For a brief, shiny moment it seemed the Senate would save the cost-sharing subsidies and the ACA. YesterdayÂ Â Sens. Lamar Alexander and Patty Murray submitted a bill that was supposed to do that, anyway.
Trump has said he will discontinue the second [cost sharing] subsidy program. But insurance companies are still requiredÂ by lawÂ to provide these subsidies to their low-income enrollees. They cannot jack up the deductibles on someone who earns 200 percent of the poverty line, even though the government has stopped providing the money.
Insurance companies don’t want to lose money. TheyÂ needÂ a way to offset the sudden loss of billions in government funds. So, they looked for other levers to pull. And many settled on raising premiums as a way to recoup those lost funds.
President Trump is facing a dilemma: Does he want to destroy the American health-care system or not? At this point, all evidence suggests that he genuinely canâ€™t decide what the answer to that question is. …
…Â When the Alexander-Murray agreement was announced yesterday, Trump at first seemed supportive. â€œIt is a short-term solution, so that we donâ€™t have this very dangerous little period â€” including dangerous periods for insurance companies,â€Â he saidÂ at a press conference. â€œFor a period of one year, two years, we will have a very good solution.â€ But then this morning, heÂ tweeted, â€œI am supportive of Lamar as a person & also of the process, but I can never support bailing out ins coâ€™s who have made a fortune w/ Oâ€™Care.â€
What gives? When you try to interpret the presidentâ€™s shifting positions â€” and figure out how this is all going to end â€” there are a few things you have to keep in mind. First, itâ€™s wise to assume that he has no idea how any provision of this agreement or the ACA itself actually works, and that will not change. For instance, he seems to have convinced himself that cost-sharing reductions are like an extra bonus given to insurance companies that theyâ€™ll just use to pad their profits. â€œThat money is going to insurance companies to lift up their stock price,â€ heÂ has said, when in fact the money is basically passed through the insurers to provide lower co-payments and deductibles for people with low incomes. He hasnâ€™t bothered to learn what the law does, and he certainly isnâ€™t going to quickly get up to speed on new proposals to provide technical fixes.
Still, it might be that if he were presented with a bill to sign, he’d sign it. However, Paul Ryan probably has more enthusiasm for cold oatmeal than he has shown for this bill.
â€œThe speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,â€ a Ryan spokesperson toldÂ Axios.
So, not much chance anything is going to happen. Jonathan Swan and David Nather write at Axios that nobody has any idea what Trump actually thinks, “But it’s fair to say that everyone who is remotely conservative inside the administration is pushingÂ notÂ to keep funding the Affordable Care Act’s insurer subsidies without serious concessions.”