The Congressional Budget Office's review of potential Trump sabotage presented less dire news than Trump has been counting on should he decide to halt cost-sharing reduction payments to insurance companies on the Affordable Care Act exchanges.
These CSR payments are reimbursements to insurance companies who subsidize the deductibles, co-pays, and other out-of-pocket costs for lower-income people purchasing the "silver" plans, the standard the law sets as a benchmark in each market for determining subsidy levels for those who qualify for them. They are the only level of plan that qualifies both for the tax credit and CSR subsidies. Insurance companies are required by the law to provide the CSR subsidies to people at 100 to 250 percent of the poverty level buying their silver plans. Here's where it gets kind of weird.
The CBO report envisions a relatively orderly process in which Trump announces his plans to cut off the money in advance, with the payments not halting until January.
The agency also assumes that insurance companies and state insurance regulators would agree on a plan to institute the higher premium increases only for Silver-level policies, not the skimpier Bronze plans or the more generous Gold and Platinum plans.
Kaiser Family Foundation's Larry Levitt points out that this means the more expensive gold plans could end up being cheaper than the silver plans, sort of a perverse result, and that the federal government is paying more—a lot more—for those tax credits. While it would save $118 billion over the next 10 years in CSR payments, it would by paying out $365 billion more in premium subsidies.
While the report doesn't show dire consequences for the insured in this report, it considers only what it can—the end of CSR payments—and not the full range of Trump's sabotage capabilities.
We're already seeing the administration's refusal to participate in outreach efforts to get people signed up. They've shown every indication of refusing to enforce the individual mandate that everyone have health insurance or pay a penalty.
They've already caused enough disruption to cause insurers to leave the program and for many remaining ones to raise premiums. So while cutting off the CSR payments might not have the disastrous impact many have feared, the combined weight of Trump's efforts to destroy the law means it could still happen.
Which means Congress has to act—or face the 8 out of 10 voters who are demanding they make the law work.