As soon as this week, according to Donald Trump adviser Kellyanne Conway, Trump intends to decide whether to cut off payments meant to stabilize insurance markets and make health care affordable for many Americans with modest incomes.
Meanwhile, his negativity about insurance companies raises a different matter entirely.
The Treasury Department has been making the subsidy payments to insurers through a permanent appropriation tied to a portion of the health care law that established premium tax credits for individuals who meet income requirements tied to the federal poverty level. The House Republicans were due to respond by November 23. The Associated Press notes that California, New York and other states intervened in the case for fear that neither side would actually defend the subsidies.
The issue is of critical importance to Republicans in all three branches of government because the party campaigned for seven years to repeal former President 's signature healthcare law.
Trump tweeted that the Affordable Care Act is "hurting people", and insurance companies and lawmakers should share in that pain.
White House counselor Kellyanne Conway announced that president Trump would decide this week whether to cut the payments or not.
On Sunday, Politico reported that the House Problem Solvers Caucus, a group of moderate Democrats and Republicans, is working with other centrists on a package of reforms to stabilize the state insurance exchanges - many of which are facing the possibility of sharply rising rates at least in part as a result of the uncertainty in Washington. The federal money that goes to insurers in these payments, known as cost-sharing reductions, or CSRs, offsets the money insurers lose by lowering the deductibles and co-payments they require of these policyholders. The provision, which requires almost all Americans to have insurance or pay a penalty, is key to getting coveted young and healthy consumers to buy policies.
One sign that the administration knows it's on shaky political ground is its obviously misleading rhetoric on both the cost-sharing subsidies and mandate. "If the federal government is not going to forward the dollars to the plans anymore the plans will look for a way to backfill that and that's called increasing everybody's premiums". Without that, the increase would be 6.4 percent. She said insurers in Virginia and New Mexico built in increases of up to 20 percent, assuming lax enforcement of the law. Under our Constitution, the president has a duty to "take Care that the Laws be faithfully executed".
The Kaiser Family Foundation estimates that this year, more than 7 million low- and middle-income people will receive cost-sharing reductions for out-of-pocket health care expenses. "Most staff are underpaid already", he said. "But it's clear to us that what we have to do is come together, find that common ground and govern for the American people".
"Without payment of these cost-sharing reductions", he said, "Americans will be hurt".
But Senate Health Committee Lamar Alexander said he will push for bipartisan efforts to stabilize the individual insurance markets when lawmakers return in September, as exchange customers in 20 counties across Nevada, Indiana and OH face the prospect of having no choices at all next year. He is the chairman of the Senate Health, Education, Labor and Pensions Committee.
If there is not more clarity on what the administration will do, a large number of insurers will most likely abandon the market, and the 12.2 million Americans in the exchanges will be left with little choice for coverage in 2018.
Alexander said his proposal was a necessary response to an imminent crisis. That decision has remained on hold as the Obama Administration took the issue to the Circuit Court in an appeal.
The case is now on hold at the request of both sides.
They have waited months for the Trump administration to commit to paying a key set of Obamacare subsidies. But that effort failed last week, meaning the court case has taken on renewed importance.
Two experts agree that health insurers would have a solid lawsuit if Trump stops paying the "cost-sharing" subsidies. "Until we can get the thing fixed, I think we have to try to maintain the status quo", said Sen.