Ending the subsidy for copays/ deductibles would increase the subsidy for premiums ..and ObamaCare enrollment would grow

The Obama-era health care law actually has two major subsidies that benefit consumers with low-to-moderate incomes. The subsidy Trump targeted reimburses insurers for reducing copays and deductibles, and is under a legal cloud. The other subsidy is a tax credit that reduces the premiums people pay, and it is not in jeopardy.
If the subsidy for copays and deductibles gets erased, insurers would raise premiums to recoup the money, since by law they have to keep offering reduced copays and deductibles to consumers with modest incomes.
The subsidy for premiums is designed to increase with the rising price of insurance. So government spending to subsidize premiums would jump.
“This is where the counting gets sort of weird,” said Matthew Buettgens, a senior research analyst with the Urban Institute.
The nonpartisan policy research group has estimated that richer premium subsidies could entice up to 600,000 more people to sign up for health law coverage, depending on how insurers and state regulators adjust.
The group also found that the federal government would end up spending more overall on health insurance through higher premium subsidies.” (A)

“A bipartisan deal to shore up ObamaCare’s insurance markets would reduce the deficit by nearly $4 billion by 2027, according to a score released Wednesday by Congress’s nonpartisan scorekeeper.
The bill, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would fund key ObamaCare insurer subsidies and give states more flexibility to change their ObamaCare programs.
The Congressional Budget Office (CBO) said in its report Wednesday that the bill would not substantially impact the number of people with health insurance.
On the flip side, a CBO report released in August concluded that not funding the insurer payments, called cost-sharing reductions, would increase the federal deficit by $194 billion through 2026.” (B)

Congressional Budget Office Cost Estimate of Bipartisan Health Care Stabilization Act of 2017
co-sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.)
https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/bipartisanhealthcarestabilizationactof2017_0.pdf

“Utah Republican Sen. Orrin G. Hatch has dealt an emerging bipartisan health care bill a body blow…
“I can’t co-sponsor it because I don’t agree with it,” the Utah Republican said. “I think he’s trying to do a good thing, but it’s only temporary.”…
It would be very difficult for legislation related to overhauling the health insurance system to move through the Senate, let alone reach the president’s desk, without the support of the Finance panel chairman, given its broad jurisdiction over health care.
Republicans and Democrats alike think Trump could be convinced to support the bipartisan health care bill. But GOP members previously said opposition from either Hatch or Alexander would prevent any proposal related to the insurance markets from advancing…
“Some are working on an approach that amounts to little more than a congressional bailout of Obamacare, including pumping tens of billions of dollars into the already failing system in the form of cost-sharing reduction payments,” Hatch wrote in The Washington Post last month, referencing the HELP committee effort.” (C)

“Many Republicans, particularly the more conservative ones, are having a hard time reconciling themselves to passing a bill that props up the marketplaces which they spent most of the year trying to erase in several ACA repeal bills. Their lack of agreement became even more pronounced yesterday, as the Republican chairmen of two key House and Senate committees introduced an alternative to the Alexander-Murray bill that Democrats immediately panned.
The competing plan, from House Ways and Means Chairman Kevin Brady (R-Tex.) and Senate Finance Chairman Orrin Hatch (R-Utah) would fund the cost-sharing reduction payments, known as CSRs, just like Alexander-Murray. But it would go further by delaying the ACA’s individual and employer mandates and giving states even more leeway in opting out of insurer regulations.” (D)

“Senate Majority Leader Mitch McConnell (R-Ky.) said on Sunday he would be willing to bring a health-care bill to the Senate floor if he had confidence President Trump would sign it into law…
“What I’m waiting for is to hear from President Trump what kind of health-care bill he might sign. If there’s a need for some kind of interim step here to stabilize the market, we need a bill the president will actually sign,” he continued…
Trump slammed the bipartisan deal on Wednesday, saying on Twitter that he could not support “bailing out” insurance companies, which he accused of making huge profits from ObamaCare.
However, the president appeared to backtrack on Thursday, saying he could be open to a bipartisan short-term ObamaCare stabilization deal in the upper chamber. “We will probably like a very short-term solution until we hit the block grants,” Trump said. “If they can do something like that, I’m open to it.” (E)

“.. White House aide Marc Short insisted that Trump would consider the Alexander-Murray compromise only if the Democrats also agreed to repeal Obamacare’s individual mandate, which requires all Americans to get health-care coverage. The mandate is essential to Obamacare markets, ensuring that enough healthy people join the insurance pool to offset the costs of the sick. Cost-sharing reduction payments, on the other hand, would help calm markets if restored, but state insurance regulators have found reasonable ways of cushioning the shock insurance-buyers would face without them. So Trump essentially asked Democrats to blow up Obamacare in return for payments that might help it a bit. If Senate Minority Leader Charles E. Schumer (D-N.Y.) did not rule this out immediately, a five-minute call with practically any independent health-care expert would have revealed this proposal for what it is: an insult.” (F)

“Senate Minority Leader Chuck Schumer said Sunday that the Alexander-Murray bipartisan health care bill has support from a majority of senators, and he urged Senate Majority Leader Mitch McConnell to bring it to the floor “immediately.”
“This is a good compromise. It took months to work out. It has a majority. It has 60 senators supporting it. We have all 48 Democrats, 12 Republicans,” Schumer (D-N.Y.) said on “Meet the Press” on NBC. “I would urge Senator McConnell to put it on the floor immediately, this week. It will pass and it will pass by a large number of votes.”…
Schumer said President Donald Trump originally urged lawmakers to come up with a bipartisan health care fix, but he added that the president’s reluctance to support the bipartisan bill comes after the “right wing” attacked it.” (G)

A federal judge sided with the Trump administration on Wednesday in a ruling against 18 states that sought to compel the federal government to pay subsidies to health insurance companies for the benefit of millions of low-income people.
“It appears initially that the Trump administration has the stronger legal argument,” Judge Vince Chhabria of Federal District Court in San Francisco wrote in the ruling.
He refused to issue a preliminary injunction requested by the states, leaving the dispute to be resolved in a trial in his courtroom over the next few months.
The states, led by the attorney general of California, Xavier Becerra, contend that the payments are needed to prevent chaos and confusion in insurance markets during the annual open enrollment period, which starts on Nov. 1.
But Judge Chhabria said at a hearing on Monday that California and other states had found “a very clever way” to protect their residents against immediate harm from termination of the subsidies by President Trump. As a result, he said in his Wednesday ruling, many low-income people will be “better off or unharmed.’’
During Monday’s hearing, state officials told Judge Chhabria that cutting off the subsidy payments would cause immediate and irreparable harm to states and to consumers, increasing the likelihood that insurers would pull out of the marketplace…
But Judge Chhabria said California and most of the other state plaintiffs “saw the writing on the wall a long time ago — that the administration was going to terminate these payments to insurance companies to subsidize co-payments and deductibles.”
“California is doing a really good job of responding to the termination of these payments in a way that is not only avoiding harm for people, but actually benefiting people,” the judge added.
In his Wednesday ruling, Judge Chhabria wrote that low-income people who now have silver plans in some cases may be able to find gold plans with lower premiums and lower deductibles for 2018.
To offset the expected loss of cost-sharing subsidies, California added a surcharge to the price of midlevel silver plans sold on its Affordable Care Act marketplace. When premiums go up, consumers receive more financial assistance to help with premium costs, so in many cases they will be no worse off….
Many other states have taken similar steps to minimize harm to consumers, the judge said. He was appointed in 2014 by President Barack Obama.” (H)

“Republican lawmakers will not take up a bipartisan plan to stabilize Obamacare insurance markets or try again to repeal and replace the law this year, House of Representatives Speaker Paul Ryan said on Wednesday, signaling his party was shelving the matter until the 2018 U.S. congressional election year.” (I)

“The CMS proposed a rule late Friday aimed at giving states more flexibility in stabilizing the Affordable Care Act exchanges and in interpreting the law’s essential health benefits as a way to lower the cost of individual and small group health plans….
The CMS said the rule would give states greater flexibility in defining the ACA’s minimum essential benefits to increase affordability of coverage. States would play a larger role in the certification of qualified health plans offered on the federal insurance exchange. And they would have more leeway in setting medical loss ratios for individual-market plans.
“Consumers who have specific health needs may be impacted by the proposed policy,” the agency said. “In the individual and small group markets, depending on the selection made by the state in which the consumer lives, consumers with less comprehensive plans may no longer have coverage for certain services. In other states, again depending on state choices, consumers may gain coverage for some services.” “ (J)

“Josh Kushner and Jared Kushner both have backgrounds in investment, but that might be where the brothers’ similarities end…..Josh, meanwhile, embarked on a sort of post-election apology tour to investment partners, denying any Trump administration connections, and was photographed taking in the Women’s March on Washington. Even the brothers’ business interests are in opposition: Jared is a crucial part of the Trump administration team seeking to repeal Obamacare—whose exchanges underpin Josh’s health-insurance company, Oscar—by any means necessary….
But on Friday, he and his Oscar co-founder, C.E.O. Mario Schlosser, published a clear, if characteristically equivocal, rebuke of Trump’s A.C.A. repeal push, in an op-ed for Axios. “The administration’s cuts to outreach and sporadic lip service to repealing the ACA do nothing to stanch growing confusion among shoppers,” Kushner and Schlosser complain, carefully, about the potential for Trump’s health-care plans to upend their business. On the plus side, “Plans will be more affordable for millions of Americans due to the seesaw impact of cuts to cost-sharing reduction subsidies, which will actually increase subsidies for many low-income consumers,” they write. “And for the first time, the I.R.S. will be aggressively enforcing the individual mandate.”” (K)

(A) Trump’s plan to end health care subsidy could yield unintended consequence, by Ricardo Alonso-Zaldivar, https://www.csmonitor.com/USA/2017/1019/Trump-s-plan-to-end-health-care-subsidy-could-yield-unintended-consequence
(B) CBO: Bipartisan health-care bill would reduce deficit by $4B over 10 years, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/357091-cbo-bipartisan-deal-would-reduce-deficit-by-4-billion
(C) Hatch Deals Blow to Bipartisan Health Care Bill, by Joe Williams, https://www.rollcall.com/news/politics/hatch-deals-devastating-blow-bipartisan-health-bill
(D) The Health 202: Trump is now the one holding up a health-care bill, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/10/25/the-health-202-trump-is-now-the-one-holding-up-a-health-care-bill/59ef549630fb045cba000a01/?utm_term=.067a1f1a14c4
(E) McConnell: I’d be happy to bring a health-care bill to the floor if I know Trump will sign it, by JULIA MANCHESTER, http://thehill.com/homenews/sunday-talk-shows/356593-mcconnell-id-be-happy-to-bring-a-health-care-bill-to-the-floor-if
(F) The latest terrible GOP plan to ruin Obamacare, by Stephen Stromberg, https://www.washingtonpost.com/blogs/post-partisan/wp/2017/10/24/the-latest-terrible-gop-plan-to-ruin-obamacare/?utm_term=.1f1eb70ba1c0
(G) Schumer: Bipartisan health care bill ‘has a majority’, by REBECCA MORIN, http://www.politico.com/story/2017/10/22/schumer-bipartisan-health-care-bill-has-a-majority-244040
(H) Siding With Trump, Judge Clears Way for Trial Over Health Subsidies, by ROBERT PEAR, https://www.nytimes.com/2017/10/25/us/politics/alexander-murray-congressional-budget-office-deficit-savings.html
(I) U.S. lawmakers will not tackle healthcare this year, Ryan says: Reuters interview, by Richard Cowan, Doina Chiacu, https://www.reuters.com/article/us-usa-healthcare-ryan/u-s-lawmakers-will-not-tackle-healthcare-this-year-ryan-says-reuters-interview-idUSKBN1CU1XW
(J) CMS to allow states to define essential health benefits, by Harris Meyer , Shelby Livingston and Virgil Dickson, http://www.modernhealthcare.com/article/20171027/NEWS/171029872?utm_source=modernhealthcare&utm_medium=email&utm_content=20171027-NEWS-171029872&utm_campaign=am
(K) JOSH KUSHNER POLITELY REBUKES HIS BROTHER’S BOSS FOR NUKING HIS BUSINESS, by MAYA KOSOFF, https://www.vanityfair.com/news/2017/10/josh-kushner-oscar-obamacare-op-ed

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