A bipartisan group of legislators calling themselves the Problem Solvers Caucus on Monday submitted a bill that would stabilize the Obamacare insurance exchanges and then look at making some moderate changes to the law that both sides can (allegedly) agree on. Vox explains what the bill would do, with five main elements.
1. It would mandate that the Cost Sharing Reduction subsidies be paid. Presently, Trump has the option of cutting them off and he has repeatedly threatened to do so. If he does, millions of people will lose their health insurance and the ACA exchanges will likely collapse entirely. This is what Trump means when he says he might just “let Obamacare implode” to force Congress to repeal the entire thing.
2. It would create a “dedicated stability fund” that would send money to the states to further keep down premiums. This was actually part of both the House and Senate repeal bills, but it’s never been clear exactly how it would work or how much money it would provide. One expert quoted by Vox says that it would likely operate as a “reinsurance plan” that would ” give insurers extra funding to cover their most expensive patients — and thus hold down premiums for the rest.”
3. It would drop the requirement that employers provide health insurance for their employees unless they have at least 500 of them. The current level to trigger that requirement, or an alternative requirement that the business pay a special tax to offset the cost of providing health insurance to their workers through the ACA exchanges, is 50 employees. This would change very little in reality. Vox quotes an expert saying, “The vast majority of the employers affected by it were already providing health benefits.”
4. It would repeal the 2.3% tax on medical devices including in Obamacare to help fund the bill. This is a priority for Republicans and for medical manufacturers, who have spent gobs of money lobbying to have it repealed. This would change little, as the tax only raises about $3 billion a year, or less than a tenth of a percent of the federal budget.
5. It would implement regulations to allow insurance companies to sell policies across state lines. For some weird reason, Republicans have long been obsessed with this. It would change virtually nothing. The ACA actually already allows it, there just aren’t implementing regulations written yet. And most insurance companies have long operated in multiple states anyway, so I’ve never understood why conservatives think this is some great policy that would change much of anything at all.
This bill would be a reasonable first step to preserve the structure of Obamacare and stabilize the markets, at least in the short term. But there are two problems. The first is whether it would pass both houses of Congress; the second is whether Trump would sign it if it does. Would Paul Ryan violate the Hastert Rule and bring to the floor a bill that does not have majority support among Republicans, which it may well not get? We have no idea, but he has resisted doing so on other issues in the past. If the full House were allowed to vote on it, I suspect it would be approved with majority Democratic support and minority Republican support. The same is likely true in the Senate.
But in neither chamber is the vote likely to be enough to override a possible presidential veto. Would Trump veto it? Who the hells knows. He’s said on the one hand that he insists that no one loses their health insurance coverage, but he has supported Republican bills that would cost more than 20 million people their insurance. He’s said at times that the two sides should work together, but he’s also at times conditioned that on the collapse of Obamacare, thus forcing the Democrats to do something. As always, Trump is all over the playground on this one, without even a hint of a consistent or coherent position. This is because he has no understanding whatsoever of health care policy or what has actually been in any of the bills he’s supported. So your guess is as good as mine as to whether he would sign it or veto it. I’m sure he has no idea either. It might well depend on who he feels slighted by that morning.