Ryan Punts On O’Care Subsidies As Confusion Continues About Their Fate

April 26, 2017 12:57 p.m.

As Congress nears a funding deal to avert a government shutdown later this week, House Paul Speaker (R-WI) said Wednesday that explicit appropriations for crucial Obamacare subsidies to insurers would not be included.

“Obviously CSRs — we’re not doing that,” Ryan said, referencing the payments known as cost-sharing reduction subsidies. “That is not in an appropriation bill, that’s something separate that the administration does.”

The fate of the subsidies, which are currently paid by the Treasury Department, is unclear as they are the target of a House GOP lawsuit and ending them has been floated by President Trump as a potential bargaining chip as he seeks to repeal the Affordable Care Act. If the subsidies were halted, it’s anticipated that insurers would jack up premiums to make for the revenue shortfall or leave the individual market entirely.

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While Ryan suggested that the administration would just continue making the payments, there has been confusion over whether the White House had really made that assurance.

A Democratic aide said that Office of Management and Budget Director Mick Mulvaney told House Minority Leader Nancy Pelosi (D-CA) Tuesday night that administration was considering not making next month’s payments and just allowing a federal court ruling against the payments to stand, according to reports in the Washington Postthe Hill and Vox. Pelosi had been stressing to Mulvaney Democrats’ desire to to see the payments included in the spending bill, according to the reports. A White House aide disputed the account somewhat to the Hill and Vox, by clarifying that the administration was still making up its mind on its next steps.

“The 11th hour is not the time nor the place for that discussion,” an OMB official told Vox, stopping short of guaranteeing the payments would continue.

The lack of clarity is making insurers, providers and patient advocates extremely antsy.

The subsidies go to insurers so they can keep out-of-pocket costs down for low income consumers, as mandated by the Affordable Care Act. House Republicans challenged the payments in 2014 under the Obama administration, arguing that Congress had not appropriated the funds for the subsidies. They won a ruling against the payments from a district court judge last year. The Obama administration appealed the ruling and the payments have been allowed to continue while the case proceeded. After Trump was elected, the appeals court now overseeing it allowed the proceedings to be paused while his administration and the House GOP work out their next steps.  They will need to update the court in May, around the time insurers will be making their decisions whether to participate in ACA exchanges in the 2018 plan year.

Trump, meanwhile, suggested earlier this month that he would use the payments as leverage to get Democrats to negotiate on Obamacare repeal, prompting Dems to ramp up their calls for the payments to be appropriated. Insurers would prefer the payments be included in congressional spending legislation, rather than simply continued by the administration.


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