Top Republicans Tell Trump: Make Obamacare Work, for Now

With Democrats accusing the administration of sabotaging the health law, two GOP committee chairmen urge the president to continue payments to insurers that could shore up the insurance market.

Senator Lamar Alexander wants the Trump administration to keep paying subsidies to health insurers. (Aaron Bernstein / Reuters)

Top congressional Republicans have delivered a surprising plea to the Trump administration: Don’t sabotage the Affordable Care Act while we try to repeal it.

Tennessee Senator Lamar Alexander on Thursday became the second GOP committee chairmen in as many weeks to urge the administration to continue payments of subsidies to insurance companies that are considered crucial to stabilizing the individual market and preventing sharp premium increases.

Under President Trump’s direction, the administration has refused to guarantee that it will pay the subsidies, which are known as “cost-sharing reduction payments” and help insurers keep down deductibles for low-income customers while still making a profit. The decision has infuriated Democrats and insurers alike, and several companies have cited the uncertainty caused by the administration as the reason for exiting Obamacare exchanges in certain states and counties.

In an unusual alliance, Republicans in Congress are now joining the effort to pressure Trump to make the payments even after they sued the Obama administration over their legality three years ago. “These payments will help to avoid the real possibility that millions of Americans will literally have zero options for insurance in the individual market in 2018,” Alexander told Tom Price, the secretary of health and human services, at a hearing on Thursday. “We have a collapsing individual market as a result of the Affordable Care Act, and as part of a transition from a collapsing market to a stable market in which Americans have more choices of insurance at a lower-cost, I believe Republicans will need to temporarily support some things we don’t want to do in the long term, and I would hope Democrats would do that as well.”

Alexander is chairman of one of the two Senate committees with jurisdiction over health policy. The head of the House Ways and Means Committee, Representative Kevin Brady of Texas, made a similar recommendation at a hearing last week, though he said the payments should be appropriated in legislation by Congress. “We should act within our constitutional authority now to temporarily and legally fund cost-sharing reduction payments as we move away from Obamacare and toward a patient-centered system that truly works for the American people,” Brady said. Other Republicans in both chambers of Congress have echoed that sentiment, and the Senate is considering including language requiring the temporary continuation of the payments in its broader health-care bill.

Whose decision it is to make the payments—Congress’s or the administration’s—is the subject of the lawsuit House Republicans filed against the Obama administration in 2014. They argued that the administration acted illegally by making payments that, while they were called for in the Affordable Care Act, Congress had not explicitly appropriated. A federal judge ruled in the House GOP’s favor initially, but the administration can continue making the payments while the case is on appeal. Trying to buy time for the repeal effort, the Trump administration has sought to delay the litigation before it decides whether to take the Obama administration’s position on the issue or drop the appeal—which would effectively kill the payments.

Under questioning by Alexander, Price refused to make any commitments on the subsidies, saying that because he was now the defendant in the lawsuit, he shouldn’t comment. Other administration officials have said they are deciding on the payments on a month-to-month basis, but insurers face a June 21 deadline for determining whether they will stay in the Obamacare marketplaces in 2018. “I don’t know how insurance companies can operate when they don’t even know whether these payments are going to be available a week from now,” said Representative Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee.

Rather than guarantee the payments in the meantime, Trump has tried to use them as a cudgel to get Democrats to negotiate either on Obamacare repeal or, during last month’s spending talks, to support his other priorities in return. But they have rejected that demand, seeing the move as a blatant attempt to undermine the ACA and one that would hurt constituents in the process. “Everything is being done by this administration to sabotage the ACA so they can go out and essentially lie and say, ‘Oh see, it’s not working’ after they’ve made every effort to sabotage it,” Pallone said in a recent interview. Trump has been talking down Obamacare for months, characterizing it as “collapsing” and “dead.”

But Republicans in Congress are essentially rejecting Trump’s political strategy in protesting his refusal to guarantee the payments. While Trump has argued that Democrats would take the blame for the collapse of the law they enacted, polls have indicated the opposite: that voters would fault the president on whose watch the health-care system deteriorated.

The requests from Alexander and Brady are also the latest evidence of tensions between the president and Republicans lawmakers as the party struggles to enact a replacement for Obamacare. After hosting a back-slapping celebration of the House’s passage of the American Health Care Act last week, Trump reportedly decried the bill as “mean” in a private meeting with Senate Republicans this week. And under questioning by Senator Patty Murray on Thursday, Price awkwardly refused to repeat his endorsement of the House proposal. “It’s not a yes or no answer,” the secretary replied when Murray asked if he agreed with Trump’s criticism of the bill. (He also said that like Democrats, the public, and even many Republicans, he had not seen a copy of the secretive alternative measure the Senate is drafting.)

Whether Republicans can pass their bill remains anyone’s guess, and the as-yet-unseen legislation’s stock among GOP senators seems to rise and fall by the day. Embedded in the GOP’s split with Trump is a recognition that even if Congress passes legislation to replace the ACA in the next few weeks, the law won’t change overnight. The proposals don’t scrap Obamacare entirely, and they envision a transition period to a new system. Alexander urged the administration not simply to continue the subsidy payments for the rest of this year, but for as many as two years beyond that. If the Affordable Care Act is going to be sticking around for awhile, he and other Republicans are reluctantly telling the impatient president, he might as well try to make it work.