President Trump’s health secretary refused to say Thursday whether his boss is committed to making disputed Obamacare-subsidy payments through the coming year, unnerving Democrats and leaving insurance companies to struggle with decisions about whether to remain part of the troubled health exchanges.
“Nobody is interested in sabotaging the system,” Health and Human Services Secretary Tom Price told members of the Senate Finance Committee — though he wouldn’t say how far the president is willing to go to prop up a law that he has repeatedly said is failing, and has demanded be repealed.
The biggest question is whether Mr. Trump will make billions of dollars in cost-sharing payments to insurance companies to cover out-of-pocket medical expenses for their poor customers. Without a guarantee of those payments, companies have said they’ll have to raise premiums.
Mr. Trump’s budget assumed the payments will be made, but he’s still trying to figure out how to settle a court case brought by the House against the Obama administration, which saw a judge rule the payments illegal.
“I’d like to be able to share more, but as the defendant in the case, I’m not able to do so,” said Mr. Price, who became a named litigant when President Obama ceded way to Mr. Trump and his team.
A string of insurers have exited Obamacare program or requested double-digit rate increases in recent weeks, citing problems with the 2010 health law itself or with Mr. Trump’s wavering commitment to it.
The plans must pick up customers’ costs whether they’re reimbursed or not, so they’re requesting higher-than-expected premiums in case Trump decides to yank the payments.
“To me, it’s like pulling the rug out from somebody and saying, ‘Oh my gosh, they fell down,’” said Sen. Debbie Stabenow, Michigan Democrat.
Mr. Price said the 2010 Affordable Care Act’s shaky framework — not the administration’s actions — are the main driver of economic pain in the marketplace, so it needs to be replaced with market-oriented reforms.
He also reminded Democrats that appropriating the cost-sharing payments is Congress’ job, even if Mr. Trump is letting Treasury disburse money while the court case is pending.
So far, GOP leaders haven’t included the payments in their spending plans, though House Ways and Means Committee Chairman Kevin Brady on Thursday said Congress ought to post the money for now.
“We should act within our constitutional authority now to temporarily and legally fund cost sharing reduction payments as we move away from Obamacare and toward a patient-centered system that truly works for the American people,” he said at Ways and Means’ own hearing with Mr. Price. “Insurers have made clear the lack of certainty is causing 2018 proposed premiums to rise significantly.”
Though billed as a chance to grill Mr. Price on Mr. Trump’s budget, both hearings turned into a grab bag of fights over the fate of Obamacare, the opioids crisis and whether employers must cover birth control as part of their health plans.
Democrats fumed over cuts to Medicaid, the government insurance program for the poor, noting the program pays for roughly half of all U.S. births, two out of three nursing home beds and treatment for a stunning number of Americans addicted to heroin and prescription drugs.
“These cuts would be a staggering blow to Americans of all generations,” said Sen. Ron Wyden, Oregon Democrat.
The White House budget request syncs with a GOP health care plan that cuts Medicaid by more than $800 million by reining in Obamacare’s vast expansion of the program and then capping federal funding to the states.
Senate Finance Chairman Orrin Hatch, Utah Republican, praised the administration for overhauling Medicaid, which Republicans view as a bloated program.
“All told, most of the budget’s overall Medicaid savings would be achieved by returning the focus of Medicaid to serving those with the greatest needs — the elderly, the disabled and needy mothers and children,” he said.