Sen. Lamar Alexander (TN) | YouTube, MSNBC

 The Facts —

  • Chair of the Senate Health Committee Sen. Lamar Alexander (Tennessee) and Sen. Patty Murray (Washington) announced on 17 October that they have reached a bipartisan agreement to save health insurance subsidy payments, known as “Cost-sharing Reduction payments,” and allow states the ability to work around certain provisions in the Affordable Care Act (ACA), according to Politico.
    • CSR payments help lower deductibles for low-income Americans’ medical expenses.
    • Politico reported the deal would would fund CSRs for two years, permit states to use waivers to approve health insurance plans with “comparable affordability” to ACA (also known as “Obamacare”) plans, and expand access to the option of catastrophic health insurance plans to individuals over the age of 30.
    • Alexander said that he and Murray were “going to round up co-sponsors as best we can,” Politico reported.
  • The White House previously announced on 12 October that the federal government would not make the next round of CSR payments of subsidies to health insurers, according to The New York Times.
    • The White House said in a statement on 12 October, according to Business Insider:

“Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments.”

    • Attorney General Jeff Sessions said, according to Reuters, that the next CSR payments scheduled for 18 October will not be made. Reuters reported:

“The subsidies cost $7 billion this year and were estimated at $10 billion for 2018, according to congressional analysts.”

  • President Donald Trump also signed an executive order on 12 October calling for the secretaries of Labor, Treasury and Health and Human Services to consider changes to health care regulations that would work around the ACA, that Trump said would expand healthcare coverage.
    • Trump said the order directs the Departments of the Treasury, Labor, and Health and Human Services to consider the following, in a statement on 12 October:
      • “[E]xpanding access to Association Health Plans (AHPs), which could potentially allow American employers to form groups across State lines;”
      • “[E]xpanding coverage through low cost short-term limited duration insurance (STLDI);” and
      • “[C]hanges to Health Reimbursement Arrangements (HRAs) so employers can make better use of them for their employees.”

The Context —

  • President Donald Trump signaled he would not sign off on saving CSR payments, with a tweet on 18 October:

  • Trump’s tweet added to comments he made during a speech at The Heritage Foundation on 17 October, where he said:

“I’m pleased the Democrats have finally responded to my call for them to take responsibility for their Obamacare disaster and work with Republicans to provide much-needed relief to the American people. While I commend the bipartisan work done by Sens. Alexander and Murray — and I do commend it — I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies.”

  • Trump previously suggested preliminary approval of Alexander and Murray’s agreement while calling the senators’ proposed plan a “short term deal,” during a press conference from the Rose Garden on 17 October. Trump said:

“Lamar has been working very, very hard with the Democratic, his colleagues on the other side. And Patty Murray is one of them, in particular. And they’re coming up and they’re fairly close to a short-term solution. The solution will be for about a year or two years. And it’ll get us over this intermediate hump.”

    • Trump also suggested this plan could possibly lead to a longer term solution that incorporated block grants to states.
  • Trump said of the executive order, which does not by itself create any new laws or change any existing ones, but instead calls for consideration of new practices and a review of how to accomplish Trump’s desired goals, on 12 October:

“[T]oday’s executive order instructs [Department of Labor Secretary Alexander] Acosta, [Secretary of the Treasury Steven] Mnuchin, and [acting Secretary of Health and Human Services Eric] Hargan to explore how they can allow more businesses to use tax-free health reimbursement arrangements or HRAs to compensate their employees for their healthcare expenses. Currently, only about one-third of small business employees receive coverage at work, forcing millions of workers to enroll in the exchanges or remain uninsured and to pay the individual mandate penalty.”

  • Trump campaigned on the promise to “repeal and replace Obamacare” and has been frustrated with Congress’ inaction on that front, alluding to impending executive action on the issue of health care on 10 October, saying:

  • Trump’s administration previously announced he would decrease advertisement funding by 90 percent, from $100 million spent last year to $10 million spent this year, for the upcoming enrollment period for Obamacare, according to the Centers for Medicare and Medicaid Services (CMS).
  • The Trump administration has also shortened the online enrollment period from approximately three months to six weeks, with the ability sign up at healthcare.gov scheduled to run from 1 November through 15 December this year, according to CMS, rather than from 1 November through the end of January as it has in years past.
  • Trump’s executive order promised to explore the option of allowing individuals access to purchasing insurance across state lines, which has been brought up by Republicans before, and Trump has said in the past that it would significantly lower premiums.
  • Sen. John McCain included the proposition in his 2008 presidential platform, saying:

“Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.”

  • McCain’s proposal came when state insurance regulations varied widely, before the ACA “enacted countrywide minimum benefit standards, limits on out-of-pocket spending, limits on how much premiums could vary based on a consumer’s age, and requirements that insurers not use health status to price premiums or reject anyone, among other regulations,” according to the fact checking website.
  • The National Association of Insurance Commissioners (NAIC), which is a support organization established by the country’s state insurance regulators, told FactCheck.org that the ability to buy health insurance across state lines would not likely lower premiums for consumers. NAIC said:

“Interstate sales will start a race to the bottom by allowing companies to choose their regulator [and allowing insurers to target the healthiest consumers]. While those individuals in pristine health may be able to find cheaper policies, everyone else would face steep premium hikes if they can find coverage at all.”

Critics of Doing Away with CSR Payments and Trump’s Executive Order —

  • Several states plan to sue the Trump administration if the President makes good on his promise to withold subsidy payments, according to Reuters.
  • Sen. Murray said on 17 October:

“I’m very pleased that in the hearings and discussions with over half the senate, Chairman Alexander and I were able to find common ground on a number of steps to stabilize the markets and to help protect families from premium spikes as a result of the sabotage we have seen from this administration.”

  • Sen. Lamar Alexander (Tennessee), Chairman of the Senate Health Committee, said in a press release dated 1 August that he urged Trump at that time to continue CSR payments through September, anticipating that Congress would pass a new healthcare bill by now that would alleviate the need for the payments. Alexander said:

“I have also urged the president to temporarily continue the cost-sharing reduction payments through September so that Congress can work on a short- term solution for stabilizing the individual market in 2018.

“Cost-sharing reduction subsidies reduce copays and deductibles and other out-of-pocket costs to help low income Americans who buy their health insurance on the exchanges that would be (those who make under 250 percent of Federal Poverty Level, roughly $30,000 for an individual or $60,000 for a family of four).

“Without payment of these cost-sharing reductions, Americans will be hurt. Up to half of the states will likely have bare counties with zero insurance providers offering insurance on the exchanges, and insurance premiums will increase by roughly 20 percent, according to America’s Health Insurance Plans (AHIP).

“In my opinion, any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced. It should include funding for the cost-sharing reductions, but it also should also include greater flexibility for states in approving health insurance policies.

“Now if the president were to approve continuation of cost-sharing subsidies for August and September, and if Congress in September passed a stabilization plan that includes cost-sharing for one year, it is reasonable to expect that the insurance companies would then lower their rates. They have told us, in fact Oliver Wyman an independent observer of health care, has told us that lack of funding for the cost-sharing reductions would add 11 to 20 percent to premiums in 2018.”

  • House Minority Leader Nancy Pelosi (California) said on 12 October:

“Thanks to President Trump’s executive sabotage, the millions of Americans with pre-existing conditions could lose access to the affordable health coverage they and their families rely on.

“The President’s cynical executive order is designed to force families across America to pay the most when they can afford it the least. After an accident or an illness, those pushed into shoddy Trumpcare plans will find they’ve been paying for coverage that doesn’t cover much at all, saddled with desperate choices and crushing medical bills.

“The American people overwhelmingly rejected Trumpcare, but President Trump is still spitefully trying to sabotage their health care, drive up their costs and gut their coverage.”

Supporters of Doing Away With CSR Payments and Trump’s Executive Order —

  • Centers for Medicare & Medicaid Services Administrator Seema Verma said of Trump’s executive order on 12 October:

“Today’s announcement represents an important step in providing Americans with more affordable health insurance coverage options by offering relief from Obamacare’s oppressive mandates and regulations that are driving up costs and driving down the quality of their healthcare. This Executive Order will promote affordable coverage options for Americans, whether they work for small businesses, large employers, or need to purchase coverage on their own. It will empower employers to offer more affordable health coverage and to provide their employees with the opportunity to exercise greater choice and control over their healthcare.”

  • Trump tweeted on 13 October:

  • Trump tweeted on 12 October:

  • Trump said in a statement published on 12 October:

“The time has come to give Americans the freedom to purchase health insurance across state lines, which will create a truly competitive national marketplace that will bring costs way down and provide far better care.”

  • Vice President Mike Pence said in a statement before Trump’s signing of the executive order on 12 October:
    • Trump is taking “decisive action to provide the American people with flexibility and freedom from the burdens of Obamacare and expand the number of affordable healthcare options for working Americans.”

Stephanie Haney contributed to this report.

The Whim News Team

The Whim News Desk

We'd rather be second and accurate than be first and wrong. The Whim News Desk is a dedicated team of researchers and investigators committed to presenting the news without bias. Follow us @TheWhimOnline for daily news coverage without the spin!

  • Michael Domino

    We can debate the drawbacks and merits to repealing Obamacare, but to undermine the program with the intent to sabotage it, rather than to make efforts to improve it pending a Cogressional verdict, seems to me to be an immoral task. It’s hard to imagine how this could be justified except as a weapon of political extremism.

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