Republican lawmakers and state officials have grown increasingly frustrated with the Trump administration as it holds some states’ health insurance exchanges hostage over the future of the Affordable Care Act.
In Iowa, some lawmakers have accused the president of playing politics, while others are frantically trying to convince him to drop his opposition to a waiver the state is seeking in order to expand access to the individual health insurance markets in 2018.
The Washington Post reported last week that Trump, in an unusual move, personally intervened to try to prevent Iowa from being granted what is known as a 1332 waiver, which gives states more flexibility in enforcing the Affordable Care Act.
If Trump’s wish is granted, an estimated 72,000 Iowans would not have access to the individual health insurance markets next year, state officials have said. A final decision from the Centers for Medicare and Medicaid Services (CMS) has not yet been announced, and GOP lawmakers are growing more testy with the lack of clarity.
“It’s been a slow walk and it’s time to speed up. I hope it’s not been undermined. It’s time to act because people are suffering. Where do the 72,000 Iowans go if they don’t have access to the individual market,” Rep. David Young (R-IA) said in a local TV interview. “...If the administration is balking on this for political expediency, I don’t think that’s right.”
Young is not your average Trump critic. Though he did not support the House’s initial bill to repeal and replace Obamacare, he ended up voting for the updated version in May. His suggestion that the administration is playing politics with Iowa’s waiver illustrates the rising tensions within the Republican party over the administration’s handling of the Affordable Care Act.
Having been unable to repeal the law, Trump has begun a campaign to undermine it from within. It’s no longer Democrats who are angered, however. Republicans are growing agitated, too, as they seek to help constituents navigate a complex law that will, at least for the time being, remain in place.
That tension is most visible in Iowa. The state’s governor, Kim Reynolds (R), has been spearheading the effort to secure a short-term waiver from the federal government. Speaking at a press conference on Tuesday morning, she said she has asked to speak with the president but has not yet been able to do so. Instead, she has been in “constant contact” with the White House and CMS on the issue.
“Our indication is they’ve been very receptive. They continue to work with us,” Reynolds said. “The White House has continued to work with us to get to ‘yes,’ to provide a solution.”
A spokeswoman for Reynolds told The Daily Beast that the federal government has confirmed that Iowa’s application for the waiver is complete, and the state is waiting out a “30-day public comment period” which ends on October 19. Officials are expecting a decision by November 1, when open enrollment for 2018 begins.
While Young has been critical of the Trump administration and Reynolds has scrambled for a resolution, other Iowa Republicans have tried to not ruffle feathers. Sen. Joni Ernst (R-IA) downplayed the significance of Trump’s apparent refusal to grant the waiver. But in an interview with the Des Moines Register, she conceded that the president had likely made his decision as an act of retribution for the numerous failed attempts to repeal and replace Obamacare.
“I think the president’s disappointed that we weren’t able to do anything on the overall repeal-replace with Obamacare and so I think again, that it was just an immediate reaction to something that he heard and I don’t put any stock, necessarily, in that,” Ernst said. “I want to see what the actions are.”
Brook Hougesen, a spokeswoman for Ernst, told The Daily Beast on Tuesday that the relevant parties—Reynolds and the Iowa Insurance Division—are “working with” the Trump administration on the waiver.
“Given the situation with our health insurance market in Iowa due to the failure of Obamacare, Senator Ernst will continue urging CMS to take up this proposal as soon as possible,” Hougesen said.
Michael Zona, a spokesman for Sen. Chuck Grassley (R-IA) told The Daily Beast that the senator has been in contact with both the White House and CMS “on behalf of Iowa’s time-sensitive request,” and that “by every indication … CMS is seriously considering a waiver.”
The administration’s slow-walking of Iowa’s waiver request is just one of several ways in which it has attempted to undermine Obamacare while it remains the law of the land. It has also slashed advertising budgets to promote enrollment by 90 percent. CMS has cut back on state funds meant to help individuals enroll, too. The Daily Beast exclusively reported that the Department of Health and Human Services has used funds meant for promoting the law to instead undermine public confidence in it. Last month, Oklahoma had to withdraw its own waiver request, citing the federal government’s “lack of timely waiver approval.”
Health care experts have pegged rising premiums under Obamacare partly to the Trump administration’s refusal to extend Obamacare subsidies—known as cost-sharing reduction (CSR) payments—on a long-term basis. In August, the White House extended the subsidies on a short-term basis, bowing to pressure from both Democrats and Republicans. (Conservative lawmakers have denounced the CSR payments as a “bailout.”). But beyond that, the future is unclear. A White House spokesman told The Daily Beast on Tuesday that “no final decisions have been made about the CSR payments.”
Despite the frustration the administration’s actions are engendering in even Republican-run states, some lawmakers haven’t seemed entirely bothered. Some Senate Republicans told The Daily Beast recently that they would not encourage Americans to sign up for health insurance under Obamacare even with repeal-and-replace temporarily tabled, reiterating their conviction that Obamacare will continue to collapse on its own.