After previously signaling support, the White House appears to be throwing a wrench into bipartisan efforts on Capitol Hill to craft a rescue package for Obamacare’s troubled individual market—demanding provisions that would undermine the purpose of the bill and push insurance premiums even higher.
Senators have been working for months on a handful of health insurance stabilization bills, including a federal reinsurance program and the restoration of cost-sharing reduction (CSR) funding terminated by the Trump administration last year. The White House’s own budget office says restoring the CSR payments could bring down premiums as much as 20 percent, while the non-partisan Congressional Budget Office says it would save the government more than $30 billion. The independent health care consulting firm Avalere estimated that both policies together could lower premiums 18 percent and increase insurance enrollment by 1.3 million people.
With many Republicans hostile to any measures that would prop up the Affordable Care Act’s market, lawmakers see the March 23 omnibus budget as the best and possibly only vehicle to pass them.
But earlier this week the White House released a new list of demands for the legislation that could further damage the already volatile market and tank the bipartisan bill’s chances of passage.
“The White House has transmitted legislative ideas that reduce health insurance premiums, expand affordable coverage options, lower overall Obamacare spending, and ensure taxpayers are not forced to subsidize abortions,” Deputy White House Press Secretary Hogan Gidley said in a statement to TPM. “While some in Congress might advocate using taxpayer money to shore up Obamacare exchanges, if there are no reforms that provide relief for middle-class Americans, such measures would just be a bailout of a failed government program.”
In exchange for funding the CSRs and a reinsurance program, the Trump administration is demanding the bill make short-term, off-market insurance plans more widely available and allow insurers to charge older patients five times as much as they charge younger enrollees (under the ACA the ratio is 3:1). The White House also indicated that they would insist on language in the bill that could potentially bar any private insurance plan that covers abortion from receiving a cost-sharing subsidy—something Democrats have already told TPM they consider “a complete nonstarter.”
“Any efforts to provide taxpayer money to stabilize the exchanges must be properly designed so that public dollars do the most good and that ensures all federal dollars are life-protected,” the White House document obtained by Politico reads.
The demand for encouraging the proliferation of short-term plans, which can deny patients coverage or charge them more based on their gender, age, and health status, will be especially problematic for many members. The cheaper, skimpier plans are expected to lure many younger and healthier people out of the more-regulated individual market, leaving the remaining risk pool smaller, sicker and with higher premiums.
Sen. Patty Murray (D-WA), the lead Democratic negotiator on the stabilization bill, said in a statement to TPM that she hopes the White House backs down from these demands.
“I certainly hope the President and Republican leaders won’t once again sabotage an opportunity to undo some of the damage they’ve done by choosing to play politics with women’s health and making last-minute, harmful demands that would raise families’ costs even more and place an age tax on seniors,” she said.
Other lawmakers, however, remain optimistic about the bill’s prospects.
“We’ve had very good conversations with the administration, and we’re proceeding well,” Sen. Susan Collins (R-ME) said in a statement to TPM.