October 19, 2017

On Thursday, Sen. Lamar Alexander (R-Tenn.) will officially roll out the health-care bill he negotiated with Sen. Patty Murray (D-Wash.), flanked by a "significant" number of Republican and Democratic cosponsors, Alexander said Wednesday. The bipartisan bill, dubbed Alexander-Murray, is expected to go nowhere for now, as President Trump and House Speaker Paul Ryan (R-Wis.) came out against it on Wednesday. But "by the end of the year, chances are very good this agreement or something like it is law," Alexander said. Analysts agree.

Congress already has a packed December, including "funding the government and raising the debt ceiling — must-pass items that can only pass with a lot of Democratic votes, just like Alexander-Murray," says Sam Baker at Axios. "If Alexander-Murray doesn't pass before then, it's pretty easy to see Democratic leaders insisting on some form of Affordable Care Act stabilization as part of the end-of-year package. And this bill, or something close to it, is likely the best Republicans are going to get."

Wrapping up something like Alexander-Murray — which guarantees two years of cost-sharing subsidies that insurance companies use to lower out-of-pocket costs for poorer customers, plus easing some coverage requirements on states — in an end-of-the-year omnibus package "would be less painful than voting on a stand-alone bill that conservatives view as a 'bailout' for insurance companies — and a vote to 'prop up' a law they've tried to dismantle for years," Politico notes. And with premiums already rising because Trump cut off the cost-sharing subsidies, or CSRs, "at some point [Senate Majority Leader Mitch] McConnell and Ryan will need this," a senior GOP aide told Axios' Caitlin Owens. Peter Weber

October 16, 2017

On Monday, President Trump told reporters that ObamaCare is dead, killed by his executive orders last week. Because he ended the cost-sharing reductions (CSRs) to insurance companies, used to subsidize health care for millions of low-income customers — 70 percent of whom live in states Trump won — "there is no such thing as ObamaCare anymore," Trump said. His action prompted Congress to start working on a short-term fix, he added, instead of "having lunch and enjoying themselves." A minute later, Trump blamed the purportedly dead law for insurers raising premiums:

Sadly, the Democrats can't join us on that which will be the long-term fix, but I do believe we will have a short-term fix because I think the Democrats will be blamed for the mess. This is an ObamaCare mess. When the premiums go up, that has nothing to do with anything other than the fact that we had poor care delivered poorly, written poorly, approved by the Democrats. [Trump]

The Congressional Budget Office predicted in August that ending the CSRs would raise premiums and the federal deficit, and on Monday, Pennsylvania's insurance commissioner announced that rates on ObamaCare exchanges will rise an average of 30.6 percent, rather than 7.6 percent, "due to President Trump's refusal to make cost-sharing reduction payments for 2018 and Congress' inaction to appropriate funds." Trump said he thinks Republicans will still "get the health care done," adding that while most GOP senators "are really, really great people ... a few people disappointed us. Really, really disappointed us. I can understand how Steve Bannon feels."

Over the weekend, incidentally, Bannon told the Values Voters Summit he feels that ending the CSRs will "blow up" the ObamaCare exchanges. Peter Weber

October 13, 2017

On Thursday night, the Trump administration formally decided to end cost-sharing subsidies that the Health and Human Services Department has been paying insurers to lower premiums for millions of lower-income customers purchasing insurance through the Affordable Care Act exchanges. House Speaker Paul Ryan (R-Wis.) praised the move as an affirmation that "the power of the purse belongs to Congress, not the executive branch" — House Republicans had sued to stop the payments, and the White House had been appealing a court ruling agreeing the subsidies were illegal.

Other lawmakers from both parties, aides to President Trump, HHS officials, and medical and insurance groups had urged Trump to continue authorizing the subsidies, so as not to sabotage the health-insurance markets and cause premiums to soar.

In August, the Congressional Budget Office reached that same conclusion. In order for customers to qualify for cost-sharing reductions (CSRs), they have to sign up for "silver" plans, and the CBO projected that "gross premiums (that is, before premium tax credits are accounted for) for silver plans offered through the marketplaces would, on average, rise by about 20 percent in 2018 relative to the amount in CBO's March 2016 baseline and rise slightly more in later years." The number of uninsured would rise by about 1 million in 2018, though it would drop again as people purchased lower-cost plans, and because customers would be shielded from the premium hikes by larger federal subsidies, the federal deficit would rise by $194 billion over the next 10 years.

Earlier Thursday, Trump signed an executive order aimed at expanding lower-cost, sparser-coverage insurance options, and "until the White House's announcement late Thursday, the executive order represented Trump's biggest step to date to reverse the health-care policies of the Obama administration," The Washington Post says. You can read the entire CBO analysis here. Peter Weber

October 12, 2017

On Thursday, President Trump — who once accused former President Barack Obama of "constantly issuing executive orders that are major power grabs of authority" — will sign an executive order to unwind parts of the Affordable Care Act. Trump has said he is furious that congressional Republicans have been unable to "repeal and replace" ObamaCare, and he promised on Tuesday to use "the power of the pen" to do something about health care. The executive order on Thursday will tell federal agencies, notably the Labor Department, to relax rules on coverage and benefits under certain plans.

The order will mostly affect smaller business and possibly individuals who band together to buy insurance as an association, short-term insurance plans, and rules on how tax-free employer-funded accounts can be spent. The cumulative goal is to leave consumers with more options, including lower-cost plans that don't cover as much. Health-insurance experts and some state insurance commissioners warn that those changes will likely undermine the federal markets more than Trump already has, in such a way that insurance could become prohibitively expensive for older and sicker people, including those with pre-existing conditions.

The association health plans and short-term plans are largely exempt from ACA rules, and expanding their reach will essentially divide the market into healthy and sick pools, says Rebecca Owen at the Society of Actuaries, adding that association health plans "have had a pretty spotty record," with some failing due to insufficient financial reserves and others accused of misleading members about benefits. "The specific steps included in the order will represent only the first moves in his White House's effort to strike parts of the law," two senior White House officials tell The Wall Street Journal, adding that they don't think the rule changes can be challenged in court. Peter Weber

October 8, 2017

President Trump on Saturday proposed a "temporary deal" on health care so it could be settled during the midterm elections in 2018. "If we made a temporary deal, I think it would be a great thing for people, but it's really up to [Democrats]," Trump told reporters outside the White House.

"If we could do a one-year deal or a two-year deal as a temporary measure, you'll have block granting ultimately to the states, which is what the Republicans want," he added. "That really is a repeal and replace." Speaking with Mike Huckabee in an interview broadcast on TBN later Saturday, Trump pledged to "have health care before the election."

On Friday, Trump reached out to Senate Minority Leader Chuck Schumer (D-N.Y.) about working together on health care, but Schumer said he rejected Trump's terms. Bonnie Kristian

September 28, 2017

Republicans have given up trying to repeal and replace the Affordable Care Act this fiscal year, which ends Saturday, but they are already saying they might try again next year; on Wednesday, President Trump said congressional Republicans will return to ObamaCare in the first quarter of 2018. "To the Republicans vowing to keep their ObamaCare repeal drive alive for as long as it takes," Politico reports, "Democrats say: Please, and thank you."

Democrats are unified in fighting to protect ObamaCare, and that's one of the things they appreciate about the GOP's repeated tries at chipping away at the law: It unifies Democrats. The other reason, Politico says, is that Democrats believe Republicans keeping their unpopular effort going during the election year could help them win control of the House and give them a fighting chance at taking the Senate. "I think they are falling into an enormous trap of their own making," said Rep. Gerry Connolly (D-Va.). "And have at it."

A recent poll from the nonpartisan Kaiser Family Foundation suggests there are upsides for both parties. Overall, 76 percent of voters say it is very or extremely important for Congress to reauthorize the Children's Health Insurance Program, 70 percent say the same for passing legislation to stabilize the ObamaCare marketplaces, and only 47 percent say that about continuing the push to repeal ObamaCare. Those numbers are about the same for independent voters. Republicans, on the other hand, want their leaders to continue the repeal fight rather than stabilize the markets by a 66 percent to 28 percent margin, while Democrats want their leaders to focus on stabilizing ObamaCare over pushing for national health care 52 percent to 43 percent. You can read more results at the Kaiser Family Foundation, and more about the Democrats' feelings on the GOP's enduring crusade at Politico. Peter Weber

September 26, 2017

Graham-Cassidy, the latest Senate Republican effort to repeal large parts of the Affordable Care Act and transform Medicaid, appeared to have died its final death on Monday evening, when Sen. Susan Collins (R-Maine) joined Sens. John McCain (R-Ariz.) and Rand Paul (R-Ky.) in stating her intention to vote no on the bill if it comes up for a vote this week. The Senate GOP's ability to pass a health-care bill with just 50 Republican votes, through the budget reconciliation process, ends Saturday, and Republicans have committed to using next fiscal year's budget resolution to pass tax reform with only GOP votes. But in theory, Republicans could combine health care and tax reform in the same budget vehicle, and that idea is gaining steam.

Sen. Lindsey Graham (R-S.C.) and Sen. Ron Johnson (R-Wis.), both sponsors of Graham-Cassidy, are pushing to combine tax reform and health care, and both Sen. Paul and Senate Finance Committee Chairman Orrin Hatch (R-Utah) are among those interested in the idea. Others, including GOP House tax leaders, are wary of threatening tax reform by mixing it up with an ObamaCare repeal effort that has thwarted Republicans all year. "I think we need to move onto tax reform," said Sen. John Kennedy (R-La.), adding about Graham-Cassidy: "I think this bill's dead."

But it didn't earn the nickname "Zombie TrumpCare" for nothing. Johnson and Graham are both on the Senate Budget Committee, and if both joined all committee Democrats in voting against a budget resolution without health care, it wouldn't pass, meaning tax reform would be at an impasse, too. Both senators threatened to do that on Sunday and Monday. "I think this whole thing is going to get derailed by health care," a GOP lobbyist told Axios. "There are a lot of Republicans who are sick of dealing with health care," says Caitlin Owens at Axios. But President Trump and GOP donors large and small are insistent, and "as we've seen over the last 10 days, it becomes politically difficult for the GOP to ignore a glimmer of hope when it comes to repealing the Affordable Care Act." Peter Weber

September 25, 2017

Senate Republicans and President Trump have not given up on their last-ditch effort to significantly modify Medicaid and the Affordable Care Act, which needs to pass this week to avoid a filibuster from Democrats. On Sunday night, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) released a new draft of their Graham-Cassidy bill, designed to win over holdouts in part by sending more money to Alaska, Maine, Arizona, and Kentucky, the home states of four key senators.

The new version of Graham-Cassidy also includes a special carveout for Alaska, a 25 percent increase in federal matching Medicaid funds. Sen. Lisa Murkowski (R-Alaska) has not said how she plans to vote, Sens. Rand Paul (R-Ky.) and John McCain (R-Ariz.) are pretty hard no votes, and on Sunday's CNN State of the Nation, Sen. Susan Collins (R-Maine) said it would be "very difficult for me to envision a scenario where I would end up voting for this bill," citing its changes to Medicaid, weakened protections for people with pre-existing conditions, and the lack of a Congressional Budget Office analysis of its effects.

In addition to the new funds for certain states, the new draft would make it easier for states to scrap federal insurance requirements, often without a waiver, including increasing the caps on out-of-pocket costs and allowing insurers to drop coverage for maternity care, mental health treatment, drug addiction, and other benefits now deemed essential. It would also allow states to create "multiple risk pools" for healthy and sick people. "This revised bill is tantamount to federal deregulation of the insurance market," said Larry Levitt of the nonpartisan Kaiser Family Foundation. "If there were any doubt that people with pre-existing [conditions] are at risk of being priced out of individual insurance, this bill removes them."

The main hospital, doctor, and insurance groups released a rare joint letter Saturday opposing the bill, though GOP donors are reportedly upset that ObamaCare is still law. Sen. Ted Cruz (R-Texas) told the Texas Tribune Festival in Austin that "right now, they don't have my vote. And I don't think they have Mike Lee's either," referring to a GOP colleague from Utah. Republicans can only lose two votes. Peter Weber

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