Well, he did it. The Trump administration has formally announced that it will stop making Obamacare’s cost sharing reduction (CSR) payments. I’ve written on this blog numerous times about Trump’s threats to stop making these payments, and how dire that would be for the Obamacare markets. I first told you about this back in April, long before the mainstream media was giving it attention.
That lack of media attention was the reason I spent so much time on the topic. I recognized it as a grave threat to Obamacare’s survival, and I was very concerned about the fact that it was getting almost no attention from the media (or from Democrats at the time). If you are not familiar with Obamacare’s cost sharing reductions and the background on Trump’s threats, you can enter “cost sharing” into the blog’s search bar and see the past posts.
In any case, thankfully by the end of the summer, the media (and the Democrats) became focused on the issue, and there was more attention being paid to the threat. This (and, likely, the possibility of passing a repeal bill) seemed to hold Trump off from following through on it. And it even eventually led to a small group of Democrats and Republicans in the Senate beginning discussions about protecting the CSR payments in formal legislation (in exchange for which the Democrats would of course have to make some trade offs). This was the Murray-Alexander discussion group, which was temporarily upended by Trump when he forced it to disband while he tried to push the Graham-Cassidy bill through.
Now Trump has ended the months of speculation and officially announced that he will stop the CSR payments. The Murray-Alexander group can still keep working toward legislation that funds the payments, but would it pass the full Congress (think especially about the House)? And would they be able to get Trump to sign it??
Anyway, I unfortunately don’t have time at the moment to do a review for you of the background on CSRs or gather more info for you on this new announcement, so instead I’ll just point you to my previous posts for the history and to this post from the editor of Talking Points Memo, Josh Marshall, which does a great job pulling together the current state of things.
But the bottom line is that, on top of Thursday’s health care executive order, Trump is making it clear that if Congress won’t repeal Obamacare, he’s going to do everything in his individual power to destroy it himself. He’s pissed off that Congress isn’t giving him his way, so he’s throwing the ultimate temper tantrum. Unfortunately, unlike a toddler’s tantrum which usually results in no long term damage, with this Trumper tantrum, everyone who buys insurance in the individual market will suffer badly.
And, as law professor Nicholas Bagley explains, it’s going to actually end up costing the federal government, because premiums will go up, and that means of course that the federal government will have to spend more on premium subsidies (which are separate from the CSRs and will still need to be paid) than they would have otherwise. Plus, there will certainly be lawsuits, as states and insurers sue. Bagley says the lawsuits to enforce the CSR payments may be the biggest (in terms of dollar amount) in U.S. history.
Trump will continue to blame any and every negative consequence on Obama and Democrats. But that becomes harder and harder to pull off (with all but his hardcore base) the more overt his sabotage becomes. The health care battle is far from over.