ACA Marketplaces: Eve of Destruction or Dawn of Bipartisanship?

ACA Marketplaces: Eve of Destruction or Dawn of Bipartisanship? October 20, 2017

When Donald Trump swore on a  book of Bronze Age mythology to protect and defend the Constitution of the United States of America, no one knew that he would have to shield it from himself. (Okay, so maybe there were hints.) At any rate, the GOP-controlled Congress failed to repeal Obamacare; it is therefore still the law of the land. The president is thus barred from bulldozing the ACA marketplaces.

But will any Republicans stand up to Trump?

Will senatorial bipartisanship save cost-sharing reductions? Or will Trump's cancellation of the payments be allowed to destroy ACA marketplaces?
CSPAN screenshot of HELP committee chairs Lamar Alexander and Patty Murray.

The answer, fortunately, is yes.

This is what Article 2, Section 3 of the Constitution states:

… he shall take Care that the Laws be faithfully executed.

Yet, at the so-called Values Voter Summit, President Trump thundered:

Congress, they forgot what their pledges were. So we’re going a little different route. But you know what? In the end, it’s going to be just as effective, and maybe it will even be better.

At a Rose Garden press conference, he said of Obamacare:

It’s dead. It’s gone. It’s no longer – you shouldn’t even mention. It’s gone.

Via Pixabay, public domain.
Via Pixabay, public domain.

Unfortunately for the Tyrant King, the United States of America is still a constitutional republic. The president is not free to pick and choose which laws he will honor. He doesn’t have to like them, but he’s not permitted to wantonly demolish laws at his whim.

The writing was on the wall when Trump personally rejected an extremely conservative Obamacare waiver proposed by Iowa that actually implemented many of the proposals from various repeal and replace bills. Why? Haven’t Republicans been demanding state flexibility?

Answer: Iowa’s proposed plan would’ve helped shore up its ACA marketplaces.

Hey, if Obamacare refuses to collapse on its own, why not send an elephant to crush it?

Indeed, the Trump administration made at least twelve separate moves to cripple Obamacare…before the president delivered the coup de grace to ACA marketplaces by discontinuing payments for cost-sharing reduction (CCRs).

As I’ve written about extensively (for instance: here and here), CCRs pay for medical expenses like premiums and deductibles to people earning up to 250 percent of the federal poverty level. But since the insurance companies are required by the ACA to provide CCRs, the companies will now be uncompensated for the payments.

Except they won’t be. Since Obamacare tax credits rise along with premiums, cutting CCRs will actually increase the deficit by nearly $200 billion in ten years.

But that doesn’t mean that no one in the ACA marketplace will be paying for the missing CCR payments. Those who earn too much for Obamacare tax credits will bear the full brunt of the 15-20% premium increase caused by the loss of CCRs.

As a commentary notes:

According to the Kaiser Family Foundation, 6.7 million people out of a total of 15.4 million in the Obamacare compliant individual health market do not get any kind of subsidy. That is 44 percent of the total market.

ACA Marketplaces: Is HELP on the way?

What about the bipartisan Senate Health, Education, Labor, and Pensions committee negotiations to give CSRs a guaranteed funding source? The majority and minority HELP committee co-chairs, Lamar Alexander and Patty Murray, seem to sincerely want to do something to provide a steady funding source for CSRs. Did anything ever happen with that?

Will bipartisanship save cost-sharing reductions? Or will Trump's cancellation of the payments be allowed to destroy ACA marketplaces?
Via Zoe Dune Media Center, CC BY-SA 2.0.

I’m glad you asked!

In a rare sighting of what was thought to be an extinct beast — bipartisan compromise was once again seen in Washington, DC. Both sides gave in the hammered out deal, like they used to before congresspeople — especially Republicans — took a tribalistic noncooperation pledge.

There were smiles all around.

Okay, not everywhere. Certainly not in the House, where Paul Ryan turned up his nose up like a picky child handed a plate of greens. But surely Mitch McConnell was happy to see an actual legislative agreement coming out of Senate committee? Oh, that’s right. I forgot that Senate committee hearings are soooo 20th century.

Well, how about the ghost-written “author” of Art of the Deal? I dunno, it depends on what hour you ask.

Sigh. For a moment there it looked like we might have a functional representative republic again.

Well, at least we can hope for the year-end budget negotiations. The betting is that a funding compromise — like the Alexander-Murray deal or the one from Ron Johnson of Wisconsin — will be slipped into the must-pass, year-end debt ceiling bill, giving Republicans cover to vote for it.

Hey, if I didn’t vote for it there would’ve been a government shutdown. And who reads fine print, anyway?

The Dems will have the GOP over the barrel, which is why McConnell and Ryan were so outraged at Trump’s chummy deal with “Chuck and Nancy.” Congress will be scrambling to keep the lights on in time for them to go home for Christmas and duck town hall meetings.

Via Mack Sennett Studios, public domain.
Keystone Kops via Mack Sennett Studios, public domain.

Of course, the Democrats will have a very long wish list, what with funding the Children’s Health Insurance Program, protecting the Dreamers, and saving ACA marketplaces on the agenda. And let’s not forget holding the line on Trump’s see-through wall.

We can’t always plan on the Republican leadership governing as if they were the Keystone Kops.

Can we?

All snark aside, I take comfort in knowing there are Republicans in congress who actually care about preventing the chaos and suffering a collapse of the ACA marketplaces would cause. The Alexander-Murray bill has been co-signed by twelve Republicans.

You won’t be shocked to hear that among them are John McCain, Susan Collins, and Lisa Murkowski. While McCain is no moderate, he’s been insistent throughout the Obamacare repeal and replace debacle that the Senate should return to regular order.

It may be a utopian to imagine Congress returning to working in common cause — from different political perspectives — in a legislative body of, by, and for the American people. Red states and blue states, after all, are still part of the United States.

We can always dream.

Is it a pipe dream to hope that bipartisanship will eventually ACA marketplaces?
Via Pixabay, public domain.

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