- The Washington Times - Sunday, October 15, 2017

Democrats on Sunday downplayed talk of forcing a government shutdown after President Trump launched a twin assault on Obamacare, saying they will continue their uphill push to negotiate fixes to the law after the administration halted critical “cost-sharing payments” to insurers and ordered agencies to explore the sale of cheaper plans across state lines.

Yet Mr. Trump has shown little interest in a deal that temporarily shores up the 2010 health care law without paving the way for repeal or bolstering other parts of his agenda, leaving little room for a deal as policymakers struggle with wobbly insurance markets before open enrollment begins in two weeks.

Mr. Trump’s decision to halt the cost-sharing payments, in particular, is sending shock waves through the insurance markets and has reignited legal fights over health care.

A slate of Democratic attorneys general immediately filed a lawsuit to try to preserve the money, which reimburses insurers for picking up low-income customers’ out-of-pocket costs.

The White House said Mr. Trump had no choice but to cut off payments that Congress specifically denied but President Obama made anyway. Mr. Obama’s move drew a rebuke from a court that ruled he was overstepping his powers.

Without the payments, insurers say, they would increase premiums, which would further upend the shaky economic underpinning of the Affordable Care Act.

Democrats accuse Mr. Trump of playing politics with people’s lives.

“What he’s doing is hurting the American people. This isn’t about policy or politics; it’s about the American people,” House Minority Leader Nancy Pelosi, California Democrat, told ABC’s “This Week.”

Democrats could use the payments as a bargaining chip ahead of a government-funding deadline in December. Republican leaders typically need their votes to overcome objections from conservatives over runaway federal spending.

But Mrs. Pelosi said Democrats are “not about closing down government” and will continue to prod Republicans who call the shots on Capitol Hill to support legislation that stabilizes the markets. She said the majority party bears responsibility for what happens next.

A bipartisan push in the Senate would include funding for now-canceled “cost sharing” payments, and some House Republicans are open to front the money as part of a broader compromise.

Prospects of a deal to defuse the situation already seem dim, however.

Conservatives don’t want to cast any votes that appear to prop up Obamacare, and White House Budget Director Mick Mulvaney, speaking to Politico, suggested Mr. Trump would be open only to a bipartisan stabilization bill that offered him something in return, such as funding for his border wall.

Mrs. Pelosi said, “He wants to negotiate the health care bill by repealing the Affordable Care Act and building a wall? No.”

Mr. Trump’s decision to halt the cost-sharing payments followed an executive order pushing his administration to allow association health care plans, which would allow individuals and small businesses to join up and purchase insurance on the group market across state lines.

Association plans are a boon for those struggling with high-cost plans, though analysts say it could sap those customers — and their high premiums — from existing markets, leaving the sick and elderly to pay more because their costs are no longer subsidized by the healthy.

Combined, the association health care plans and the renunciation of cost-sharing payments underscore Mr. Trump’s frustration with Congress, which has failed to confront all the problems that have arisen with Obamacare over the years.

Mr. Obama managed to patch over many problems by using executive actions, and the cost-sharing payments were one part of that. Though envisioned by the original Obamacare law, the payments were left up to the annual appropriations process.

The president asked for the money, but Congress did not approve it. Mr. Obama made the payments anyway, drawing a lawsuit from the Republican-controlled House.

A Republican-appointed federal judge in the District of Columbia ruled against Mr. Obama, and the case now sits with an appeals court — though the lower-court judge allowed the payments to be made while the appeal is continuing.

The White House said the Justice Department has concluded the initial judge’s ruling is correct, and there is no valid legal ability to make the payments.

“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,” White House press secretary Sarah Huckabee Sanders said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

Conservative pressure groups praised Mr. Trump’s steps to unwind the health care law after congressional Republicans failed to produce a promised repeal bill, though Democrats and some Republicans accused the White House of making a rash move that will force some families to pay more for coverage.

Rates are expected to rise up to 20 percent without the cost-sharing payments because insurers must pick up customers’ costs whether they are reimbursed or not, analysts said.

Nevada Gov. Brian Sandoval, a Republican, was particularly vocal in his criticism of Mr. Trump’s decision to yank the cost-sharing money, saying it will hurt families. Some House Republicans endorsed bipartisan fixes endorsed by the Problem Solvers Caucus.

“It funds the cost-sharing reduction program through the congressional appropriations process and implements free-market policies to improve our health care system and lower medical and insurance costs for all,” said Rep. Leonard Lance, New Jersey Republican.

During appearances on ABC and CNN’s “State of the Union,” Sen. Susan M. Collins, Maine Republican, called Mr. Trump’s decision disruptive.

The Obamacare payments cost about $7 billion a year, according to the latest accounting.

The Congressional Budget Office and other analysts say the decision to withdraw the money will cost taxpayers more over time because the federal government doles out subsidies that rise with premiums tied to “benchmark” plans in the program’s exchanges.

Insurers have chafed at characterizations of the payments as a windfall or bailout, saying they serve as a pass-through for a payment mechanism written into the 2010 law.

“These benefits help real people every day, and if they are ended, there will be real consequences. These payments are not a bailout; they are passed from the federal government through health plans to medical providers to help lower costs for patients who see a doctor to treat their cancer or fill a prescription for a life-saving medication,” a leading insurers lobby, America’s Health Insurance Plans, and Blue Cross Blue Shield Association said in a joint statement.

Some states told insurers to submit two sets of rates to hedge against the prospect that Mr. Trump would cancel the payments. Yet others did not, forcing a scramble to figure out whether rates can be revised or if open enrollment can be delayed.

Mrs. Pelosi characterized Mr. Trump’s move as his latest attempt to go rogue and unwind his predecessor’s legacy, despite criticism from members within his own party.

“[There are] so many things that are not based on evidence — and that’s problematic,” Mrs. Pelosi said. “Either he doesn’t know or he doesn’t care.”

House Speaker Paul D. Ryan, Wisconsin Republican, said Mr. Trump had no choice but to halt the payments after Mr. Obama ignored Congress and was rebuked by the courts.

“Today’s decision by the Trump administration to end the appeal of that ruling preserves a monumental affirmation of Congress‘ authority and the separation of powers. Obamacare has proven itself to be a fatally flawed law, and the House will continue to work with the Trump administration to provide the American people a better system.”

House Republicans have passed a repeal-and-replace bill, but Senate Republicans have struggled to find a consensus on their own bill. Senate Majority Leader Mitch McConnell, Kentucky Republican, has tried three versions. He had to cancel votes on two of them after facing an embarrassing floor defeat on the first.

A poll by the Kaiser Family Foundation says 7 in 10 Americans want Mr. Trump to do what he can to make the current program work.

Stephen Dinan contributed to this report.

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