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Trump Qualifies Support for Senate Deal to Fund Health Subsidies Trump Pulls Back From Senate Deal to Fund Health Subsidies
(about 9 hours later)
WASHINGTON — President Trump on Wednesday qualified his endorsement of a bipartisan Senate proposal to stabilize health insurance markets, even as the chief architect of the deal predicted that it would become law before the end of the year. WASHINGTON — President Trump on Wednesday backed away from his endorsement of a bipartisan Senate proposal to stabilize health insurance markets, throwing the legislative effort into doubt even as the chief architect of the deal predicted that it would become law before the end of the year.
Mr. Trump on Tuesday appeared to give his blessing to a deal to restore health insurance subsidies that he had just canceled when the accord was announced. Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, agreed on legislation that would continue federal payments to insurance companies through 2019 to reimburse them for discounts they are required to provide to millions of low-income people who have coverage under the Affordable Care Act, popularly known as Obamacare. The latest actions by the White House confused Republicans on Capitol Hill and irked Democrats — but in the end, their effect was not clear. Regardless, the effort to calm roiled insurance markets appears destined for a showdown in December, when supporters of the compromise, drafted by Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, will have the most leverage.
On Wednesday, the president appeared to send a different message: The mixed signals began Tuesday, when Mr. Trump appeared to give his blessing to the deal to restore subsidies to health insurers that he said days before he would cut off. Mr. Alexander and Ms. Murray agreed on legislation that would continue federal payments to insurance companies through 2019 to reimburse them for discounts that they are required to provide to millions of low-income people who have coverage under the Affordable Care Act, popularly known as Obamacare.
But that message may have been more of a caveat than a rejection. Mr. Alexander, the chairman of the Senate health committee, said he received a telephone call on Wednesday from the president. “He wanted to be encouraging about the bipartisan agreement that Senator Murray and I announced yesterday,” Mr. Alexander said. On Wednesday, the White House sent a different message.
Mr. Trump “intends to review it carefully to see if he wants to add anything to it,” Mr. Alexander said, adding that the president “wants to reserve his options.” The White House press secretary, Sarah Huckabee Sanders, said later that Mr. Trump did not support the deal in its current form but indicated that changes could win him over.
In fact, Mr. Alexander and Ms. Murray have already moved to address concerns that restoring the payments to insurers could be viewed as providing them with a “bailout.” On Tuesday, Mr. Alexander said that their deal would contain “the strongest possible language” to ensure that the money provided for the subsidies would go to the benefit of consumers, not insurers. “We want something that doesn’t just bail out the insurance companies but actually provides relief for all Americans,” she said, adding that the deal was “a good step in the right direction.”
And on Wednesday, he took to Twitter to say he and Mr. Trump are in agreement on the cost-sharing reductions, or CSRs. Republicans in Congress have hardly rushed to embrace the deal, but it has won endorsements from a handful of Republican senators, including Susan Collins of Maine, Bob Corker of Tennessee, John McCain of Arizona and Lisa Murkowski of Alaska.
The measure is creating friction. Speaker Paul D. Ryan of Wisconsin, reflecting his most conservative members, came out against the deal on Wednesday. “Congress has a responsibility to ensure that families in Tennessee and across our country who receive health insurance through the individual market do not continue to be burdened with rising premiums and fewer choices,” Mr. Corker said.
And an unavoidable fiscal deadline this year still offers an opportunity for lawmakers to demand that the subsidies be funded, regardless of the president’s position. Lawmakers need to pass a funding measure to keep the government open beyond Dec. 8, and no bill can pass without Democratic votes.
At that point, supporters of the Alexander-Murray measure could insist on its inclusion in any spending bill and threaten to shut down the government if they do not prevail. If Republican leaders relent, Mr. Trump’s veto of the health measure would effectively shutter the government.
Still, the uncertainty around the legislation grew on Wednesday. Speaker Paul D. Ryan of Wisconsin, reflecting his most conservative members, came out against the deal.
“The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” said Doug Andres, a spokesman for Mr. Ryan.“The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” said Doug Andres, a spokesman for Mr. Ryan.
But the authors of the measure may be gaining support for the moment that they have the most leverage. In December, the government will run out of money, and no bill to keep it funded can pass without Democratic votes. At that point, supporters of the Alexander-Murray measure can insist on its inclusion in any spending bill and threaten to shut down the government if they do not prevail. Already, several Republicans have backed the agreement, including Senators John McCain of Arizona, Susan Collins of Maine and Lisa Murkowski of Alaska. And the Senate Democratic leader, Chuck Schumer of New York, expressed frustration over a president who “keeps zigging and zagging, so it’s impossible to govern.”
Senator Bill Cassidy, Republican of Louisiana and the co-author with Senator Lindsey Graham of the most recent legislation to repeal the Affordable Care Act, offered his qualified support: “If combined with greater flexibility to allow states to lower costs, this will set the stage for replace through a mechanism such as Graham-Cassidy. I will study this proposal to see if it accomplishes these goals.” “You never know from hour to hour what he thinks,” Mr. Schumer said.
Mr. Alexander, speaking Wednesday at a forum convened by Axios, a news website, said: “The president engineered the bipartisan agreement by calling me and asking me to work with Senator Murray to do it. I’ve talked with him three times in the last 10 days about it.” Senator John Thune of South Dakota, the third-ranking Senate Republican, had predicted on Tuesday that Congress would “move fairly quickly” on the bipartisan proposal, but he revised that forecast on Wednesday. For now, he said, the plan has “stalled out.”
Mr. Alexander predicted that the plan would “pass in some form before the end of the year.” And he said the deal included several victories for conservatives, making it easier for states to revamp their insurance markets and allowing people of any age to buy low-cost, high-deductible health plans providing catastrophic coverage. “We’re kind of in a holding pattern,” he said, as Mr. Alexander tries to convince the president that the deal would benefit consumers, not insurance companies.
Senator Orrin G. Hatch of Utah, the chairman of the powerful Finance Committee, said he disagreed with Mr. Alexander’s plan. “I think he’s trying to do a good thing, but it’s only temporary, and it leads us down a primrose path that we don’t want to go,” Mr. Hatch said.
Mr. Alexander, the chairman of the Senate health committee, said he received a telephone call on Wednesday from the president. “He wanted to be encouraging about the bipartisan agreement that Senator Murray and I announced yesterday,” Mr. Alexander said at a forum convened by Axios, a news website.
Mr. Trump “intends to review it carefully to see if he wants to add anything to it,” Mr. Alexander said of the Senate plan.
In fact, Mr. Alexander and Ms. Murray had already moved to address concerns that restoring the payments to insurers could be viewed as providing them with a “bailout.” On Tuesday, Mr. Alexander said that their deal would contain “the strongest possible language” to ensure that the money provided for the subsidies would go to benefit consumers, not insurers.
The bill drafted by Mr. Alexander and Ms. Murray would provide “such sums as may be necessary” through 2019 for cost-sharing payments to insurers under the Affordable Care Act. State insurance regulators would have to certify that insurers use the money to provide “a direct financial benefit to consumers.”
Mr. Alexander said later Wednesday that he was open to “improvements or changes that the president wants to make” in the deal and that he completely agreed with Mr. Trump that “we don’t want to bail out insurance companies.”
The draft bill would also make it easier for states to obtain waivers from some requirements of the Affordable Care Act. But the bill includes protections for consumers: Any state plan would have to provide coverage “of comparable affordability, including for low-income individuals, individuals with serious health needs and other vulnerable populations.”
Not content to wait for Congress, the attorneys general of California, New York and 16 other states asked a federal district judge on Wednesday for a temporary restraining order that would force the Trump administration to continue making the subsidy payments. A court order is urgently needed, they said, because the next installment of federal subsidies is due on Friday.
The states, which filed suit against the federal government last Friday, said the payments are required by the Affordable Care Act and that ending them would destabilize insurance markets and cause increases in premiums and in the number of uninsured.
On Wednesday, Mr. Alexander predicted that the plan would “pass in some form before the end of the year,” and he said that Mr. Trump had “engineered the bipartisan agreement by calling me and asking me to work with Senator Murray to do it.” Mr. Alexander said the deal included several victories for conservatives, making it easier for states to revamp their insurance markets and allowing people of any age to buy low-cost, high-deductible health plans providing catastrophic coverage.
A federal judge ruled in 2016 that the federal payments to insurance companies, known as cost-sharing reductions, violated the Constitution because Congress never provided money for them. Citing that ruling, Mr. Trump announced last week that he would stop the payments.A federal judge ruled in 2016 that the federal payments to insurance companies, known as cost-sharing reductions, violated the Constitution because Congress never provided money for them. Citing that ruling, Mr. Trump announced last week that he would stop the payments.
Mr. Trump says he still supports longer-range efforts to repeal the Affordable Care Act and replace it with block grants to the states.Mr. Trump says he still supports longer-range efforts to repeal the Affordable Care Act and replace it with block grants to the states.
Such big changes would not take effect until 2020 or 2021, Mr. Alexander said. “What do you do in the meantime?” he asked. “What you don’t want to do in the meantime is create chaos and hurt millions of Americans.” Such big changes would not take effect until 2020 or 2021, Mr. Alexander said, offering a warning against creating “chaos” in the meantime.
“What does chaos do?” Mr. Alexander asked. “It’s a four-lane highway to a single-payer solution. It’s a birthday present for Bernie Sanders,” the independent Vermont senator and leading advocate for a single-payer “Medicare for all” health care system.“What does chaos do?” Mr. Alexander asked. “It’s a four-lane highway to a single-payer solution. It’s a birthday present for Bernie Sanders,” the independent Vermont senator and leading advocate for a single-payer “Medicare for all” health care system.
The Senate Democratic leader, Chuck Schumer of New York, quickly pushed back on the president’s Twitter post, expressing exasperation in remarks on the Senate floor.
“Frankly, the president doesn’t know what he’s talking about in the compromise,” Mr. Schumer said. “It doesn’t bail out insurance companies. It helps people who are sick and who need health care.”
Mr. Schumer said the president “keeps zigging and zagging, so it’s impossible to govern.”
“Our only hope is maybe tomorrow he’ll be for this again,” he added.
Indeed, Mr. Trump’s exact views on the Senate measure have been hard to pin down over the past 24 hours or so.
At a news conference at the White House on Tuesday afternoon, virtually as the deal was being announced at the Capitol, Mr. Trump voiced support for the plan. He vowed to try again to repeal the Affordable Care Act but said the emerging bipartisan deal would “get us over this intermediate hump” in the meantime.
The president described the Senate plan as a “short-term solution so that we don’t have this very dangerous little period.”
Hours later, in a speech to the conservative Heritage Foundation, Mr. Trump commended the work of Mr. Alexander and Ms. Murray, but he said that Congress needed to “find a solution to the Obamacare mess instead of providing bailouts to insurance companies.”
And with his Twitter post on Wednesday morning, he stepped back even further from the support he had offered just a day earlier.