There are a two events scheduled to occur next week on the “Obamacare” front that could affect the status of both “Obamacare” and the awful American Health Care Act passed in a rush by the Tea-Publican House a couple of weeks ago.
I previously gave you a backgrounder on the House GOP lawsuit House v. Price (née House v. Burwell) for which the next status report to the Court is due on Monday, May 22. The Trump administration could opt to sabotage “Obamacare” by not funding the cost-sharing reductions (CSRs) and blowing up health insurance markets across the country.
The second scheduled event is the release of the nonpartisan Congresssional Budget Office (CBO) score for the American Health Care Act (AHCA), which is scheduled to be released on Wednesday, May 24. The CBO score for the Zombie Trumpcare bill is widely expected to be far worse than for the Trumpcare 2.0 bill.
And there is another complication that that “the zombie-eyed granny starver from the state of Wisconsin” and Ayn Rand fanboy, House Speaker Paul Ryan, did not seriously consider when he forced a House vote on the AHCA without the benefit of the CBO score.
NBC News reports, Uh-Oh: The House May Need to Vote on Health Care (Again!):
Speaker Paul Ryan confirmed on Friday that that the House may need to vote on the American Health Care Act a second time before the Senate can take up the bill, even as he stressed it was unlikely.
Republicans are using the budget “reconciliation” process to pass their health care bill, which allows them to push legislation through the Senate with a simple majority. But that depends on the bill meeting certain requirements — and one of them is that it reduces the deficit by at least $2 billion over the next decade.
The trouble is that Republicans voted on their House bill without waiting for the Congressional Budget Office, the federal agency that evaluates legislation, to finish its projections, which will be released on Wednesday.
Bloomberg News reported Thursday and NBC News confirmed that House leaders have not formally sent their bill to the Senate on the chance that it fails to meet the deficit requirements.
“We just want to, out of an abundance of caution, wait to send the bill over to the Senate with the final score,” Ryan told radio host Hugh Hewitt on Friday morning. “So we’re basically being overly cautious, but there’s really not an issue here.”
A previous version of the American Health Care Act saved $150 billion over 10 years and both Ryan and some outside health experts expect the new one to maintain sufficient savings. But there were major changes to the final version that add a degree of uncertainty.
The wildcard is a new provision that would allow states to opt out of Obamacare’s requirements that insurance plans carry a minimum package of benefits as well as its rule that insurers charge customers the same price regardless of whether they have a pre-existing condition.
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If states opt out of Obamacare’s requirements, though, millions more might be able to afford cheaper, if less generous, plans. The nonpartisan Committee for a Responsible Federal Budget estimates that if 10 million more people purchased insurance under the new version, the additional contributions to their tax credits would add $300 billion in costs.
If that happens, the House would have to vote again on changes, bringing them back to a politically charged bill that they barely carried over the finish line in a narrow 217-213 vote.
More importantly, the years of Tea-Publican attempts to repeal “Obamacare” are having their intended effect of sabotaging “Obamacare” even without passage of the AHCA. As the GOP frequently reminds us in other contexts, “the markets hate uncertainty.”
The Los Angeles Times reports, Health insurers plan big Obamacare rate hikes — and they blame Trump:
Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues.
At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.
The growing frustration with the Trump administration’s management — reflected in letters to state regulators and in interviews with more than two dozen senior industry and government officials nationwide — undercuts a key White House claim that Obamacare insurance marketplaces are collapsing on their own.
Instead, according to many officials, it is the Trump administration that is driving much of the current instability by refusing to commit to steps to keep markets running, such as funding aid for low-income consumers or enforcing penalties for people who go without insurance.
“All this uncertainty is not helpful,” warned Blue Shield of California Chief Executive Paul Markovich, who said health plans were being forced to make plans to raise premiums to account for the turmoil, jeopardizing Americans’ coverage.
Markovich was one of the few senior insurance officials who agreed to speak on the record, as many fear retribution from the White House or its allies.
But privately, many executives, including chief executives of major health plans, offered withering criticism of the Trump administration’s lack of leadership.
“It’s hard to know who’s home,” said one chief executive. “We don’t know who is making decisions.”
Another chief executive said: “There seems to be no coordination or coherent planning.… It’s a mess.”
A third official observed: “There is a sense that there are no hands on the wheel and they are just letting the bus careen down the road.”
Trump and GOP congressional leaders insist the marketplaces are collapsing because of flaws in the original law. They cite premium hikes in some states, and decisions by several insurers to stop selling Obamacare plans, including major national companies such as Humana and UnitedHealth Group. That has left some areas of the country with just one health plan option next year.
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But most health plans and state regulators interviewed for this story said the Trump administration has significantly exacerbated turmoil in the marketplaces in recent months, contributing to rising premiums and the threat of marketplaces exits.
“There is no consistency to the messages,” said Ceci Connolly, chief executive of the Alliance of Community Health Plans, whose members include leading health systems such as Kaiser Permanente and Geisinger Health Plan. “We are very confused.”
The Trump administration has sent mixed signals about whether it will enforce penalties on people who don’t buy health insurance. The penalty, though unpopular, is seen as crucial to inducing younger, healthier people to get coverage.
Trump and his deputies have also repeatedly threatened to withhold federal aid that helps millions of low-income Americans afford their deductibles and co-pays.
The aid, which reimburses insurers for lowering out-of-pocket costs, was paid by the Obama administration, but is now the subject of a lawsuit by congressional Republicans, who argue Congress must approve the payments.
The Trump administration hasn’t taken an official position in the lawsuit [House v. Price (née House v. Burwell)]. But in recent months, the president publicly mused about stopping the payments to force Democrats to negotiate a repeal of the current law. It remains unclear whether the administration will continue the payments, known as cost-sharing reductions, or CSRs.
In a letter to Washington state insurance regulators this month, California-based Molina Healthcare, a leading provider of Obamacare plans in many states, warned halting CSRs may cause the collapse of the state’s market.
“If the federal government’s full CSR funding commitments are in jeopardy, we believe that the viability of the exchange market is in immediate jeopardy of failing,” wrote Peter Adler, who oversees Molina’s plans in Washington.
The uncertainty created by Trump comes as some Obamacare markets were beginning to stabilize, according to many industry and government officials. In several states, insurers and regulators noted that 2017 was shaping up to be a better year than the first several years of the marketplaces.
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Many state insurance regulators are similarly dismayed by the Trump administration’s actions, which Washington state Insurance Commissioner Mike Kreidler compared to playing Russian roulette with Americans’ health insurance coverage.
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In Colorado, where most consumers continue to have multiple insurance choices, commissioner Marguerite Salazar said the Trump administration threatens the whole market. “My fear is it may collapse,” she said.
Mississippi Insurance Commissioner Mike Chaney, a Republican, is so concerned the turmoil will drive away insurers that he’s exploring whether the state can make available limited benefit insurance plans as a stopgap.
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Insurance industry officials and state regulators have met repeatedly in recent months with senior Trump administration officials in an effort to explain that administration’s actions are jeopardizing health coverage for millions of Americans.
But in many cases, the meetings only left insurers and regulators more confused about the administration’s plans, according to attendees.
At one recent meeting, Seema Verma, whom Trump picked to oversee the federal Medicare and Medicaid programs, stunned insurance industry officials by suggesting a bargain: The administration would fund the CSRs if insurers supported the House Republican bill to repeal the Affordable Care Act. [Otherwise known as “extortion.”]
“It made no sense,” said one official at the meeting.
Many insurers, as well as every leading patient and physician group, believe the House bill is deeply flawed. Independent analyses suggest the legislation, which Trump has enthusiastically backed, would increase the ranks of uninsured by 24 million [or more] over the next decade.
Trump administration officials denied Verma suggested the administration would fund the CSRs. “What she said at the … meeting in April was that no decisions had been made about CSRs,” said Jane Norris, a spokeswoman for the Centers for Medicare and Medicaid Services, who according to the agency also attended the meeting.
Attorneys general from 15 states and the District of Columbia say that health insurance for millions of Americans has become “political bargaining chips” and that they can’t trust the Trump administration to defend their interests. States get involved in lawsuit to shield Obamacare, saying Trump can’t be trusted:
Attorneys general from 15 states and the District of Columbia filed a motion Thursday to intervene in a long-running lawsuit over a core part of the Affordable Care Act. [House v. Price (née House v. Burwell).]
In their legal filing, the attorneys general say they can’t trust the Trump administration to defend their interests, because health insurance for millions of Americans has become “little more than political bargaining chips” for the White House.
The lawsuit is challenging how billions of dollars of federal payments were made to health insurers. Those payments are critical to the stability of the Affordable Care Act marketplaces, which are designed to help individuals buy government-subsidized health coverage. The attorneys general want to step in to defend the payments, saying there is a “sharp divide” between the administration’s goals and those of states.
For months, health insurance companies have been trying to get a solid answer from Congress and President Trump’s White House on the future of the payments, called cost-sharing reductions (CSRs), that help lower-income Americans afford their deductibles and co-payments. Their calls for certainty have grown increasingly urgent as they face deadlines to decide whether to offer plans in states and how much to charge.
The lawsuit over the payments was originally brought by House Republicans against the Obama administration. House Republicans won the lawsuit, which was appealed. Now, it has been inherited by the Trump administration, which has been unclear about whether it will defend the payments. A status update on the case is due on Monday.
Trump and Congress have sent mixed signals about whether the payments will continue on an almost weekly basis.
The repercussions of discontinuing the payments have been made clear by insurance executives, who warn that if the funding disappears, insurers could leave markets altogether or raise their premiums significantly.
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The National Association of Insurance Commissioners sent a letter this week to senators and to White House budget director Mick Mulvaney stressing the importance of the payments.
“This is not a theoretical argument — carriers have already left the individual market in several states, and too many counties have only one carrier remaining,” the association wrote to Mulvaney. “The one concern carriers consistently raise as they consider whether to participate and how much to charge in 2018 is the uncertainty surrounding the federal cost-sharing reduction payments.”
The motion to intervene was filed by the attorneys general of New York and California, and was joined by Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, Pennsylvania, Vermont, Washington and the District of Columbia.
“The President has increasingly made clear that he views decisions about providing access to health insurance for millions of Americans — including the decision whether to continue defending this appeal — as little more than political bargaining chips,” the attorneys general wrote in their motion to intervene in the case, saying they could not depend on the White House to represent states’ interests.
“The number of uninsured Americans would go back up, hurting vulnerable individuals and directly burdening the States,” they wrote. “The wrong decision could trigger the very systemwide ‘death spirals’ that central ACA features, such as stable financing, were designed to avoid.”
This is purposeful and malicious behavior, intentionally meant to harm millions of Americans, some of whom face certain death without access to affordable health care. Such amoral behavior rightfully must be punished. Voters need to remove these Tea-Publicans from office in 2018.
UPDATE: POLITICO reports Trump said to favor move that could destabilize Obamacare:
President Donald Trump has told advisers he wants to end payments of key Obamacare subsidies, a move that could send the health law’s insurance markets into a tailspin, according to several sources familiar with the conversations.
Many advisers oppose the move because they worry it will backfire politically if people lose their insurance or see huge premium spikes and blame the White House, the sources said. Trump has said that the bold move could force Congressional Democrats to the table to negotiate an Obamacare replacement.
Trump told aides in a Tuesday Oval Office meeting that he wants to end the payments to insurers, according to people familiar with his comments. Trump has previously expressed conflicting opinions on the issue. Insurers have been pressing for certainty as they plan for next year.
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Many senior administration officials, including Health and Human Services Secretary Tom Price, are leery of ending the payments, however, because it could immediately unravel the Obamacare insurance markets and strongly discourage insurers from participating next year. Insurance companies in many states would be allowed to pull out of the Obamacare markets, which in many states already have scant competition.
Several polls show that the public would blame the administration and the Republican-controlled Congress if the markets collapsed.
The issue is coming to a head: On Monday, the Trump administration has to inform the U.S. Court of Appeals for the District of Columbia how it wants to resolve a lawsuit the House Republicans brought against the Obama administration saying the White House was making the payments without congressional approval. The White House and House could also ask for a 90-day hold on the case.
Defunding the cost-sharing program could destabilize the market immediately.
In a statement, the administration said the White House has told Congress it will continue the payments through May but no commitment has been made beyond that.
“No final decisions have been made at this time, and all options are on the table,” the statement said.