This morning President Trump tweeted the following:
If ObamaCare is hurting people, & it is, why shouldn't it hurt the insurance companies & why should Congress not be paying what public pays?
— Donald J. Trump (@realDonaldTrump) July 31, 2017
That tweet seems to be a restatement of something Trump tweeted Saturday:
If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!
— Donald J. Trump (@realDonaldTrump) July 29, 2017
And that followed a statement Trump made Friday after the Senate repeal effort went down to defeat:
3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!
— Donald J. Trump (@realDonaldTrump) July 28, 2017
The references to insurance companies and the one to letting Obamacare “implode” are all reference to cost-sharing payments which are paid directly to insurance companies. I’ve described these so many times that I’ll let the Associated Press do it this time:
The subsidies, totaling about $7 billion a year, help reduce deductibles and copayments for consumers with modest incomes. The Obama administration used its rule-making authority to set direct payments to insurers to help offset these costs. Trump inherited the payment structure, but he also has the power to end them.
The payments are the subject of a lawsuit brought by House Republicans over whether the health law specifically included a congressional appropriation for the money, as required under the Constitution. Trump has only guaranteed the payments through July, which ends Monday.
Just to give a little backstory, President Trump has been suggesting for months that he could cut off the payments at any time as a way to force Congress to act. He eventually committed to funding them through July which means that as soon as tomorrow, which is August 1st, he could change his mind and announce the payments will end in light of the fact that there is no congressional authorization for them.
Cutting off the payments would lead to numerous insurers dropping out of the exchanges and that would mean large areas of the country (the ones that already have just one insurer) left with zero plans available. Just last week, Anthem said it was waiting to see what happened with the cost-sharing payments to decide if it would pull out of additional states.
The only way to stop insurers from heading for the exits would be for Congress to pass an authorization for the cost-sharing spending. That’s something most Democrats and at least a few moderate Republicans already want to do. On the other hand, Democrats could benefit by not fixing this problem and seeing it become a major issue in 2018 campaigns across the country. They won’t admit it on television of course, but behind the scenes, the party could benefit if Trump follows through on this.
So President Trump really could let Obamacare “implode” as soon as tomorrow, but will he? He’d have to believe there was an upside to doing so, i.e. a better chance of getting repeal passed. But cutting cost-sharing payments probably won’t cause the GOP holdouts to reconsider. Skip about 3 minutes into this clip and you’ll see Sen. Susan Collins saying cutting off the payments won’t change her vote on repeal.
Does President Trump want to take the heat for causing Obamacare to implode even if it won’t get him closer to repeal? His HHS Secretary doesn’t think so. We’ll find out what Trump thinks tomorrow.