After the Senate failed to repeal Obamacare on Thursday, when a critical "Nay" vote by John McCain crushed Trump's biggest campaign promise shortly after midnight, on Saturday the President threatened to end key payments to Obamacare insurance companies if a repeal and replace bill is not passed. "After seven years of 'talking' Repeal & Replace, the people of our great country are still being forced to live with imploding ObamaCare!" Trump tweeted, followed by: "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!."
Now, in previewing what may be Trump's next potential step to keep the fight against Obamacare alive, Reuters reports that Senator Rand Paul told reporters that Trump is "considering taking some form of executive action" to address problems with the healthcare system.
Paul said he spoke to President Donald Trump by phone about healthcare reform on Monday and told the president he thought Trump had the authority to create associations that would allow organizations to offer group health insurance plans.
Allowing groups like AARP, which represents retirees, to form health associations could enable individuals and small businesses to form larger groups to negotiate with health insurance companies for lower rates.
Such a move would also allow Trump to implement his threat of "ending bailouts for insurance companies."
Saturday was not the first time Trump had made a similar threat: the president previously threatened to withhold Cost Sharing Reduction payments, or CSR, which lower the amount individuals have to pay for deductibles, co-payments and insurance. While the White House announced earlier this month that key ObamaCare subsidies to insurers would be paid this month, the administration did not make a commitment beyond July.
As Bloomberg explained over the weekend, there are two key ways the President of the U.S. could undermine the law: asking his agencies not to enforce the individual mandate created under Obamacare; and stopping funds for subsidies that help insurers offset health-care costs for low-income Americans. Both moves could further disrupt the Affordable Care Act’s individual markets and eventually lead to higher premiums, or rather even higher premiums that Obamacare itself has led to.
Which means that even without an executive order, one of the first steps the president could take should he wish to pursue his crusade against Obamacare, would be to stop the monthly CSRs. The administration last made a payment about a week ago for the previous 30 days, but hasn’t made a long-term commitment. Trump has called the subsidies a “bailout” for insurance companies in the past, and he just did it again on Saturday.
“We are still considering our options,” Ninio Fetalvo, a spokesman for Trump, said in an e-mail. Meanwhile, America’s Health Insurance Plans, a lobby group for the industry, said premiums would rise by about 20 percent if the payments aren’t made. Many insurers have already dropped out of Obamacare markets in the face of mounting losses and blamed the uncertainty over the future of the cost-sharing subsidies and the individual mandate as one of the reasons behind this year’s hikes in premium.
Another way Trump could hamper the ACA is to instruct Price’s department to direct little or no support to open enrollment when people sign up for Obamacare plans near the end of the year. It could include ignoring website upkeep, not advertising the enrollment period and offering little help for people who have difficulty signing up.
Finally, the Trump administration could simply choose not to enforce the penalties surrounding the individual mandate of Obamacare for uninsured people or broaden exemptions to the law. The Internal Revenue Service, which enforces the penalty, said in January it would no longer reject filings if taxpayers didn’t indicate whether they had insurance. Unless the IRS follows up with each silent filing, this could let some uninsured people dodge the penalty.
All the moves would only have a gradual impact over time. For now, only one thing is certain: nothing is certain. As Larry Levitt, senior vice president of the Kaiser Family Foundation, put in a series of tweets:“The big question in health care now is what will happen with the individual insurance market,” Levitt said. “Insurers will be reading all the tea leaves for what the administration will do with cost-sharing payments and the individual mandate.”
Finally there is the question of how state Attorneys General would respond: an Executive Order by Trump would likely by immediately challenged in court, delaying the process indefinitely, and potentially pushing it all the way to the Supreme Court. In other words, without Congress, any real repeal of Obamacare will take many months, if not years.