Republicans are coming around to the idea of paying insurers to reduce medical expenses for low-income customers for the long term, but they are disagreeing over whether the payments should come from White House or Congress.
Congress has shown no signs recently of making an emergency appropriation of cost-sharing reduction payments to insurers, which have been pushing Congress and the Trump administration to decide if the payments will be made next year, as they are sending in their plan proposals.
Republicans are calling for Congress to make the payments, but some are floating the idea of having the White House make them instead. The question over who makes the payments comes as a lawsuit over the payments sits in court, as Republicans sued the Obama administration for bypassing Congress on the funding.
Sen. Lamar Alexander, R-Tenn., wants the payments to be made by any means necessary, whether it be Congress or the White House.
The chairman of the Senate Health, Education, Labor and Pensions Committee recommended Thursday that the White House “find a way, either through administrative action or legislation or a combination to extend temporary cost-sharing payments under the Affordable Care Act at least through 2018 — and probably should go ahead and do it through 2019.”
Sen. Bill Cassidy, R-La., told reporters Thursday that he would prefer Congress make the payments, which totaled $7 billion last year. The money reimburses insurers for lowering co-pays and deductibles for low-income Obamacare customers.
Cassidy was then asked if he supported the White House funding the payments.
“I suppose, but I would not want that to be a long-term solution. I think the Constitution has to be obeyed,” he said.
Rep. Kevin Brady, R-Texas, said during a budget hearing last week that he wants the payments to be made for 2018, according to the Associated Press. But an aide clarified to the Associated Press that Brady wants the payments to be made through Congress and not the White House.
Sen. Ron Johnson, R-Wis., also wants Congress to make the payments.
“I think we should take the responsibility and appropriate that,” he said. “I don’t think it should have been handled the way the Obama administration did.”
Johnson was one of the senators pushing hard for a short-term stabilization bill to help prop up the individual market, which includes Obamacare’s exchanges and is used by people who don’t have insurance through work.
He added that he understood why leadership shied away from a short-term bill.
“By not doing anything we have put pressure on ourselves to get this completed,” he said.
The funding source is more than a mere formality for Republicans.
In 2014, the House sued the Obama administration over the payments, charging that the administration illegally bypassed the congressional appropriation process.
A federal judge agreed with the House last year but stayed her ruling until appeals were exhausted. Then the White House changed hands, and the appeal filed by the Obama administration has been left in legal limbo.
The Trump administration has said that it will continue to make the payments in the short term but hasn’t made a decision for 2018.
Insurers have wanted to know for months if the payments will be made for 2018 since they are formulating rates and plans now.
Some insurers have said they plan to charge higher rates if the cost-sharing subsidies are cut off.
A major deadline is coming up for Obamacare insurers. Rates for plans to be sold on healthcare.gov, which is used by residents in 38 states and the District of Columbia, are due Wednesday.
