A day after endorsing a bipartisan health care bill drawn up by two US senators, the Trump administration came out against the legislation on Wednesday. The deal crafted by Senators Lamar Alexander (Republican of Tennessee) and Patty Murray (Democrat of Washington) appears now to be stalled for the foreseeable future.
The Alexander-Murray bill would restore cost-sharing reduction payments (CSRs) that President Trump announced last week that he was scrapping, while loosening Affordable Care Act (ACA) waivers. Insurance companies would be allowed to offer catastrophic plans to people of all ages, as well as to approve insurance plans with supposed “comparable affordability” to plans offered under the legislation commonly known as Obamacare.
During a White House Rose Garden appearance Tuesday, Trump called the agreement “a short-term deal” that could “get us over this intermediate hump,” and lead to a longer-term solution, involving block grants to states. By the evening, however, the president was commending the deal, while trashing the idea of a “bailout” to the insurers.
On Wednesday, Alexander was still insisting that the president had “completely engineered” the bipartisan proposal. But that same morning, Trump tweeted: “I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins[urance] co’s who have made a fortune w/O’Care.”
House Speaker Paul Ryan also expressed opposition to the bipartisan measure. “The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” Ryan spokesman Doug Andres said.
The apparently doomed Alexander-Murray deal was announced after a series of Trump executive orders over the past two weeks aimed at gutting or weakening some of the ACA’s components. The president has expanded ACA exemptions for employers who claim moral or religious objections from requirements to provide their workers with no-cost birth control.
Trump also finalized an executive order to allow “association health plans” an exemption from the ACA’s requirements to provide 10 essential services in their insurance coverage. The administration also announced that beginning October 18 it would stop CSR payments to private insurers that help low-income Americans purchase health coverage.
Alexander-Murray deals solely with Trump’s executive order regarding CSRs, and would fund them only through 2019. In a modest concession by the Republicans, the bill would provide $106 million in Obamacare outreach funding in 2018 and 2019, directed to the states to help sign up new ACA enrollees.
The bulk of the bipartisan legislation, however, is aimed at lowering requirements for private insurers selling policies in the Obamacare marketplace. Under the ACA’s 1332 waiver program, states can pursue their own health care programs if they provide coverage that is as comprehensive and “at least as affordable” as Obamacare plans themselves would provide.
Under Alexander-Murray, the standard for waivers would be changed to provide coverage “of comparable affordability, including for low-income people, people with serious health needs, and other vulnerable populations.” On this basis, the Department of Health and Human Services (HHS) could grant waivers to states to provide plans less protective than under current law.
Another change would be the expansion of catastrophic coverage under the ACA, making it available to everybody, instead of only to those under age 30. While these plans have lower premiums, they come with higher out-of-pocket costs. This means that older, less healthy people purchasing such plans due to their lower cost could end up with debilitating debt for high out-of-pocket costs from an unexpected—and uncovered—medical event or emergency.
Trump’s flip-flop on supporting the bipartisan measure is in response to Republican pressure to continue pursuing the kind of sweeping changes contained in the numerous failed attempts by Congressional Republicans to “repeal and replace” Obamacare.
Press Secretary Sarah Huckabee Sanders made this clear in a White House Press briefing Wednesday afternoon. While stating that the president felt the legislation was a “good step in the right direction,” she said he could not support a bailout of the insurance companies. She said Trump supports legislation that will “drive competition, lower premiums, and block grants” to the states. She reiterated that the president “does not support the deal.”
In an appearance on Fox News Tuesday morning, President Trump feigned outrage over the profits of the insurance companies, even bringing along visual aids. Pointing to the 270 percent profit increase for Anthem, Humana’s 420 percent increase, Aetna’s 470 percent increase, and Cigna’s 480 percent increase, he said:
“They [the insurers] got a great deal with Obamacare. The one beneficiary—the great beneficiaries for Obamacare is not the people.” While the president here for once speaks a truth, his aim is thoroughly cynical. While decrying the CSR “bailouts” for the insurers, it is clear that insurers will respond to any profit loss due to his cutoff of these payments by charging ACA customers higher premiums, or by pulling out of the Obamacare market altogether.
Both the Republicans and Democrats are interested in reducing costs for the government and corporations, not in improving the quality of health care for working families.
Block granting federal Medicaid payments to the states has been a central component of all the failed Republican “repeal and replace” plans. By providing a capped amount of funding to the states that does not keep pace with need, the Medicaid health insurance program for the poor, elderly and disabled would be virtually ended as a guaranteed program, blocking enrollment for increasing numbers of people who should qualify.
This is the first step toward privatizing Medicaid; and Trump and the Republicans see this as a stepping stone to similar attacks on the Medicare program for the elderly and Social Security, the government retirement benefit.
The Alexander-Murray bill proposes nothing to counter these reactionary proposals to gut Medicaid, or to expand coverage to the 28 million people who remain uninsured nearly eight years after the ACA was signed into law by President Obama. This is because the differences between the Republicans and Democrats on health care “reform” are tactical in nature.
Both parties agree with the underlying foundation of Obamacare, which is based on the capitalist market and places the health of the vast majority of ordinary Americans at the mercy of the profiteering insurance companies, pharmaceuticals and giant health care chains.
Senate Minority Leader Chuck Schumer was outraged over Trump’s change of heart on Alexander-Murray. “The president is pointing fingers,” Schumer said. “He blames [Senate Majority Leader] Mitch McConnell for obstruction. He blames the Democrats for obstruction. He’s the obstructionist-in-chief because he cannot stick to a position.”
But Congressional Democratic leaders have made it clear that they are willing to work with Trump and the Republicans to “fix” Obamacare. The kind of fix they have in mind was expressed in the Alexander-Murray bill, which maintained the CSR payments to private insurers while lowering the availability and quality of coverage for workers and their families.
While they demagogically attack Trump, the Democrats are above all fearful of the growing working-class opposition to growing social inequality and the bipartisan attacks being prosecuted on the social and democratic rights of the working class, including the right to high-quality, affordable health care.