Just a day after Senators Lamar Alexander and Patty Murray signaled a tentative agreement on bipartisan legislation to stabilize individual insurance markets while giving states more leeway via waivers in implementing the Affordable Care Act, Speaker Paul Ryan let it be known the House was having none of it. His spokesman told Axios: “The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare.” That’s congressionalese for “Forget about it.”
In conjunction with the president’s cancellation of Cost-Sharing Reduction (CSR) reimbursements for insurance companies required under the Affordable Care Act to limit out-of-pocket expenses for low-income consumers, that means the premium spikes already evident in insurers’ offerings for 2018 will go into effect and perhaps intensify. Because under ACA the federal government will automatically offset higher premiums for low-income consumers with larger insurance purchasing tax credits, the real losers in this equation will be federal taxpayers and individual insurance policyholders whose incomes are too high to qualify them for tax credits. You’d think this would be a suboptimal result for Republicans, but a lot of conservatives have bought into the specious idea that CSR payments are a “bailout for insurance companies” rather than a cost that is passed on to consumers and to the federal government. Actually, dropping CSR payments just changes the “bailout” method from direct reimbursements to tax credits.
Nonetheless, those promoting the dubious “bailout” meme include the President of the United States, who just yesterday was encouraging Alexander and Murray and all but pre-endorsing their legislation. He’s now suddenly in a this very different place:
No one knows at this point whether Trump’s 180-degree turn on Alexander-Murray is related to Ryan’s thumbs-down. But unless something happens to change their minds, it now appears Republicans are committing themselves firmly to a policy of doing nothing to make Obamacare function better even if they cannot get their act together to repeal and replace it. Lamar Alexander ought to be very angry.