After President Trump threw his most destructive grenade yet into the Obamacare insurance markets, Republican lawmakers on Monday said they felt a renewed sense of urgency to come together on a bipartisan health care reform package that has been in the works for weeks.
Many lawmakers spoke only in generalities, not explicitly endorsing a legislative proposal that is being put together by the chairman and the ranking member of the Senate Committee on Health, Education, Labor and Pensions. But even those who just weeks ago had pledged to support nothing short of an overturn of Obamacare now seemed open to the idea of repairing the damage to the existing law that Trump had done.
“To the extent that it focuses people on the need to do something about a health care delivery system, I think it will be helpful,” Sen. John Kennedy (R-LA) told The Daily Beast. “Now, having said that, I don’t think anyone—including the president—wants to see people thrown off their insurance.”
Congress often only works in moments of peak crisis or when it has exhausted all other legislative options. And that appears to be the case again as the Senate figures out what to do with Trump’s decision to end cost-sharing reduction (CSR) payments—subsidies that are paid to insurers to help offset deductibles and copays for low-income Americans.
Lawmakers were confronted over the weekend with the possibility of a health care insurance market severely damaged by the president’s latest action to undermine Obamacare. The nonpartisan Congressional Budget Office has warned that, in the absence of CSR payments, consumers could face an estimated 20 percent hike in premiums in 2018. Health care experts have warned that in addition to higher premiums passed on to consumers, insurers could pull out of the exchanges altogether. Neither outcome was particularly welcomed on Capitol Hill.
“At the end of the day,” Sen. Tim Scott (R-S.C.) told The Daily Beast bluntly, “what it does is it forces us to come to the table and work on a bipartisan solution that actually solves the problem.”
Even Trump, on Monday, seemed frightened by the potential fallout of what he had done. Having destabilized the markets with a stroke of his pen, the president seemed to take credit for and embrace the bipartisan bill being negotiated by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA). The senators are seeking a two-year extension of the CSR payments in addition to measures that would give states more flexibility to set insurance regulations.
“In my opinion what’s happening is that as we meet, Republicans are meeting with Democrats because of what I did with the CSRs because I cut off the gravy train,” Trump said on Monday. “If I didn’t cut off the CSRs, they wouldn't be meeting. They’d be enjoying lunch by themselves.”
In fact, Alexander and Murray started negotiating their legislation in August, long before Trump made his latest decision on CSR payments but very much in anticipation of his ultimate decision. Those negotiations were put on hold as Trump and GOP leadership took another stab at Obamacare repeal-and-replace efforts.
Alexander did not explicitly condemn the administration’s CSR decision. But he shared that he talked with the president over the weekend, and that Trump “encouraged me to get a result with Sen. Murray—he said, ‘I don’t want people to suffer.’ Those are his words.”
Sources close to the negotiations told The Daily Beast that the White House could, indeed, sign off on a package that includes a two-year extension of the CSR payments because the funds would be appropriated by Congress instead of mandated by the executive branch, which Republicans have said is unconstitutional. A White House spokesman told The Daily Beast last week that “Congress could resolve any uncertainty about the payments at any time.”
But even though there were signs of progress on health care, other Republican senators seemed more than comfortable in allowing the damage Trump had inflicted on Obamacare to take root.
“It doesn’t bother me,” Sen. Richard Shelby (R-AL) told The Daily Beast when asked whether he was concerned about higher premiums. “I voted against Obamacare. And I’ve advocated we ought to repeal it outright, no restrictions, because that’s not the will up here yet. So the sooner we get rid of it, the better we’re going to be. Because it’s going to collapse on its own weight. I don’t think we should subsidize everything.”
Health care remains, very much, a tricky legislative endeavor for the GOP, and the debate over CSRs is no different. For years, Republicans argued that the Obama administration had extended the payments illegally since, they insisted, the law never explicitly authorized the executive branch to do so. They also have tarred the subsidies as a bailout for insurers, who they believe could stomach the extra cost instead of passing it down to consumers.
But other Republicans had encouraged the Trump administration to continue paying the subsidies until Obamacare was fully repealed and replaced, lest individuals see their premiums skyrocket. Sens. Bob Corker (R-TN), John Thune (R-S.D.), and Bill Cassidy (R-LA) were among that group. Corker told The Daily Beast in August that “there would be a lot of poor people that would, obviously, be negatively affected” if the subsidies were cut off. But on Monday, Corker declined to comment on the matter, while others reiterated the administration’s legal argument for ending the CSR payments.
“Clearly, the courts have already spoken on that, and it wasn’t legal until Congress actually appropriates funds. It’s entirely appropriate for them to actually follow the court order,” Sen. James Lankford (R-OK) told The Daily Beast. Lankford said he worries about the higher premiums likely to come, adding: “But this is actually a consequence of the law itself.”
In ending the subsidies, Trump runs a political risk in addition to a humanitarian one. By dismantling Obamacare via executive action, he claims more ownership of the problems within the remaining system. He himself seemed to acknowledge that on Monday when he declared that “Obamacare is finished. It’s dead. It’s gone.” And Democrats have been more than happy to make the case—even prior to Trump’s decision on the CSR payments.
“If he breaks it, he will own it,” Sen. Tom Carper (D-DE) previously predicted to The Daily Beast. “And ironically and cruelly, some of the people who will suffer the most are the people who live in those red states that voted for him, including West Virginia and Kentucky and places like that.”
An Associated Press analysis found that nearly 70 percent of Americans who benefit from the CSR subsidies live in states that Trump won in 2016 and that the president won nine out of the 10 states with the highest percentage of CSR beneficiaries.