Sometimes what appears to be news is really just a mirage. An illusion. A whole lot of stories will suddenly get generated about a particular thing, so it seems like news must be happening, but when the flurry of activity dies down, it turns out nothing has really changed. In this case the “nothing” has to do with Obamacare’s cost-sharing reductions. Last week I wrote a post, Sharing is Caring?, because it appeared in the news that there had been a happy development on this very important feature of Obamacare. However, when I looked a little closer, I came to the conclusion that what was being reported as good news was really no news at all.
But backing up for a moment, in an even earlier post Obamacare Wars – Part 3, I explained what the cost-sharing reductions (CSRs) are, and why they are so vital to Obamacare. In that earlier post, I also explained that (for complicated reasons, which I hope you’ll go read about) it was unclear whether the cost-sharing reductions would continue to be funded under the new GOP administration. If the funding is not maintained, it will likely be devastating to Obamacare, because many – probably most – of the remaining insurance companies will pull out of the Obamacare markets for 2018.
This funding can be continued either by an appropriation from Congress in a spending bill, or for now, simply by Trump making the decision that funding will continue from a pot of money that already exists. But either way, insurance companies need to know very soon whether the funding will continue, because they are making their decisions about whether to participate in the markets in 2018 right now. Congress has already said that it will not appropriate the money, so that leaves the decision entirely with President Trump. Up until last week, Trump would not give any assurances to Democrats or the insurance companies, and in fact, had even been making some threats that he might pull the funding immediately if Democrats didn’t help him pass a new health care bill.
Then, last week there was suddenly an array of reporting that made it sound like the cost-sharing issue had been resolved. Last Wednesday, the Trump administration apparently told Congress that it would keep funding the CSRs. There was a bunch of excitement (both from reporters and from Democrats) touting this as real progress on the issue. But I was unable to see what progress had actually been made – as far as I could tell, Trump hadn’t made any actual commitment on the issue. He hadn’t said he’d keep paying the CSRs for 2018, or even for the rest of 2017. All that had really happened was Trump basically said, I’ll keep funding the CSRs for right now. He was still free to cut the payments off at any time.
Yet there was all that reporting that made it seem like something significant had happened. So in the hopes of clarifying things, last week I wrote this post explaining what I thought was really going on, which was essentially: nothing. Despite all the excited reporting, Democrats hadn’t gained anything. Yes, Trump had backed off his threat – for now – but he could still pull the CSR funding at any moment on a whim. And that is really significant because 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. With any other President, the possibility that they might change their mind on a whim would be of only slight concern, if it even entered our minds at all. With Trump, it’s a very real and ever-present threat.
So, that was where I left things – it seemed clear to me that the CSR issue was still as up in the air as ever. But then a whole new round of reporting on the CSRs appeared: This past weekend it was reported that Democrats and Republicans in Congress had come to an agreement on a budget for the rest of the fiscal year. Many of the reports coming out about the contents of the budget deal declared Democrats the big winners in the agreement (to the surprise of almost everyone). And one item that was on nearly every list of the various ways Dems won was the cost sharing payments. Some outlets reported that the CSRs are actually being written into the budget. Other outlets reported it as the Democrats winning the CSRs as a side note to the budget negotiations process (i.e. they were reporting again on last week’s event, wherein Trump supposedly needed to agree to the CSR payments in order to get Democrats to move on to talking about the budget).
Either way, this once again raised the question: did something significant actually happen with the CSRs?? So again I searched, and again it appeared that nothing new had actually happened. Funding for the CSRs is not in the budget. And Trump had still not made any specific time commitment for funding the CSRs, so he is still free to drop the funding at any time. Just as before, the Democrats hadn’t actually gained anything on the CSR’s. But once again, I was left wondering if I was missing something, because so much of the reporting was saying that the Democrats had scored a win here.
But then, at an afternoon press conference this Tuesday afternoon, the mystery was finally solved once & for all. Trump’s Budget Director (OMB) Mick Mulvaney said this about funding the CSR’s:
“We have not made any decision, I think I’ve said that to you folks before. We’ve not made any decision. The payments are due I believe the 20th or 21st of every single month. We have not made any decisions at all on May.”
So not only was Mulvaney saying the White House wouldn’t guarantee funding for 2018, or even for the rest of 2017, he was saying they wouldn’t even guarantee funding for the rest of this month. Of course, because this is the Trump administration, just a few hours later, OMB staff walked Mulvaney’s comments back, saying they would make the May CSR payments after all. But they also made a point of saying that there was no decision on any payments beyond that. Like with so many things in this administration, the statements and the decisions on this issue literally change by the hour. So there’s no guarantee this position won’t change yet again by tomorrow.
Which brings me back to the point I’ve reiterated throughout this article: there are still no assurances on the CSR payments. For nearly a week it was reported in many different news outlets as if there had been resolution on this extremely urgent issue.* And that was really harmful because it was a precious week that went by where people were falsely reassured and the issue wasn’t actually getting resolved. At this point, it should be clear to everyone that this dire question still hangs out there unanswered. Hopefully now reporters will begin to push Trump and/or the GOP more forcefully on what they plan to do about this issue in the long term. Millions of lives literally depend on it.
*I just want to make a note that while I’m being critical of the press coverage on this particular issue, I have an extraordinary amount of admiration and gratitude for our press. We have a free country because we have a free press. And many of the people working as journalists today (including those whose work I’ve cited as examples in this post) do really good work at a difficult job that has only gotten harder since Trump has decided to make them the enemy. So my point with this post is not to vilify or denigrate the media. It’s impossible for them to get everything right every single time. This happens to be one where I think they missed. And because I think this issue is so crucial to so many people, I believe it’s worth pointing out what happened here.