Not surprisingly, President Trump last week stopped payments to health insurers that help lower deductibles and other out-of-pocket costs for low-income enrollees in the Affordable Care Act (ACA) Marketplaces. This advances Trump’s self-fulfilling prophecy of “ObamaCare imploding.” Also not surprisingly, Congress has failed to do what it says is required: appropriate funding for this assistance.
Now is the time, Congress: do your job.
As part of its crusade since 2010 to repeal the ACA, the House of Representatives sued the Obama administration in 2015 over health care payments called cost-sharing reductions, or subsidies. They did not challenge whether insurers are owed this funding, nor whether eligible consumers are guaranteed lower costs as a result of the funding. Instead, the lawsuit is solely based on the claim that the ACA did not, and the Congress should, appropriate funding for this mandatory program. This claim that payments cannot be made without Congress’s action was adopted by the Trump Administration last week—stopping payments to insurers for the reduced cost sharing that they must, by law, provide.
A Republican Congress with a Republican President could easily appropriate these funds. They know how to do so. In fact, legislative language providing an appropriation was included in the Senate ACA “repeal and replace” bills. Furthermore, it does not increase the deficit. The Congressional Budget Office recognizes that the government owes these payments to insurers, so assumes they will be paid irrespective of the source of the funding.
Securing an appropriation has widespread support, not just among Democrats. All the Republican health care committee chairs, Republican governors, Republican insurance commissioners and even the Chamber of Commerce support appropriating these funds. In the words of Washington State Republican Greg Walden, “That’s an obligation not only to insurers but also to the people who took on those plans. We cannot leave them high and dry.”
Not doing so through Congress or the courts has real-world consequences. Insurers will raise their premiums to pay for their unfunded obligations—or pull out of the Marketplace altogether. This means millions of Americans will pay more and have fewer choices.
Yet, the White House has said that Republicans oppose providing the appropriation that they agree is needed unless Democrats agree to “insurance reforms.” We learned through the President’s executive order last week that these reforms would mainly consist of allowing insurers to market plans with lower health benefits, higher cost sharing, and weaker protections for people with pre-existing conditions.
Democrats support a number of proposals to improve the system, such as additional funding for high-cost enrollees and simpler processes for State Innovation Waivers. But only in Washington can Republicans seriously expect Democrats to accept policies that shift health costs to Americans to prevent shifting health costs to Americans.
Congressional Republicans launched the lawsuit that led to the President’s stopping payments for cost-sharing reductions. They now control all three branches of government. They can restart payments by simply providing what they said was lacking: a half-page Congressional appropriation. Hopefully, they will defy conventional wisdom and do what people elected them to do: their job.