Tuesday, August 1, 2017

Trump Threatens Insurer Payments To Push Congress On Health-Law Repeal

Ending federal payments may be the most potent tool at the president’s disposal.

By Michelle Hackman, Siobhan Hughes and Anna Wilde Mathews
The Wall Street Journal
August 1, 2017

President Donald Trump warned Monday that he could end federal payments to insurers, allowing them to be “hurt” by the Affordable Care Act, as a way to press members of Congress to revive efforts to repeal the Obama-era health law.

“If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies,” Mr. Trump wrote on Twitter.

The president was alluding to the ACA’s “cost-sharing reduction” payments, which the government pays to insurers to help them cut deductibles and other costs for low-income consumers.

Some Republicans lawmakers Monday advocated a pause to regroup following last week’s collapse of the repeal effort, but Mr. Trump wasn’t backing down from his push to resurrect those efforts.

Several GOP governors, including Scott Walker of Wisconsin and Asa Hutchinson of Arkansas, met with White House officials to discuss repeal options. Mr. Trump has also held discussions on a proposal from Sen. Lindsey Graham (R., S.C.) that would convert ACA funding into block grants that states could use to remold their own health-care systems.

But a legislative path excluding Democrats narrowed last week when Senate Republicans failed to approve several proposals to overhaul the 2010 health-care law, leading Senate Majority Leader Mitch McConnell (R., Ky.) to say it was time to “move on.”

While Mr. Trump suggested he might end the insurance payments, a bipartisan group of more than 40 House members released a proposal on Monday aimed at permanently authorizing them.

“My hope is we don’t have to go down the path of stopping these payments or cutting off other areas of payment out there,” said Rep. Tom Reed (R., N.Y.), the leading Republican on the bipartisan plan.

Some Republican senators indirectly took issue with Mr. Trump’s recent tweet that they were “total quitters” if they didn’t vote again on repeal before tackling other bills.

“It’s time to move on to something else, come back to health care when we’ve had more time to get beyond the moment we’re in,” said Sen. Roy Blunt (R., Mo.). “Obviously we didn’t give up and we didn’t quit and we gave it our best shot.”

Senate Finance Committee Chairman Orrin Hatch (R., Utah) said it wouldn’t make sense to vote again on a health plan until Republicans knew the Senate would pass it.

“You’ve got to have a system that has a reasonable chance of success,” Mr. Hatch said. “We are moving on to tax reform, but that doesn’t mean we can’t do more than one thing at a time. We can still keep working on health care.”

For now, ending the insurance payments may be the most potent tool at Mr. Trump’s disposal. Insurers say that without them, they would be forced to increase premiums or exit the ACA’s exchanges, where consumers buy insurance if they don’t get it through their employer or a government program.

The administration has maintained an uneasy relationship with insurers since taking office, regularly threatening the payments while working behind the scenes to encourage insurers to continue to sell coverage. Mr. Trump has allowed the payments every month since taking office, often within days of suggesting he was about to cut them off.

Underscoring the fluid landscape, Ohio regulators announced Monday that insurers had agreed to offer plans in 2018 in 19 counties that risked ending up with no insurers on their exchanges. That leaves one Ohio county still potentially without an exchange offering.

The 20 Ohio counties were at risk of being “bare” after withdrawals by two other insurers, including Anthem Inc., which cited the uncertain federal landscape as a major factor in its decision.

Insurers have until late September—when they sign federal contracts to offer exchange products—to make final calls on their participation, and some could still change their minds.

“We recognize there is a lot of uncertainty at the federal level,” said Jillian Froment, director of the Ohio Department of Insurance. “Change at that level could affect coverage, not only in those 19 counties but all 88 [Ohio] counties.”

Insurers are also facing a mid-September federal deadline for completing their premium rates for 2018 exchange plans, leaving them little breathing room as the Trump administration and Congress send mixed signals about next steps.

The Kaiser Family Foundation has estimated that ending the cost-sharing payments could generate average premium increases of 19% for the marketplaces’ middle-tier “silver” plans.

Senate Minority Leader Chuck Schumer (D., N.Y.) warned against such a result Monday. “If President Trump does not guarantee these payments permanently, Americans will have to pay a Trump tax on their premiums next year,” he said on the Senate floor.

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