Category Archives: Affordable Care Act

Trump Changes Mind, Comes Out Against Bipartisan Obamacare Stabilization Bill

If you feel like you’re getting whiplash just from trying to follow the healthcare policy debate in Washington, you’re not alone; the hits in this saga have been coming seemingly nonstop. After saying the federal government would no longer pay certain subsidies that make the insurance marketplace work, President Trump at first seemed to support a bill that would create short-term stability. But that was yesterday. Today, he’s apparently changed his mind and is now against it.
There’s been a lot going on in healthcare policy in recent weeks; it seems like one of the many unrelenting drumbeats of 2017. But the TL;DR of where we stand today with healthcare is: The payments are a critical part of making the ACA work. The federal government provides cost-sharing subsidies (CSRs) to insurers to offset certain expenses incurred by health plans. Insurers receive those payments to guarantee that co-pays and deductibles for low-income Americans buying coverage on the exchange can stay low. Cut the CSRs, and the insurers have to make up the money somewhere. And that “somewhere” is the consumer’s pocket. Absent the subsidies, premiums, co-pays, and deductibles all shoot upwards — with the effect of utterly destabilizing the individual marketplace. And that brings us to today, when two things at once are going on.

The White House Suddenly Hates Bipartisan Bill

Trying to figure out the White House’s strategy at any given moment in 2017 is, well… let’s be diplomatic and call it a challenge. The day the Alexander-Murray proposal was announced, the President seemed to be in favor of it. He told reporters, “Yes, we have been involved,” adding:
Lamar [Alexander] has been working very, very hard with the Democratic, his colleagues on the other side. And Patty Murray is one of them in particular. And they are coming up and they are fairly close to a short-term solution. The solution will be for about a year or two years. And it will get us over this intermediate hump, because we have, as you probably know — we have — either have the votes or we are very close to having the votes. And we will get the votes for having really the potential of having great health care in our country. So they are indeed working, but it is a short-term solution, so that we don’t have this very dangerous little period.

However, President Trump this morning on Twitter made very clear his personal opinion of the bill has shifted, saying that although he is “supportive of [Sen.] Lamar [Alexander] as a person & also of the process,” he cannot support “bailing out” insurance companies who have “made a fortune” under the ACA.
That’s a pretty significant shift, and it even surprised the Senators involved. “Trump completely engineered the plan that we announced yesterday,” Alexander told Axios about the bill. “He wanted a bipartisan bill for the short term.”

Heading to Court

Meanwhile, the coalition of attorneys general who are suing the administration have also asked the courts to intervene. New York Attorney General Eric Schneiderman and California Attorney General Xavier Becerra both announced today that the coalition was seeking an injunction to put Trump’s policy change on hold and make the payments continue. In the petition [PDF], the attorneys general asked the court “to enter a nationwide temporary restraining order and preliminary injunction requiring [the federal government] to continue making the cost-sharing reduction payments required by the [ACA] pending judicial resolution of this action.” In other words, the AGs are asking the court to maintain the current status quo — where the payments exist — until such time as the lawsuits are decided one way or the other, which can take years. “This is no longer about a campaign promise or a punchline. The Trump Administration is willingly breaking the law by refusing to make required payments that keep healthcare affordable for millions of Americans. It is taking active steps to sabotage the Affordable Care Act,” Becerra said in a statement. Scheiderman echoed the sentiment, saying, “President Trump’s abrupt move to cut these subsidies is reckless, dangerous, – and illegal.” He added, “We won’t stand for it – and we’re moving to block these dangerous cuts before they do any more harm.”

Senate Traffic Jam

There are a heap of other healthcare proposals also floating around in the Senate as we speak. There’s the single-payer, Medicare-for-all proposal co-signed by nearly two dozen Democrats out for consideration. Democratic Sens. Tim Kaine (VA) and Michael Bennet (CO) also just introduced a bill proposing to add a public option that consumers could buy into through the marketplace. But Senate Majority Leader Mitch McConnell has the privilege of setting the chamber’s agenda. So even if a bill actually has enough bipartisan support to move through a committee and pass a vote, it won’t see the light of day if leadership doesn’t want to let it. The Washington Post reports that the Alexander-Murray proposal stalled out in the Senate almost immediately, with “discord” swiftly “casting the plans’ viability into serious doubt.” House Speaker Paul Ryan joined Trump in his criticism of the proposal, Politico notes, which further limits its odds of success (a bill has to pass both the House and the Senate to become law). With Congress either unwilling or unable to take action, that leaves the ball in the court’s court, to either approve or deny the states’ request for an injunction as a next move.

Senators Propose Bipartisan Compromise To Restore Insurance Subsidies

President Trump recently announced that he was pulling the plug on $7 billion a year in federal cost-sharing subsidies to insurance companies selling individual policies to lower-income Americans, but today a pair of influential senators announced a bipartisan compromise that, if approved, would restore those payments for two years, while also giving states more flexibility with rules under the current law. These subsidies, which are paid out monthly by the federal government, are part of the 2010 Affordable Care Act and are intended to keep out-of-pocket expenses — like co-pays and deductibles — low, particularly for Americans making between 100% and 250% of the federal poverty line. Trump had ridiculed these payments as “bailouts” for the insurance industry, and had repeatedly threatened to cut them off, which insurers and other critics said would have the immediate effect of destabilizing the individual insurance market. On Oct. 12, only hours after he signed an executive order undermining other key aspects of the Affordable Care Act, the President released a one-paragraph statement directing that the payments come to a halt. If the payments were to end, it’s expected that many insurance companies would flee the individual marketplace in 2018 and that premiums would continue to soar. Rates for 2018, which were recently locked in, had already been increased in expectation of the White House ending these subsidies. But this afternoon, Sen. Lamar Alexander (TN) and Sen. Patty Murray (WA) — the Republican and Democratic heads, respectively, of the Senate Health, Education, Labor, & Pensions Committee — announced they had ironed out a deal that would preserve the payments for two more years. The compromise also reportedly includes additional flexibility in what’s known as the Section 1332 waiver program, which allows states to apply for innovation wavers. Under a 1332 waiver, any tweaks a state makes to its insurance requirements must result in insurance that is just as comprehensive and as affordable as what would be available without the waiver; in other words, it can’t be used to make insurance worse in a state. Alexander told reporters this afternoon that the proposed change to the 1332 waivers would both speed up the review process for each waiver request and loosen the threshold to “comparable affordability,” meaning a waiver could open the door to insurance that is more expensive than what would be purchased without the waiver. The senators claim that the change to the waiver program will not — as was proposed by GOP lawmakers multiple times during the failed repeal and replace legislative efforts — allow states to opt of requiring that insurance carriers cover the ACA’s list of mandatory Essential Health Benefits. In an apparent effort to make insurance more affordable for some, the bill proposes letting Americans over the age of 30 buy catastrophic insurance plans — aka “copper” plans — that cost less but also provide less coverage for general health maintenance. Politico reports that the bill adds $106 million back into support for ACA enrollment. The Trump administration recently gutted funding for the upcoming enrollment period, which has also been cut in half. The Alexander-Murray legislation has not been finalized, but Murray told reporters this afternoon that the final details are being ironed out and that she’s “very optimistic” that it will move forward. If the compromise does make it to the Senate floor, it would be first bipartisan piece of health insurance reform to do so. Unlike the unsuccessful repeal bills, this legislation could pass without full support from either party. Right now, some GOP lawmakers are being cautiously supportive of the proposed compromise. Sen. John Thune (SD) said today that, from what he’s seen of the bill, it “is something I think will attract a good number of votes for people who want to see a near-term solution that ensures stability in the markets and enables and sets up a debate down the road.” While some more hardline conservatives are already opposing the proposal, claiming that they won’t stand for anything other than full repeal of the ACA. “The GOP should focus on repealing & replacing Obamacare, not trying to save it,” Tweeted Rep. Mark Walker (NC), head of the conservative Republican Study caucus. “This bailout is unacceptable.” One big question that remains to be answered is whether Senate leadership will make time for this bill to be considered in the coming weeks, or if it will be delayed until after Congress has dealt with other matters, like tax reform. While legislators move forward with this possible compromise, several states are currently suing the Trump administration in the hope of restoring the subsidies. They argue that the President doesn’t have the authority to cut off these payments on a whim, and that he is violating the Take Care clause of the Constitution by not faithfully executing the laws of the country.

Senators Reach Bipartisan Deal On Resuming Payments To Health Insures

WASHINGTON (AP) — Key senators reached a breakthrough deal Tuesday on resuming federal payments to health insurers that President Donald Trump has blocked. Insurers had warned that unless the money is quickly restored, premiums will go up. At the White House, the president spoke favorably about the bipartisan compromise, which is still likely to face opposition in Congress. The agreement would involve a two-year extension of federal payments to insurers that Trump halted last week, said Sen. Lamar Alexander, R-Tenn. Unless the money is quickly restored, insurers and others say that will result in higher premiums for people buying individual policies and in some carriers leaving unprofitable markets. Alexander and Sen. Patty Murray, D-Wash., have been working for weeks on health care legislation, separate from repeated and unsuccessful efforts by GOP leaders to dismantle Barack Obama’s Affordable Care Act. Emerging from a closed-door GOP luncheon on Tuesday, Alexander said, “Senator (Patty) Murray and I have an agreement,” and added that Trump has encouraged them and the “president likes this idea.” While the agreement is a breakthrough, they still need to secure the support of fellow Republicans and Democrats. Majority Leader Mitch McConnell, R-Ky., was noncommittal while Minority Leader Chuck Schumer, D-N.Y., welcomed the agreement as a step forward that will provide stability for insurance markets in the short-term. Murray hailed the bipartisan effort, saying “when Republicans and Democrats take the time … we can truly get things done” for the American people. In brief comments at the White House, Trump offered support. “It is a short-term solution so we don’t have this very dangerous little period,” the president said. Murray and Alexander began talks on extending the payments months ago, when Trump was frequently threatening to stop the subsidies. Both had said they were close to a deal, but GOP leaders shut the effort down in September when the Senate revisited the Republican drive to repeal Obama’s law. The repeal effort failed, as did an earlier GOP attempt to dismantle the law in July. Trump’s halt of the payments and worries about its impact have galvanized lawmakers in both parties to take action to prevent it. Even so, strong opposition by some conservatives means the congressional fate of a compromise would be uncertain. For their part, Democrats believe Republicans in control of Washington will be blamed by voters for future health care problems and are reluctant to bend too far toward GOP demands for opening loopholes in Obama’s law. Alexander said Trump has twice in recent days urged him to reach a deal with Murray. “He says he doesn’t want people to be hurt in this interim,” said Alexander, a reference to Trump’s desire to revisit the effort to scrap Obama’s statute next year. Trump repeated his gloomy assessment of a law that’s expanded health coverage to 20 million people and required insurers to cover specified services and limit costs, but has also seen premiums rise and limited competition in some regions. “Obamacare is virtually dead. At best you could say it’s in its final legs. The premiums are going through the roof. The deductibles are so high that people don’t get to use it. Obamacare is a disgrace to our nation and we are solving the problem of Obamacare,” he told reporters in the Oval Office. Senate Minority Leader Chuck Schumer, D-N.Y., said Trump’s stoppage of the payments “showed that he’s willing to take a wrecking ball to our nation’s health care for the sake of politics.” He said congressional support for an agreement between Alexander and Murray would show lawmakers have “no intention of going along with President Trump’s reckless sabotage of the nation’s health care law.” Under Obama’s 2010 overhaul, the government must pay insurers for reducing out-of-pocket expenses for lower-earning customers. A federal judge has ruled that Congress hadn’t legally approved the payments, but Obama — and initially Trump — continued them anyway. Trump halted them last week, even though by law insurers must continue reducing costs for lower-income consumers. Trump and some Republicans consider the payments to be bailouts to carriers. But Democrats and some Republicans say halting them would create chaos in insurance market places. The so-called cost-sharing reductions cost around $7 billion this year and lower expenses like co-payments and deductibles for more than 6 million people. © Copyright 2017 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.

Denver Teacher Sues President Trump Over New Contraceptives Rules

By Rick Sallinger DENVER (CBS4) – A school teacher in Denver is suing President Trump and members of his cabinet over contraceptives. Under the new rules made to the Affordable Care Act, employers and insurers can decline to provide birth control if it violates their religious beliefs or moral convictions. Jessica Campbell, a math teacher at Colorado Academy in Denver has now filed a lawsuit challenging that. Her attorney Alan Kennedy-Shaffer says the changes are unconstitutional.
contraceptives lawsuit Denver Teacher Sues President Trump Over New Contraceptives Rules

A lawsuit over new mandates on contraceptives lists President Donald Trump as a defendant. (credit: CBS)

“This gives employers a license to discriminate against women by taking away with their birth control,” Kennedy-Shaffer says. The suit names President Trump and members of his cabinet as defendants. It states Campbell uses contraception not just for birth control, but for “medically necessary health and safety reasons.” It cites statements made during the election campaign by Trump the suit calls “vulgar and derogatory about women.” On the other side, there are those who feel contraception is wrong. A prayer vigil took place outside Planned Parenthood in the Stapleton area of Denver y the group “40 Days for Life”, it was directed primarily against abortion, some of those present spoke about contraception with CBS4 regarding the changes to the Affordable Care Act, known as Obamacare. Nickie Tomaino said, “Obamacare is not going to pay for that and I am not going to pay for anyone else’s contraception,”
contraceptives2 Denver Teacher Sues President Trump Over New Contraceptives Rules

A prayer vigil happens outside of a Denver Planned Parenthood. (credit: CBS)

Several attorneys general have already filed lawsuits by states against the government over the changes. The lawsuit by Jessica Campbell is believed to be the first in Colorado. Her employer, Colorado Academy issued a statement from Dr. Mike Davis, the head of the school saying, “Any questions about the lawsuit filed by Ms. Campbell should be directed to her attorney, Alan Kennedy-Shaffer. In choosing to file the lawsuit, she is acting independently from Colorado Academy. Ms. Her employer, Colorado Academy issued a statement from Dr. Mike Davis, the head of the school saying, “Any questions about the lawsuit filed by Ms. Campbell should be directed to her attorney, Alan Kennedy-Shaffer. In choosing to file the lawsuit, she is acting independently from Colorado Academy. Ms. Campbell continues to receive health insurance coverage as an employee of Colorado Academy and her benefits, which include coverage for contraception and contraceptive care, have not changed, and there are no plans to change those benefits.” Rocky Mountain Planned Parenthood’s Adrienne Mansanares issued a statement that read, “Planned Parenthood of the Rocky Mountains proudly stands by increasing access to reproductive health care, that includes access to birth control.  With this rule in place, a woman’s decision to access birth control is made for her by her boss. Placing barriers in front of health care that the vast majority of women will use in their lifetime is an insult to our fundamental rights and health. This administration is telling women in America they can’t be trusted to make their own health care decisions and must get permission from their employer first: it’s a dangerous intrusion in women’s ability to get the care they need.” The lawsuit by Jessica Campbell is asking for a temporary injunction to block the changes to the regulations that have already taken effect. CBS4’s Rick Sallinger is a Peabody award-winning reporter who has been with the station more than two decades doing hard news and investigative reporting. Follow him on Twitter @ricksallinger.

States Sue Trump Administration For Halting $7 Billion In Cost-Sharing Payments To Insurers

With a one-paragraph statement released late in the evening on Thursday, President Trump announced he was pulling the plug on $7 billion a year in payments from the federal government to insurance companies who sell individual policies through the exchanges set up by the Affordable Care Act. Today, at least five states say they are suing to keep these subsidies in place. The monthly payments, known as cost-sharing subsidies, are part of the 2010 Affordable Care Act and are intended to keep out-of-pocket expenses — like co-pays and deductibles — low, particularly for Americans making between 100% and 250% of the federal poverty line. Because the exact payments are not appropriated by Congress, President Trump has maintained that he has the authority to end them at any time. However, some state attorneys general disagree that Trump can turn these payments off like a garden spigot, and are planning to file a lawsuit against the administration this afternoon in a California federal court. Canceling these subsidies, says California Attorney General Xavier Becerra, is a violation of the Administrative Procedures Act, the law that details how federal agencies do things like make, change, and repeal rules and regulations. What’s more, these states argue, President Trump is violating the “Take Care” clause of the Constitution, which states that the President shall “take Care that the Laws be faithfully executed.” Becerra and the other attorneys general involved in this suit contend that President Trump is violating the Take Care clause by deliberately going against the intent of the Affordable Care Act. “It’s lost past time that President Trump learn he doesn’t get to pick and choose which laws he will follow,” said Becerra at a Friday morning press conference. He was joined by Kentucky Attorney General Andy Beshear, Attorney General Maura Healey of Massachusetts, and Connecticut AG George Jepsen, all of whom have signed on as plaintiffs in this case. New York is also part of this lawsuit, and it’s possible that other states could also sign on. —
UPDATE: Per Becerra’s office, the states signing on to this lawsuit are currently California, Kentucky, Massachusetts, Connecticut, New York, Delaware, Maryland, Oregon, North Carolina, Illinois,Vermont, Pennsylvania, Rhode Island, Virginia, Minnesota, New Mexico, Washington, Iowa, and Washington, D.C.
— “The government’s plan to stop paying subsidies will cripple healthcare here in Kentucky,” said Beshear in a statement, pointing out that 88,000 Kentuckians have coverage through the ACA exchange, but will likely see their health insurance costs rise at least 20%. “These companies are going to pass on the costs of the federal government’s broken promises to you and me,” said Beshear. “And for so many Kentuckians, who are already struggling at the end of the month to pay the power bill and to pay for their healthcare, it’ll get that much harder if not impossible.” The higher premiums and lack of subsidies, noted the AGs, won’t necessarily be felt by the lowest-income Americans, whose premiums are currently capped under the law. It’s the middle-class Americans who are purchasing insurance on their own — families that make too much money to qualify for the premium caps but not enough to afford the higher rate — that will likely be harmed the most, whether it’s because they have to overpay for coverage or go without insurance. “This lawsuit isn’t about the president at all,” said Beshear, acknowledging that probably 70% of the Kentuckians that could be negatively affected by these cuts voted for Trump. “It’s about Kentuckians deserving healthcare that they can afford and the federal government keeping its word.” At a later press conference, New York Attorney General Eric Schneiderman argued that the Trump administration is illegally disregarding existing statutes in order to “simply to blow up the system.” “The Affordable Care Act is the law of the land” said Schneiderman, pointing out that the law has withstood multiple challenges before the Supreme Court. “We are not going to let the President destroy a system that has been providing for so many of our people.” The suit being filed by the states is seeking a preliminary injunction that would bar the government from halting the payments pending the outcome of the case. It’s also seeking a declaratory judgment from the court that these payments are allowed by the Affordable Care Act. That second part might be a bit tricky, as these subsidies are also the subject of a separate, ongoing legal dispute involving their legality. In 2014, Republican members of the House of Representatives sued the Department of Health and Human Services, arguing that Congress had not properly authorized these payments. A District Court judge agreed with the GOP in 2016, but allowed the payments to continue pending the outcome of an appeal filed by the Obama administration. However, after Trump took office, the new administration has made it clear that it has no intention of continuing that appeal. So in Aug. 2017, the Court of Appeals for the D.C. Circuit allowed a coalition of states — including all of the states involved in the lawsuits being filed today — to intervene and effectively take the government’s place, defending the subsidies. That appeal has yet to be heard by the D.C. Circuit. All of the lawsuits can be mooted by Congressional action. If, as many of the attorneys general have suggested, legislators can revise the law so that it explicitly includes these payments in appropriations then there would nothing for the President to halt, and nothing for the states to sue over.

Trump To Issue Stop-Payment Order On Health Care Subsidies

WASHINGTON (AP) — In a brash move likely to roil insurance markets, President Donald Trump will “immediately” halt payments to insurers under the Obama-era health care law he has been trying to unravel for months. Before sunrise Friday morning, Trump went on Twitter to urge Democrats to make a deal: “The Democrats ObamaCare is imploding,” he wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” The Department of Health and Human Services had made the announcement in a statement late Thursday. “We will discontinue these payments immediately,” said acting HHS Secretary Eric Hargan and Medicare administrator Seema Verma. Sign-up season for subsidized private insurance starts Nov. 1, in less than three weeks, with about 9 million people currently covered. In a separate statement, the White House said the government cannot legally continue to pay the so-called cost-sharing subsidies because they lack a formal authorization by Congress. Officials said a legal opinion from the Justice Department supports that conclusion. However, the administration had been making the payments from month to month, even as Trump threatened to cut them off to force Democrats to negotiate over health care. The subsidies help lower copays and deductibles for people with modest incomes. Halting the payments would trigger a spike in premiums for next year, unless Trump reverses course or Congress authorizes the money. The next payments are due around Oct. 20. The top two Democrats in Congress sharply denounced the Trump plan in a joint statement. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” said House and Senate Democratic leaders Nancy Pelosi of California and Chuck Schumer of New York. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.” In a subsequent tweet, Trump asserted, “Obamacare is a broken mess. Piece by piece we will now begin the process of giving America the great HealthCare it deserves.” The president’s action is likely to trigger a lawsuit from state attorneys general, who contend the subsidies to insurers are fully authorized by federal law, and say the president’s position is reckless. “We are prepared to sue,” said California Attorney General Xavier Becerra. “We’ve taken the Trump Administration to court before and won.”
Word of Trump’s plan came on a day when the president had also signed an executive order directing government agencies to design insurance plans that would offer lower premiums outside the requirements of President Barack Obama’s Affordable Care Act. Frustrated over setbacks in Congress, Trump is wielding his executive powers to bring the “repeal and replace” debate to a head. He appears to be following through on his vow to punish Democrats and insurers after the failure of GOP health care legislation. On Twitter, Trump has termed the payments to insurers a “bailout,” but it’s unclear if the president will get Democrats to negotiate by stopping payment. Experts have warned that cutting off the money would lead to a double-digit spike in premiums, on top of increases insurers already planned for next year. That would deliver another blow to markets around the country already fragile from insurers exiting and costs rising. Insurers, hospitals, doctors’ groups, state officials and the U.S. Chamber of Commerce have urged the administration to keep paying. Leading GOP lawmakers have also called for continuing the payments to insurers, at least temporarily, so constituents maintain access to health insurance. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., is working on such legislation with Democratic Sen. Patty Murray of Washington. The so-called “cost-sharing” subsidies defray copays and deductibles for people with low-to-modest incomes, and can reduce a deductible of $3,500 to a few hundred dollars. Assistance is available to consumers buying individual policies; people with employer coverage are unaffected by the dispute. Nearly 3 in 5 HealthCare.gov customers qualify for help, an estimated 6 million people or more. The annual cost to the government is currently about $7 billion. But the subsidies have been under a legal cloud because of a dispute over whether the Obama health care law properly approved them. Adding to the confusion, other parts of the Affordable Care Act clearly direct the government to reimburse the carriers. For example, the ACA requires insurers to help low-income consumers with their copays and deductibles. And the law also specifies that the government shall reimburse insurers for the cost-sharing assistance that they provide. But there’s disagreement over whether the law properly provided a congressional “appropriation,” similar to an instruction to pay. The Constitution says the government shall not spend money unless Congress appropriates it. House Republicans trying to thwart the ACA sued the Obama administration in federal court in Washington, arguing that the law lacked specific language appropriating the cost-sharing subsidies. A district court judge agreed with House Republicans, and the case has been on hold before the U.S. appeals court in Washington. Up to this point the Trump administration continued making the monthly payments, as the Obama administration had done. While the legal issue seems arcane, the impact on consumers would be real. The Congressional Budget Office estimated that premiums for a standard “silver” plan will increase by about 20 percent without the subsidies. Insurers can recover the cost-sharing money by raising premiums, since those are also subsidized by the ACA, and there’s no legal question about their appropriation. Consumers who receive tax credits under the ACA to pay their premiums would be shielded from those premium increases. But millions of others buy individual health care policies without any financial assistance from the government and could face prohibitive increases. Taxpayers would end up spending more to subsidize premiums. © Copyright 2017 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.

Trump To Halt Health Insurer Subsidies In New Blow To Obamacare

WASHINGTON (AP) — In a brash move likely to roil insurance markets, President Donald Trump plans to halt payments to insurers under the Obama-era health care law he has been trying to unravel for months. RELATED ARTICLE: Trump Signs Executive Order To Begin Dismantling Obamacare Two people familiar with the decision described the plan late Thursday night, seeking anonymity because they were not authorized to speak publicly. The White House said in a statement that the government cannot legally continue to pay the so-called cost-sharing subsidies because they lack a formal authorization by Congress. However, the administration had been making the payments from month to month, even as Trump threated to cut them off to force Democrats to negotiate over health care. The president’s action is likely to trigger a lawsuit from state attorneys general, who contend the subsidies to insurers are fully authorized by federal law, and say the president’s position is reckless. Among the likely consequences: a spike in premiums for next year. The top two Democrats in Congress sharply denounced the Trump plan in a joint statement. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” said House and Senate Democratic leaders Nancy Pelosi of California and Chuck Schumer of New York. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.” Word of Trump’s plan came on a day when the president had also signed an executive order directing government agencies to design insurance plans that would offer lower premiums outside the requirements of President Barack Obama’s Affordable Care Act. Frustrated over setbacks in Congress, Trump is wielding his executive powers to bring the “repeal and replace” debate to a head. He appears to be following through on his vow to punish Democrats and insurers after the failure of GOP health care legislation. On Twitter, Trump has termed the payments to insurers a “bailout,” but it’s unclear if the president will get Democrats to negotiate by stopping payment. Experts have warned that cutting off the money would lead to a double-digit spike in premiums, on top of increases insurers already planned for next year. That would deliver another blow to markets around the country already fragile from insurers exiting and costs rising. Insurers, hospitals, doctors’ groups, state officials and the U.S. Chamber of Commerce have urged the administration to keep paying. Leading GOP lawmakers have also called for continuing the payments to insurers, at least temporarily, so constituents maintain access to health insurance. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., is working on such legislation with Democratic Sen. Patty Murray of Washington. The so-called “cost-sharing” subsidies defray out-of-pocket expenses for people with low-to-modest incomes, and can reduce a deductible of $3,500 to a few hundred dollars. Assistance is available to consumers buying individual policies; people with employer coverage are unaffected by the dispute. Nearly 3 in 5 HealthCare.gov customers qualify for help, an estimated 6 million people or more. The annual cost to the government is currently about $7 billion. But the subsidies have been under a legal cloud because of a dispute over whether the Obama health care law properly approved the payments to insurers. Adding to the confusion, other parts of the Affordable Care Act clearly direct the government to reimburse the carriers. For example, the ACA requires insurers to help low-income consumers with their copays and deductibles. And the law also specifies that the government shall reimburse insurers for the cost-sharing assistance that they provide. But there’s disagreement over whether the law properly provided a congressional “appropriation,” similar to an instruction to pay. The Constitution says the government shall not spend money unless Congress appropriates it. House Republicans trying to thwart the ACA sued the Obama administration in federal court in Washington, arguing that the law lacked specific language appropriating the cost-sharing subsidies. A district court judge agreed with House Republicans, and the case has been on hold before the U.S. appeals court in Washington. Up to this point the Trump administration continued making the monthly payments, as the Obama administration had done. The round of payments would be due around Oct. 20. A panel of appellate judges recently ruled that a group of states can defend the legality of the subsidies if the Trump administration decides to stop paying. While the legal issue seems arcane, the impact on consumers would be real. The Congressional Budget Office estimated that premiums for a standard “silver” plan will increase by about 20 percent without the subsidies. Insurers can recover the cost-sharing money by raising premiums, since those are also subsidized by the ACA, and there’s no legal question about their appropriation. Consumers who receive tax credits under the ACA to pay their premiums would be shielded from those premium increases. But millions of others buy individual health care policies without any financial assistance from the government and could face prohibitive increases. It’s also estimated that taxpayers would end up spending more to subsidize premiums. Earlier Thursday, Trump had directed government agencies to design a legal framework for groups of employers to band together and offer health insurance plans across state lines, a longstanding goal for the president. © Copyright 2017 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed

RNC Chairwoman Visits Denver Amid Health Care Fight

By Shaun Boyd DENVER (CBS4) – The Chair of the Republican National Committee says President Trump’s commitment to repeal and replace Obamacare is one of the reasons the RNC is seeing record fundraising in a post-presidential year. Ronna Romney McDaniel made the remarks while in Denver to celebrate Hispanic Heritage Month. The comments came on the same day the president signed an executive order to start unwinding the Affordable Care Act.
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(credit: CBS)

“I was aware this was something the White House was looking at, and I’ve heard it from other senators that they thought it was a great idea,” McDaniel said. The idea is to make it easier for small businesses, trade associations and labor unions to band together across state lines and buy less expensive, less comprehensive policies.
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(credit: CBS)

“Small businesses haven’t had the same leverage as bigger companies,” McDaniel said, “So this is going to give them the opportunity to lower the cost of health care for their employees. It is a great thing and I applaud the president for taking this action.” But, democrats say the bare-bones plan will draw young, healthy people out of exchanges, causing premiums to skyrocket and the marketplace to collapse. Colorado’s Democratic Senator Michael Bennet says the order “will weaken consumer protections, resulting in skimpier plans and higher health care bills for people with preexisting conditions.” Bennet sits on a health committee which is in the process of drafting legislation to stabilize the marketplace.
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(credit: CBS)

McDaniel says more needs to be done, “The president hasn’t given up on repeal and replace and neither has Congress. We still have next year under reconciliation to look at that.” She wouldn’t comment on whether the party would punish lawmakers who voted against the legislation. It could take up to six months for the administration to implement the order. Cabinet agencies will need to write rules and the changes will be subject to public comment. Some democratic attorneys general are also threatening to sue over the order. RELATED: ‘We Are Relieved’: Hickenlooper Reacts To Latest GOP Health Care Failure Shaun Boyd is CBS4’s political specialist. She’s a veteran reporter with more than 25 years of experience. Follow her on Twitter @cbs4shaun.

Trump Signs Executive Order To Begin Dismantling Obamacare

(CBS News) — President Trump on Friday announced he is “starting that process” of repealing and replacing Obamacare with his executive order to unilaterally change some aspects of health insurance coverage. Mr. Trump, surrounded by top administration officials, business leaders and Sen. Rand Paul, R-Kentucky, in the White House Roosevelt Room, praised his executive order as step towards repealing and replacing his predecessor’s signature health care law. Mr. Trump, stuck with a Republican-led Congress that hasn’t passed a bill to undo Obamacare, announced earlier this week that he is resorting to his “pen” instead. Mr. Trump began to walk out of the room Friday without signing the order, until Vice President Mike Pence reminded him to, used that pen on Friday. “We’ve been hearing about the disaster of Obamacare for so long — in my case, many years, most of it outside in civilian life,” Mr. Trump said. “And for a long period of time since I’ve started running and since I became president of the United States, I just keep hearing ‘repeal and replace, repeal and replace.’ Well, we’re starting that process, and we’re starting it in a very positive manner.” Mr. Trump said the order will cost the federal government “virtually nothing,” and will force insurance companies to start “fighting” to sign people up for care. “But the competition will be staggering,” Mr. Trump said. “Insurance companies will be fighting to get every single person signed up, and you will be hopefully negotiating, negotiating, negotiating, and you’ll get such low prices for such great care.” Mr. Trump didn’t back down from his goal of repealing Obamacare and fulfilling a signature campaign promise, despite the GOP-led Congress’ inability to agree on how to do that. Mr. Trump said he will “pressure” Congress to repeal and replace Obamacare, “once and for all.” “Well, this is promoting healthcare choice and competition all across the United States,” Mr. Trump said. “This is going to be something that millions and millions of people will be signing up for, and they’re going to be very happy. This will be great health care.” The president’s executive order is intended to make lower-premium plans more widely available. Mr. Trump has long talked about his desire to make health insurance plans available across state lines. His order directs Labor Secretary Alexander Acosta to consider expanding access to association health plans, which could possibly allow American employers to form groups across state lines, according to the White House. The order could also allow employers in the same line of work to join together to offer health care to employees, no matter their state. The president’s order, according to the White House, also directs the Labor Department, Treasury Department, and Health and Human Services Department to consider expanding coverage for short-term, limited duration plans that could be made available to people in specific circumstances, like if a person loses his job or misses the open enrollment deadline. But the president’s executive order is likely to face backlash from medical groups, and could very well face a legal challenge.

Former President Barack Obama was criticized heavily by Republicans in 2014 when he said, I’ve got a pen and I’ve got a phone,” a nod to his intention to use executive action when Congress wouldn’t cooperate. © 2017 CBS Interactive Inc. All Rights Reserved.

Trump Issues Executive Order To Kill Off Several Key Obamacare Provisions

What the Senate twice failed to do, the White House is now doing by fiat: President Trump today signed an executive order to undercut several key provisions of the Affordable Care Act and once again transform the nation’s health insurance markets. In his signing remarks, Trump said the executive order was, “Very very powerful for our nation” and outlined the key provisions he sought to change.

What’s changing?

The order can’t entirely repeal and replace the ACA, as the President noted in his remarks, but it can take aim at certain key provisions. The specific changes the White House seeks are to:
  • Expand Association Health Plans — less-regulated group insurance plans purchased collectively by similar sorts of employers — to permit any “association” to purchase policies across state lines
  • Expand short-term limited-duration insurance — plans lasting only a few months intended to bridge gaps in coverage — to last longer and be available to more buyers
  • Expand tax-privileged reimbursement accounts that employers can use to reimburse workers for healthcare costs

What will the effects be?

This is where it gets complicated. What Are Association Health Plans?
They let individuals and small employers band together to negotiate group insurance plans like the ones large employers provide for their employees. In theory, they don’t sound like a bad idea but the non-partisan Kaiser Family Foundation notes that those plans could offer fewer benefits than plans which currently fall under regulation by the ACA. So while they would cost less, that would be because they provide less coverage, with higher deductibles and out-of-pocket costs for anyone covered under those plans. Vox recently observed that a loophole in Tennessee law has allowed Association Health Plans to continue into the ACA era, with negative results. The Tennessee association plan estimates that it has roughly 23,000 members enrolled in plans that are not ACA-compliant, Vox reports. Those 23,000 are, presumably, younger, healthier patients that don’t have need for extensive medical coverage at this time. But insurance works, at a very basic and fundamental level, by pooling risk. Early insurers sold policies to a hundred ships; 99 made it back to shore safely and they only had to pay out for the one that sank. A car insurance company insures both good drivers and bad, and makes money by pocketing premiums from everyone who doesn’t need to file claims and distributing a smaller amount back to those who do. A health insurance company theoretically works the same way: it takes in premiums from young and old, healthy and sick alike, and then only needs to pay out claims for a small percentage of its overall customer base. But when you sell two tiers of plans, you end up splitting your pool into two tiers of customers, too. Younger customers, or those who manage to keep aging without developing a single pre-existing condition, opt for the cheaper, skimpier plans. That means that customers who are aging, and those who have ever had a disease or injury to contend with, end up having to pay significantly higher costs to obtain coverage that does what they need. And that’s exactly what has happened in Tennessee: the state’s marketplace has some of the sickest participants in the entire country, Vox reports, and as a result also some of the highest premiums in the country. The National Association of Insurance Commissioners — an organization representing the various state insurance regulators — has been cautious of deregulating association health plans. Each state regulates and licenses the insurance sold in its borders, and the NAIC has raised concerns that expanding association plans to allow for cross-state selling could “result in less protections for the most vulnerable populations and the collapse of individual markets across the country.” “If the federal government pre-empts state licensure requirement out-of-state insurers would be able to lure healthy enrollees away from existing risk pools,” the NAIC told a House Judiciary subcommittee in February, “which would become progressively sicker and more expensive until they ultimately fail, leaving consumers in those states with, possibly, no carriers in their states and no in-state networks of participating providers.” In response to today’s executive order, NAIC CEO Mike Considine expressed concern about possible expansion of association plans but noted that “nothing is written in stone yet,” since the order is just the first step in a lengthy process of rulemaking that will involve multiple agencies. Longer Short-Term Plans
Similarly, short-term limited-duration plans are currently exempt from many ACA requirements, as Trump noted in his remarks. These plans are currently limited to a maximum of three months, and they’re meant to provide basic coverage for individuals who are otherwise between coverage — when you’ve left school but haven’t left started your job, or are between jobs, for example. They’re a stopgap. The upshot of both policies, taken together, is that critics fear this executive order could split the insurance market into separate risk pools, leaving many Americans without coverage when they need it, and sending costs skyward for others. Meet The New HSA: Healthcare Reimbursement
The third tentpole of the executive order has to do with expanding “Health Reimbursement Arrangements,” which seems to be the Administration’s new catch-all term for Health Savings Accounts and other similar vehicles. MORE: WHAT ARE HEALTH SAVINGS ACCOUNTS, AND WHY ARE THEY A BIG PART OF ACA REPLACEMENT PLANS? As we’ve explained before, HSAs are tax-advantaged accounts — the money comes out before your taxes are calculated, like 401(k) contributions. These accounts largely exist to offset the high out-of-pocket costs individuals with high-deductible health plans face when seeking care. However, with changes that were proposed in the now-abandoned House effort to repeal and replace the ACA, these small tax shelters were poised to become bigger, better tax shelters for those who have money to squirrel away — a plan that the executive order now seeks to try to resurrect.

Is this binding? When will the law change?

The President doesn’t create regulations on private business. The best he can do is direct federal agencies to make rules, so long as they comply with existing law. So this executive order specifically asks several cabinet agencies — the Department of Labor, the Department of the Treasury, and the Department of Health and Human Services — to themselves investigate how best to make changes to current federal regulations that would result in the White House’s desired outcome. The various departments could, in theory, examine the directive, determine it’s unworkable, and return a consideration of “no.” That won’t happen, of course, but it is technically possible. The Cabinet officials in question, instead, are friendly to the proposal — but making real change takes time, even for an agency that wants to move quickly. An administration official told CNN that actually crafting and enacting policy changes could take six months or more. Some complicated regulations have taken years and gone through multiple iterations before being finalized, and even then they may face legal challenges, and possibly legislative repeal efforts if the political makeup of either chamber of Congress changes significantly in the interim. In the meantime however, the executive order may become moot if Congress manages to rally and pass some kind of repeal-and-replace legislation. “This is only the beginning,” Trump noted at the end of his remarks. The White House has a plan to curtail more pieces of the ACA, “to take measures to provide our people with more relief and freedom,” mainly in the form of “massive tax cuts,” he said. Trump also added, “We are going to also pressure Congress very strongly to finish the repeal and the replace of Obamacare once and for all,” concluding, “We will have great healthcare in our country.”

Is there going to be a legal challenge?

Some kind of challenge is all but guaranteed — the question is, what kind, and from whom. Legal experts speaking with Politico considered that reinterpreting the Employee Retirement Income Security Act (ERISA) in order to expand association health plans might be a violation of that law. “How that doesn’t get challenged, how that isn’t such an expansive interpretation of ERISA that goes beyond the administration’s authority — someone’s absolutely going to” file a challenge, one insurance industry official told Politico, adding, “This is chaos.” The Wall Street Journal and Washington Post also both speculate that the part of the order targeting ERISA is the most likely to face legal complaints. Pretty much every single kind of stakeholder you can think of, including the insurance companies, absolutely hated the last bill the Senate ultimately abandoned, and many groups that criticized that bill are already out with criticisms of the executive order. “While this executive order claims to help improve consumers’ access to affordable care, it would have the exact opposite effect,” our colleague Betsy Imholz, special projects director at Consumers Union, notes in a statement. “Allowing insurers to sell substandard association health plans that aren’t required to cover basic services and benefits will further fragment and destabilize the insurance markets as a whole,” Imholz added. “This action splits the market into two, pitting the healthy against those with preexisting conditions and life-threatening illnesses — but ultimately both groups lose in this new scheme.”