Donald Trump’s done a lot of bad things in his 10 months in the White House, but until Thursday, none of them constituted a direct attack on the well-being of millions of Americans. With his health-care executive order and then his late-night announcement that the government would be immediately ending cost-sharing reduction payments (CSRs), he has created a situation that will throw millions of Americans—sick Americans, people with diabetes and cancer and other diseases—into turmoil.
I suspect he has no idea what he’s uncorked, and the price he and his party are likely to pay politically. We’ll get to that, but first let’s talk about the real price being paid by real people.
These payments, about $7 billion this year, are made by the government to insurance companies to help them afford the cost of covering sick people. They’ve been fundamental to the whole idea of making sure that sick people, people with pre-existing conditions, could purchase health coverage.
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Now, because of this decision—announced in the dark of a Thursday night when Washingtonians were mostly focused on that endless Nationals game—insurance companies are contemplating a future in which they are no longer subsidized for covering people it’s expensive to cover. What are they going to do? Pretty simple: Jack up rates, or stop covering them. The Congressional Budget Office in August estimated premiums will be 20 to 25 percent higher than with the subsidies.
And get this. The decision will dramatically increase the budget deficit! That’s because even though premiums will increase, the people buying the coverage won’t magically have more income, so someone has to cover the cost of the premium hikes. Who? Yep, the federal government, but this time in the form of direct subsidies to purchasers. Which is $194 billion more expensive! Party of fiscal responsibility.
I can’t think of a time a president has gone out of his way, and he really did, to put citizens at direct risk—deliberately and openly causing people to suffer. And for what? To erase from the books a law that bears the name of his hated predecessor. This isn’t close to normal. Other presidents want to undo the work and legacies of predecessors with whom they disagreed, sure. But they haven’t done it like this, playing with the lives of Americans, and with no Plan B to replace what they’re taking away.
And then Trump tweeted at 5:30 Friday morning:
“Has stopped”? Has stopped? He stopped it! And now it’s on the Democrats to come to him? That’s political extortion.
Well, the Democrats won’t come to him. And they won’t need to. The political impact of this move should be clear enough. Going back to 2010, it was obvious that whatever problems and disruptions in health care the Affordable Care Act caused were going to be blamed on the Democrats. They owned it politically, and that was reasonable and proper.
Since Trump’s been president, it’s been more of a jump ball. But over the course of these 10 months, we’ve seen public opinion move pretty dramatically in support of Obamacare, or at least in support of keeping the law on the books and improving it, and very dramatically against repealing it. I don’t think anyone’s yet polled sabotaging the law through executive actions, but it’s bound to be down there with root canals. And people will know. Now when premiums go up or coverage is canceled, they’ll know which side to blame.
And it won’t be just Trump. It will be the Republican Party. Many of them stood there cheering yesterday as Trump signed his executive order. They’re applauding the CSR decision. And crucially—it’s important that people understand this part—they could be doing something about it.
That’s right. All that needs to happen right now to fix what Trump has created is for Congress to step in and authorize the CSR payments. So this is something that Paul Ryan and Mitch McConnell could address starting today if they wanted to.
But I know of only one Republican who has indicated in any way that he’d extend these payments for even a short time, and that’s Tennessee Senator Lamar Alexander, who chairs the relevant Senate committee. He was negotiating in good faith with his Democratic counterpart, Patty Murray, but as I wrote last month, Alexander was given little room to maneuver by his caucus, and then was undercut by the White House and by Ryan, who announced that even if the Senate reached a bipartisan deal extending the payments, there was no way the House would pass it.
Enrollment for 2018 starts in about two weeks, on November 1. Insurance companies are scrambling right now to set new rates for next year and to start telling customers what they are. There are going to be lots of stories of people with serious illnesses finding they’re paying 20 and 25 percent more than they were, and they’re going to be red-staters and blue-staters and Trump voters and Clinton voters and nonvoters and everyone.
And the stories will be heard. And people will know who did it.
