“… President Donald Trump on Wednesday backed away from a bipartisan deal on healthcare reached by two senators…

a day earlier, saying he could never support legislation “bailing out” insurance companies.
On Tuesday, Trump appeared to embrace the deal struck by Republican Senator Lamar Alexander and Democratic Senator Patty Murray as “a short-term solution so that we don’t have this very dangerous little period,” apparently referring to possible premium spikes in the wake of his recent decision to cut off subsidy payments to insurance companies.
But in a tweet on Wednesday he took a different tack on the bill, which would continue the cost-sharing subsidies that lower premiums for lower-income Americans, writing: “I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co’s who have made a fortune w/ O’Care.” (A)

“A proposal in the Senate to help stabilize Affordable Care Act marketplaces would ensure that subsidies paid to insurance companies benefit consumers rather than padding the companies’ profits.
A draft of the bill, obtained by NPR, requires health plans to offer the subsidies as one-time or monthly rebates to consumers or they will be repaid to the federal government. The subsidies, known as cost-sharing reduction payments, are designed to reimburse insurance companies for discounts they are required to offer their customers on copayments and deductibles. President Trump has criticized the payments as a “bailout” and said last week he would cut them off.” (B)

“Sens. Lamar Alexander and Patty Murray have reached a deal “in principle” to restore Affordable Care Act cost-sharing reduction payments for two years in exchange for more state flexibility in Obamacare.
One Senate aide said the plan would also restore just over $100 million in funding for Obamacare outreach, which is particularly critical since the Trump administration has slashed support for 2018 open enrollment, which begins on November 1.
An Alexander aide told CNN that Republicans would get a provision they wanted, a major change in how states measure the affordability of insurance under their waiver requests. This would allow states a lot more flexibility, but that final language was still being ironed out.
The deal would make it easier for states to obtain waivers to customize Obamacare rules to their needs. States have complained that applying for waivers is a long and complicated process. Alaska and Minnesota, for instance, have received permission to use federal funds for reinsurance programs that reduce premiums. This agreement would speed administration approval of the waivers and allow states to copy provisions in waivers that were already approved.
However, it does not actually loosen any of Obamacare’s regulations, which had been a key goal of the Republican effort to repeal the health reform law.
The agreement would also allow all Obamacare enrollees to sign up for so-called catastrophic plans, which have lower premiums but have higher deductibles. Right now, these so-called copper policies are only open to those under 30.
There are no guarantees that Republican leadership would bring such a plan to the floor without significant support from rank-and-file members. Getting a sizable number of co-sponsors will be key to the Murray and Alexander’s success. That work has yet to begin. “ (C)

“A bipartisan Senate deal that would extend critical ObamaCare payments to insurers for two years got the cold shoulder from Republicans on Tuesday, suggesting it faces a rocky path to become law.
The chairman of the conservative Republican Study Committee in the House dismissed the offering from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) as an affront to GOP promises to repeal President Obama’s signature legislation.
“Anything propping [ObamaCare] up is only saving what Republicans promised to dismantle,” said Rep. Mark Walker (R-N.C.), who leads a group of more than 150 conservatives.
Senate Majority Leader Mitch McConnell (R-Ky.) stopped short of promising to bring the bill to the floor, and while Sens. John McCain (R-Ariz.) and Susan Collins (R-Maine) offered some praise, not a single Senate GOP conservative offered strong public support for the compromise.
Senate Democrats, in contrast, hailed the deal, and pressed GOP leaders to quickly bring it to the floor.” (D)

Hospitals should see rising bad debt in 2018 as these co-pays/deductibles go unfunded
Without CSRs, insurers say, Obamacare patients will see costs jump 25% or more in 2018
The nation’s doctors and hospitals are bracing for an increase in unpaid medical bills after President Donald Trump’s decision on Friday to stop funding subsidies that low-income Americans use to pay their out-of-pocket costs.
Trump’s decision comes just before the beginning of open enrollment on Nov. 1 for subsidized individual coverage sold on public exchanges for 2018 under the Affordable Care Act. Cost-sharing reductions (CSRs) help purchasers of subsidized silver plans pay their co-payments and deductibles…
Trump’s move also comes with Americans, beyond just those in Obamacare plans, already seeing a jump in their out-of-pocket healthcare costs. Employee benefits consultancy Aon says out-of-pocket costs for workers at large employers will, for the first time in 2018, eclipse $2,500, and that trend has impacted providers.” (E)

“As a candidate, Donald Trump sold himself as a deal maker. As president, he’s governing more as a hostage taker.
Across an array of domestic and foreign challenges, Trump’s go-to move has become to create what amounts to a political hostage situation. He’s either terminating, or threatening to terminate, a series of domestic and international policies adopted by earlier administrations — and insisting that others grant him concessions to change his mind….
Trump’s expectation is that his threats will strengthen his leverage over whoever he’s negotiating against — whether Democrats in Congress, foreign governments, or both. But the early experience suggests that Trump’s actions more often may have the opposite effects: to isolate him, divide his allies, and harden opposition to his proposals.
Trump’s threats to undo major agreements have unquestionably heightened anxiety and created disruption for those he’s trying to pressure.
Just the possibility that Trump would end the cost-sharing payments, which reimburse insurance companies for limiting out-of-pocket health care costs for low income consumers, already forced insurers to preemptively raise premiums this year, adding more pressure on Obamacare markets. His move to actually stop the payments could make coverage unaffordable for many more of the uninsured and/or prompt insurance companies to flee more states under the ACA.” (F)

“Now, in reality, the Obama administration was highly selective in enforcing the Affordable Care Act as written. Here are just some examples of ways in which Obama simply ignored the Affordable Care Act and decided to do what he thought was best, regardless of the law:
The Obama administration decided not to enforce the law’s employer mandate until 2015, and then delayed its enforcement a second time.
After millions of Americans complained that their insurance plans had been canceled—contrary to Obama’s promise that “if you like your plan, you can keep your plan”—Obama declined to enforce aspects of the law that required those plans to shut down—until he was reelected.
The Obama administration decided—unilaterally—to waive Obamacare’s individual mandate, by granting a “hardship exemption” to anyone for whom Obamacare’s offerings were “unaffordable.”
The Affordable Care Act forced insurers to offer plans with reduced co-pays and deductibles for those with very low-incomes, but didn’t appropriate the cost-sharing subsidies needed to pay for them. Facing a rebellion from insurers, who were being forced to cover these individuals at a loss, the Obama administration decided to spend the money anyway, even though they had no legal authority to do so.” (G)

(A) Trump Backs Away From Bipartisan Senate Healthcare Bill, by Tim Ahmann, https://www.usnews.com/news/top-news/articles/2017-10-18/trump-backs-away-from-bipartisan-senate-healthcare-bill
(B) Draft Of Health Care Bill Addresses Trump Concerns About ‘Bailouts’ For Insurers, by Alison Kodjak, http://www.npr.org/2017/10/18/558546804/draft-of-health-care-bill-addresses-trump-concerns-about-bailouts-for-insurers
(C) Bipartisan senators reach small deal on health care, by Lauren Fox and Tami Luhby, http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html
(D) New health deal falls flat with GOP, by PETER SULLIVAN, http://thehill.com/policy/healthcare/355917-new-health-deal-falls-flat-with-gop
(E) Hospitals Brace For Unpaid Patient Bills After Trump Ends Obamacare Subsidies, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2017/10/15/hospitals-brace-for-unpaid-patient-bills-after-trump-ends-obamacare-subsidies/#f1ee9b251f8d
(F) How Donald Trump is negotiating like a hostage-taker, by Ronald Brownstein, http://www.cnn.com/2017/10/17/politics/donald-trump-negotiating-strategy/index.html
(G) Sorry Everbody, But Trump Hasn’t Instigated The Obamacare Apocalypse, by Avik Roy, https://www.forbes.com/sites/theapothecary/2017/10/14/sorry-everbody-but-trump-hasnt-instigated-the-obamacare-apocalypse/#219155ae7099

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