Days after inflicting major damage to Obamacare and declaring the law virtually dead, President Donald Trump signaled on Tuesday that he supports a deal to both repair that damage and prop up that supposedly “dead” law in the short-term.
His comments added to yet another chaotic day on the health care policy front, which has had no shortage of said days in the past seven years. As Trump spoke in the White House Rose Garden, a bipartisan group of senators announced that they had agreed to a preliminary deal that would restore the cuts Trump had made to a subsidy program for poor Americans buying insurance, known as cost-sharing reduction (CSR) payments.
Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), the chair and ranking member of the Senate Committee on Health, Education, Labor, and Pensions, announced on Tuesday that they had agreed on a package that authorizes a two-year extension of the CSR payments through 2019—a measure sought by Democrats—and grants increased flexibility for state governments to set insurance regulations, a provision pushed by Republicans. The process by which a state can seek those waivers, known as 1332 under Obamacare, will be streamlined to allow states to obtain one faster, and the deal would make it more difficult for the executive branch to scrap a state’s waiver, according to an aide familiar with the talks. It would also restore funding directed toward Obamacare outreach in the form of state grants.
“What we do know is that President Trump has encouraged this. He did that directly to me as recently as last Saturday. He said he doesn’t want people to be hurt these next two years by the possibility of rising premiums or by not being able to buy insurance in the counties where they live,” Alexander told reporters at the Capitol.
Sen. Mike Rounds (R-S.D.), who was involved in the effort alongside Alexander, told The Daily Beast that the package would allocate $7 billion for the CSR payments for the remainder of 2017, and $10 billion for 2018.
“If we don’t do this, there will be a lot of people that will not be able to afford to pay even the deductibles and copays,” Rounds said. “But we needed to also have flexibility built in as a reason for Republicans to actually agree to change this law, which is flawed, to allow those CSRs to continue on.”
Despite the agreement between Alexander and Murray, the effort has an uphill climb before it can become law. Senate Minority Leader Chuck Schumer (D-NY) encouraged fellow lawmakers to move quickly on the measure. But Rounds said that it wasn’t clear yet if a majority of all the Republicans supported it. “I think we’re moving closer,” he added.
But the biggest hurdle might actually be Trump himself. Though he spoke supportively of the measure at the White House, it is not clear yet that the president would sign the newly announced deal into law. White House Legislative Affairs Director Marc Short said that the Trump administration will want more concessions in order to get his final signature. In particular, Short said the White House already believes that they have enough state flexibility under the 1332 waivers.
“I don’t see that a simple 1332 waiver for CSRs is something that the White House would get that excited about,” Short told reporters at the Capitol after meeting with Republican senators. “I don’t see how we go for something that basically gives us what we think we already have in the waiver in exchange for a policy we don’t agree with.”
Asked by The Daily Beast if the president would sign legislation that included a two-year extension of the CSR payments, Short said: “That’s a hypothetical. Depends what else is in there.”
The prospects of the deal passing in the House, meanwhile, were thrown into question almost immediately after it was announced, with at least one prominent conservative calling it a betrayal of the GOP’s promise to repeal and replace Obamacare.
Rep. Mark Walker (R-N.C.), the chairman of the Republican Study Committee, said it amounts to a “bailout,” calling it “unacceptable.”
“Obamacare is in a ‘death spiral.’ Anything propping it up is only saving what Republicans promised to dismantle,” Walker added.
The whiplash on the Hill comes as insurers have set prices for plans that they will be offering during the upcoming enrollment period. Many of those insurers had assumed that Trump would cancel the CSR payments and had raised premiums accordingly. Trump’s willingness to embrace the Alexander-Murray deal would alleviate some of that uncertainty (though likely for the next enrollment period and not this one). But it’s unclear if insurers will be able to decipher one clear message.
Just moments prior to saying that he was involved in a short-term deal to fund the CSR payments after all, Trump derided the payments as a bailout to insurers and spoke of Obamacare in general as a law whose time had ended.
“When I knocked out the hundreds of millions of dollars a month being paid back to the insurance companies by politicians, I must tell you, that they wanted me to continue to pay this,” Trump said. “I said, ‘I'm not going to do it. This is money that goes to the insurance companies to line their pockets, to raise up their stock prices, and they have had a record run. They have had an incredible run. And it is not appropriate. Obamacare is a disaster. It's virtually dead as far as I'm concerned, it really is dead, and I predicted that a long time ago. It is a concept that doesn’t work.”