The Affordable Care Act’s biggest challenge right now has nothing to do with the flailing Republican bid to repeal and replace it. It’s President Trump’s threats to cut subsidies that help millions of Americans afford their health care.
The ACA (Obamacare) has aided millions in purchasing private health insurance through billions of dollars of federal subsidies. Much of that is in the form of tax credits, which reduce the premiums that many people pay every month for their coverage.
A recent Vox article highlights a lesser-known piece of the heath care law that helps make health care even more affordable for lower-income people: cost-sharing reductions, or CSRs, which help make copays and deductibles cheaper for people who got insurance through Obamacare.
The Affordable Care Act expanded health coverage for Americans, where insurers are required to sell plans to everyone, no matter their medical history, at similar prices, and to cover a range of “essential health benefits.”
More than half of people who buy individual insurance through Obamacare got this help. About 12 million people bought health insurance through Obamacare’s insurance markets this year, and 7 million of them qualified for CSRs, according to the Kaiser Family Foundation.
Now, those subsidies are facing a huge threat. Trump can try to cut off those payments, which would disrupt Obamacare’s insurance markets and cause them to collapse entirely. Cutting off CSR payments could throw the markets into chaos. And Trump is threatening to do just that.
To counter, Democrats in Congress are warning that the government could shut down at the end of this month if Trump and Republicans refuse to make the payments. They say they would block any spending bill that doesn’t fund the CSR subsidies.
But with Trump and the Republicans in control of the federal government, they can sabotage the law or hold it hostage to try to force Democrats to compromise on a new health care plan.
Trump has taken Obamacare hostage, but at his own risk. Americans would overwhelmingly blame Trump and Republicans if something went wrong with Obamacare, according to the best available surveys.
On top of that, some top House Republicans have said that the payments should be made, one way or another.
According to the New York Times:
Representative Greg Walden, Republican of Oregon, who is the chairman of the Energy and Commerce Committee, said Thursday, “I will do everything I can to make sure that the cost-sharing reduction payments get made.”
“That’s an obligation we have not only to the insurers,” but also to consumers who enrolled in plans under the health care law, Mr. Walden said. “We cannot leave them high and dry.”
As Vox’s Sarah Kliff reported recently:
Trump’s threat is making insurers nervous. Health plans are struggling to decide whether to stay in the law’s marketplaces, because they don’t yet know what’s going to happen to the CSR payments. Trump’s rhetoric could help destabilize the markets on its own — though, again, he may end up taking the blame.
So Trump is wearing a “terrorist jacket” packed with rhetorical dynamite to threat Obamacare. But if he pulls the metaphorical trigger he might end up blowing himself up.