purchasing insurance through the Affordable Care Act exchanges. House Speaker Paul Ryan (R-Wis.) praised the move as an affirmation that "the power of the purse belongs to Congress, not the executive branch" — House Republicans had sued to stop the payments, and the White House had been appealing a court ruling agreeing the subsidies were illegal.
Other lawmakers from both parties, aides to President Trump, HHS officials, and medical and insurance groups had urged Trump to continue authorizing the subsidies, so as not to sabotage the health-insurance markets and cause premiums to soar.
Cutting health care subsidies will mean more uninsured in my district. @potus promised more access, affordable coverage. This does opposite.
— Ileana Ros-Lehtinen (@RosLehtinen) October 13, 2017
In August, the Congressional Budget Office reached that same conclusion. In order for customers to qualify for cost-sharing reductions (CSRs), they have to sign up for "silver" plans, and the CBO projected that "gross premiums (that is, before premium tax credits are accounted for) for silver plans offered through the marketplaces would, on average, rise by about 20 percent in 2018 relative to the amount in CBO's March 2016 baseline and rise slightly more in later years." The number of uninsured would rise by about 1 million in 2018, though it would drop again as people purchased lower-cost plans, and because customers would be shielded from the premium hikes by larger federal subsidies, the federal deficit would rise by $194 billion over the next 10 years.
Earlier Thursday, Trump signed an executive order aimed at expanding lower-cost, sparser-coverage insurance options, and "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," The Washington Post says. You can read the entire CBO analysis here. Peter Weber
On Thursday, President Trump — who once accused former President Barack Obama of "constantly issuing executive orders that are major power grabs of authority" — will sign an executive order to unwind parts of the Affordable Care Act. Trump has said he is furious that congressional Republicans have been unable to "repeal and replace" ObamaCare, and he promised on Tuesday to use "the power of the pen" to do something about health care. The executive order on Thursday will tell federal agencies, notably the Labor Department, to relax rules on coverage and benefits under certain plans.
The order will mostly affect smaller business and possibly individuals who band together to buy insurance as an association, short-term insurance plans, and rules on how tax-free employer-funded accounts can be spent. The cumulative goal is to leave consumers with more options, including lower-cost plans that don't cover as much. Health-insurance experts and some state insurance commissioners warn that those changes will likely undermine the federal markets more than Trump already has, in such a way that insurance could become prohibitively expensive for older and sicker people, including those with pre-existing conditions.
The association health plans and short-term plans are largely exempt from ACA rules, and expanding their reach will essentially divide the market into healthy and sick pools, says Rebecca Owen at the Society of Actuaries, adding that association health plans "have had a pretty spotty record," with some failing due to insufficient financial reserves and others accused of misleading members about benefits. "The specific steps included in the order will represent only the first moves in his White House's effort to strike parts of the law," two senior White House officials tell The Wall Street Journal, adding that they don't think the rule changes can be challenged in court. Peter Weber
President Trump on Saturday proposed a "temporary deal" on health care so it could be settled during the midterm elections in 2018. "If we made a temporary deal, I think it would be a great thing for people, but it's really up to [Democrats]," Trump told reporters outside the White House.
"If we could do a one-year deal or a two-year deal as a temporary measure, you'll have block granting ultimately to the states, which is what the Republicans want," he added. "That really is a repeal and replace." Speaking with Mike Huckabee in an interview broadcast on TBN later Saturday, Trump pledged to "have health care before the election."
Republicans have given up trying to repeal and replace the Affordable Care Act this fiscal year, which ends Saturday, but they are already saying they might try again next year; on Wednesday, President Trump said congressional Republicans will return to ObamaCare in the first quarter of 2018. "To the Republicans vowing to keep their ObamaCare repeal drive alive for as long as it takes," Politico reports, "Democrats say: Please, and thank you."
Democrats are unified in fighting to protect ObamaCare, and that's one of the things they appreciate about the GOP's repeated tries at chipping away at the law: It unifies Democrats. The other reason, Politico says, is that Democrats believe Republicans keeping their unpopular effort going during the election year could help them win control of the House and give them a fighting chance at taking the Senate. "I think they are falling into an enormous trap of their own making," said Rep. Gerry Connolly (D-Va.). "And have at it."
A recent poll from the nonpartisan Kaiser Family Foundation suggests there are upsides for both parties. Overall, 76 percent of voters say it is very or extremely important for Congress to reauthorize the Children's Health Insurance Program, 70 percent say the same for passing legislation to stabilize the ObamaCare marketplaces, and only 47 percent say that about continuing the push to repeal ObamaCare. Those numbers are about the same for independent voters. Republicans, on the other hand, want their leaders to continue the repeal fight rather than stabilize the markets by a 66 percent to 28 percent margin, while Democrats want their leaders to focus on stabilizing ObamaCare over pushing for national health care 52 percent to 43 percent. You can read more results at the Kaiser Family Foundation, and more about the Democrats' feelings on the GOP's enduring crusade at Politico. Peter Weber
Graham-Cassidy, the latest Senate Republican effort to repeal large parts of the Affordable Care Act and transform Medicaid, appeared to have died its final death on Monday evening, when Sen. Susan Collins (R-Maine) joined Sens. John McCain (R-Ariz.) and Rand Paul (R-Ky.) in stating her intention to vote no on the bill if it comes up for a vote this week. The Senate GOP's ability to pass a health-care bill with just 50 Republican votes, through the budget reconciliation process, ends Saturday, and Republicans have committed to using next fiscal year's budget resolution to pass tax reform with only GOP votes. But in theory, Republicans could combine health care and tax reform in the same budget vehicle, and that idea is gaining steam.
Sen. Lindsey Graham (R-S.C.) and Sen. Ron Johnson (R-Wis.), both sponsors of Graham-Cassidy, are pushing to combine tax reform and health care, and both Sen. Paul and Senate Finance Committee Chairman Orrin Hatch (R-Utah) are among those interested in the idea. Others, including GOP House tax leaders, are wary of threatening tax reform by mixing it up with an ObamaCare repeal effort that has thwarted Republicans all year. "I think we need to move onto tax reform," said Sen. John Kennedy (R-La.), adding about Graham-Cassidy: "I think this bill's dead."
But it didn't earn the nickname "Zombie TrumpCare" for nothing. Johnson and Graham are both on the Senate Budget Committee, and if both joined all committee Democrats in voting against a budget resolution without health care, it wouldn't pass, meaning tax reform would be at an impasse, too. Both senators threatened to do that on Sunday and Monday. "I think this whole thing is going to get derailed by health care," a GOP lobbyist told Axios. "There are a lot of Republicans who are sick of dealing with health care," says Caitlin Owens at Axios. But President Trump and GOP donors large and small are insistent, and "as we've seen over the last 10 days, it becomes politically difficult for the GOP to ignore a glimmer of hope when it comes to repealing the Affordable Care Act." Peter Weber
Graham and Cassidy release new health bill draft with more money for Alaska, Maine, Arizona, Kentucky
Senate Republicans and President Trump have not given up on their last-ditch effort to significantly modify Medicaid and the Affordable Care Act, which needs to pass this week to avoid a filibuster from Democrats. On Sunday night, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) released a new draft of their Graham-Cassidy bill, designed to win over holdouts in part by sending more money to Alaska, Maine, Arizona, and Kentucky, the home states of four key senators.
The new version of Graham-Cassidy also includes a special carveout for Alaska, a 25 percent increase in federal matching Medicaid funds. Sen. Lisa Murkowski (R-Alaska) has not said how she plans to vote, Sens. Rand Paul (R-Ky.) and John McCain (R-Ariz.) are pretty hard no votes, and on Sunday's CNN State of the Nation, Sen. Susan Collins (R-Maine) said it would be "very difficult for me to envision a scenario where I would end up voting for this bill," citing its changes to Medicaid, weakened protections for people with pre-existing conditions, and the lack of a Congressional Budget Office analysis of its effects.
— CNN Politics (@CNNPolitics) September 24, 2017
In addition to the new funds for certain states, the new draft would make it easier for states to scrap federal insurance requirements, often without a waiver, including increasing the caps on out-of-pocket costs and allowing insurers to drop coverage for maternity care, mental health treatment, drug addiction, and other benefits now deemed essential. It would also allow states to create "multiple risk pools" for healthy and sick people. "This revised bill is tantamount to federal deregulation of the insurance market," said Larry Levitt of the nonpartisan Kaiser Family Foundation. "If there were any doubt that people with pre-existing [conditions] are at risk of being priced out of individual insurance, this bill removes them."
The main hospital, doctor, and insurance groups released a rare joint letter Saturday opposing the bill, though GOP donors are reportedly upset that ObamaCare is still law. Sen. Ted Cruz (R-Texas) told the Texas Tribune Festival in Austin that "right now, they don't have my vote. And I don't think they have Mike Lee's either," referring to a GOP colleague from Utah. Republicans can only lose two votes. Peter Weber
President Trump's badgering and other pressure tactics arguably backfired in July, when three Senate Republicans sank the previous last effort to repeal much of ObamaCare, but when you have a very large megaphone, you apparently use it.
Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as "the Republican who saved ObamaCare."
— Donald J. Trump (@realDonaldTrump) September 22, 2017
Senate Republicans are holding a vote next week on the Graham-Cassidy health-care bill, and Sen. Rand Paul (R-Ky.) — who voted for the last GOP health-care bill, says he is a solid no on this one. The other Republicans up in the air are believed to be Sens. Susan Collins (Maine), John McCain (Ariz.), and Lisa Murkowski (Alaska) — though if Republicans let Alaska keep ObamaCare, who knows? Peter Weber
National Review asks why Jimmy Kimmel won't 'leave policy talk to health-care experts,' gets an earful
Weirdly, late-night comedian Jimmy Kimmel is now a big part of America's health-care debate. His critiques of the Graham-Cassidy health-care bill — after one of its sponsors, Sen. Bill Cassidy (R-La.), promised to oppose any bill that failed his "Jimmy Kimmel Test," which Graham-Cassidy appears to do — have hit a nerve perhaps because Kimmel is a goof and probably the least political of the late-night TV hosts. So on Wednesday, Theodore Kupfer at National Review published an article critical of Kimmel's audacity to weigh in on health care, as if he had "deep and hidden reservoirs of knowledge on risk-adjustment programs, the Medicaid expansion, or per capita caps." The article is titled, "Jimmy Kimmel, Policy-Wonk Wannabe," but the NRO social media editor posed it as a question:
— National Review (@NRO) September 21, 2017
It so happens that Politico had examined that question, and found that "in the war of words between Jimmy Kimmel and Sen. Bill Cassidy, the late-night host has the better grasp of health policy, health-care analysts say." So a lot of the responses to National Review's tweet were along those lines. But that was just the tip of the iceberg. If Kimmel isn't an expert, some asked, why are these guys being invited on cable news to talk health care?
Uh huh... pic.twitter.com/LZtvBeiIAJ
— Jade (@jade3457) September 21, 2017
— Silver Shamrock Mask (@dogdadbod) September 21, 2017
Several people noted that the occupant of the Oval Office doesn't exactly have a long health-care résumé, either:
Wow good point, National Review. pic.twitter.com/ZCH5IfWFFd
— Cody Johnston (@drmistercody) September 22, 2017
Others, like Nancy Sinatra, asked why National Review thinks Kimmel doesn't have the right to weigh in:
Because he is a patriotic American, that's why. It is a patriot's responsibilty to stand up and speak out. Thanks, @jimmykimmel
— Nancy Sinatra (@NancySinatra) September 21, 2017
Am I allowed discuss about policy publicly? If not, may I apply for a permit at your offices?
— Mike Cukan (@mcukan) September 22, 2017
And then Jason Helgerson, who runs New York State's Medicaid program, stepped in and dropped the mic:
— Jason Helgerson (@policywonk1) September 21, 2017
Twitter: Ask, and ye shall receive. Peter Weber