There’s been a lot of frantic action in D.C. this week as Trump tries to get something – anything – done in time to have a significant accomplishment to show for his “first 100 days” in office. One area that’s seemed particularly frenetic this week is health care. Nothing of substance has actually happened yet, but as has become the norm with this administration, we’ve had all sorts of dribs and drabs of news coming out the last few days about things that might be happening or that could, maybe be on the verge of happening.
Earlier this week in Obamacare Wars – Part 3 I told you about a crucial element of Obamacare, the cost-sharing subsidies, the fate of which is currently up in the air. Insurance companies – and many of the rest of us – have been anxiously waiting to see if the Trump administration or the GOP Congress would agree to continue payments to reimburse insurance companies for these cost sharing expenses. (The issue is much more complex than this brief description, so if you’re not already familiar with it and would like the full explainer, please see this post).
It appears there’s been action on this in the last 24 hours. However, the press coverage wasn’t clear on exactly what happened. Wednesday morning, Greg Sargent of the Plum Line reported that Nancy Pelosi spoke the night before with Trump’s Budget Director Mick Mulvaney about the cost-sharing payments. According to Pelosi, Mulvaney told her that the Trump administration might stop making the payments as soon as next month. This was something no one had been expecting, so it came as a serious ratcheting up of rhetoric on the issue from the Trump administration. It was basically a new and more immediate threat from the Trump administration to end the cost-sharing payments. This part of the reporting was straightforward.
But then Wednesday afternoon, reports came out that the White House was telling lawmakers that it would continue making the cost sharing payments. Pelosi confirmed the news and touted it as “making progress.” Obamacare supporters on Twitter celebrated this as good news, while Obamacare opponents slammed the news.
However, I’m not sure what to make of this. As Politico reports, the funds will not be included in the budget that’s being negotiated this week but will instead continue to be paid for outside of the Congressional appropriation process. This means that there is no guaranteed funding for the cost-sharing but it will instead be subject to Trump’s whims. The cost-sharing will continue to be funded only as long as Trump feels like funding it. Any time he wants to drop the funding, he can.
All that seems to have happened here is the Trump administration pulled back from Mulvaney’s new threat. But there’s no commitment on the time frame whatsoever. The Trump administration has simply said they’ll continue funding the cost-sharing for now. There’s no reassurance about funding for 2018, there’s not even any reassurance that funding will continue all the way through 2017, or even that Trump won’t renew the threat in 2 weeks if he needs Democrats to cooperate on a health care bill.
We’re all counting on Trump’s word here that funding will continue for some indefinite period of time. And if we’ve learned anything from observing Trump for the last couple years it’s that Trump feels very little obligation to live up to things he promised last week or yesterday or even earlier this morning. So I’m having a lot of trouble seeing what Democrats (or the insurance companies or Obamacare supporters) have gained here.
And sure enough, while Democrats in Congress seem happy with this statement from the White House for some reason, insurance companies are saying this is not enough to give them the certainty they need to stay in the markets for 2018:
Insurers say they need to be certain the payments will continue through 2018 in order to make decisions about participating in ObamaCare’s marketplaces next year. Those decisions must be made within a few months.
The reporting on this was quite confusing, because throughout Wednesday afternoon this news was announced as if there had been a big breakthrough on the cost-sharing payments. And as noted above, the Democrats seem quite excited about it, especially Pelosi, who is generally no easy mark. It’s one of those scenarios where if you think Trump is a master strategist (I don’t, but there are still those who do), you might believe the whole thing was a clever ploy from the start to make it appear as though he was being unifying & conciliatory, without actually having to give away a thing. But then he topped off Wednesday by sending this tweet . . .
making it glaringly obvious he has no master strategy at all, and reminding you that you better look out because he could take the complete opposite position on this issue tomorrow. So in the end this all seems to have been a lot of sound and fury over a whole bunch of nothing. It’s good news that Trump’s & Mulvaney’s immediate threats seem to have abated, but beyond that, we’re back exactly where we started.