As Republicans try to find agreement within their ranks to repeal and replace Obamacare once and for all, there is one Obamacare-era issue that needs Congress’ attention sooner rather than later.
On Monday, the Trump administration requested another three-month delay in a case over Obamacare subsidies known as cost sharing reduction payments — government payments aimed to reduce deductibles and co-pays of low-income participants.
The payments, a pillar of the Affordable Care Act, have been controversial since they started, so much so that the House of Representatives sued the White House, arguing that the Obama administration couldn’t lawfully make the payments to insurers because they weren’t appropriated by Congress.
Now, however, congressional Republicans find themselves in a precarious political position. While the Trump administration has been making the payments, and will continue to do so, mixed messages from the White House — including a Politico report last week that Trump personally told aides he wanted to stop the payments — have insurers spooked that the subsidies’ days may be numbered.
If the subsidies end, some insurers will likely try to pull out of Obamacare immediately. But just the uncertainty over the payments’ future is a main reason why some carriers have already decided to exit the Obamacare market for 2018 and others have filed for big premium increases. Without the payments, Republicans could be blamed for a mass exodus of insurers from the Obamacare marketplace next year, potentially leaving many of their constituents without any options.
So Republicans, having put in the effort to fight Obamacare, now ironically say its time for Congress to step in and spend the money. Some Republicans say they are talking behind closed doors and publicly about how they can pass something in the short-term to stabilize the market.
“I’ve stated in the meetings and publicly, I’d be in support of doing something very quickly, short term to stabilize the insurance markets for 2018,” said Sen. Ron Johnson, a Republican from Wisconsin. “This process dragged on longer than I would have liked it and in fairness to the insurance companies and even more importantly the American people, they need some certainty in terms of what’s going to happen in 2018.”
Sen. Susan Collins, a moderate Republican from Maine, said that she thinks there needs to be some kind of certainty for people who rely on the cost-sharing reduction payments.
“It’s my understanding that the administration’s asked for another stay of the court’s decision,” She said. “I’m not sure what that portends. I don’t know whether that means that the administration is considering allowing those cost sharing subsidies to go forward in an attempt to stabilize the market and help low income people or what. I just don’t know.”
Collins added “It’s my understanding that the House has not be interested in appropriating the funds. The problem is that if you don’t have cost-sharing for people who are below 250 percent of the poverty level, then the insurance becomes far less useful to them because they can’t afford the deductible or the co-pays.”
Since the subsidies began, House Republicans have railed against the payments, and some Republicans fear allocating the money now could make the GOP look like they are trying to prop up Obamacare, a law they are actively trying to dismantle.
Making CSR payments in a separate bill could get in the way of repealing Obamacare all together.
“It’s controversial,” said Florida Republican Rep. Mario Diaz-Balart.
Many Republicans asked about the payments rebuffed questions entirely.
“I’m still looking at it,” Sen. Jeff Flake, an Arizona Republican said. “There are negotiations going on over the whole health care fix and I’ll leave that to those that are involved.”
“I have no thoughts,” Rep. John Shimkus, a member of the House’s Energy and Commerce Committee, told CNN when asked about whether Congress needs to appropriate the money now for the Obamacare subsidies.
But after not making the payments during the Obama administration, making them now could make Republicans look disingenuous.
Rep. Mark Meadows, a North Carolina conservative and leader of the House Freedom Caucus said he would support Congress making the payments in the short term “as long as we’re looking at Obamacare from a historical perspective.”
“Then a smooth transition with CSR payments seems to be the most practical way to make sure we don’t create a crisis for people on Main Street,” Meadows said.
But he acknowledged the political risks of the situation.
“Part of it is that if you just put forth those payments and continue those payments without actually repealing Obamacare, you’re reinforcing the very thing that you’re campaigning against and so I think you want to make sure it doesn’t send the narrative that you’re supportive of Obamacare as much as you’re trying to create a smooth transition,” Meadows said.