On Friday, I posted a diary in which I warned that, as much as we should celebrate the defeat of the AHCA/Trumpcare bill, winning that victory also opens up the next phase in the battle to save the ACA: Deliberate sabotage by Donald Trump and his HHS Secretary Tom Price.
I listed a bunch of actual sabotage incidents along with some potential stunts they could pull to weaken/injure the law. However, I just realized that I made a major error in that diary: I listed the Cost Sharing Reduction (CSR) reimbursement lawsuit issue last, as almost an afterthought, instead of making it the #1 focus.
Here's the link explaining the backstory again, but the bottom line is this:
- In addition to the 9 million+ people receiving APTC assistance for their premiums, around 7 million also receive CSR assistance, which cuts their deductibles/co-pays down to size.
- Unlike APTC assistance, with CSR, the insurance carriers cover the balance, and then the HHS Dept. reimburses the insurance carriers for the expense.
- Due to some questionable wording in the ACA, a lawsuit filed by the House Republicans, and a federal judge who has ruled (for now) in favor of the GOP's case, those CSR payments are currently in legal limbo until the case works its way up to the Supreme Court (think "King vs. Burwell Jr.", but with a slightly stronger case)
- The payments are being allowed to continue month to month for the time being, but Donald Trump could instruct the HHS Dept. to stop defending the payments.
- If that happens, there's an "exit clause" in the carrier contracts which would allow them to immediately terminate the policies in question. And by "immediately", I mean "the end of that month", which could theoretically be as early as April 30th at this point, I believe, assuming the April reimbursements are cancelled. That would mean a good 7 million people losing their policies almost instantly.
- Those terminations may be prevented by state laws preventing such things...but even in that instance, I guarantee that pretty much every carrier would flee the exchanges for 2018, and would likely leave the entire individual market (off-exchange as well) next year.
Again, the specifics are more complicated, but this is my understanding of how the worst-case scenario could play out.
If the President was anyone other than Donald Trump--even another Republican--I can't fathom that they would pull the plug on the CSR payments, even if they also wanted to repeal the ACA entirely--they'd urge Congress to amend the ACA to resolve the legal question and ensure CSR payments (at least for another year, for instance, until the SCOTUS hears the case) rather than throw the entire market into disarray. While the GOP would obviously try to blame the wording of the law and the Democrats for the ensuing carnage, the ACA is entirely in their hands now; come 2018 it would be awfully difficult to try and pin the blame on an obscure legal argument dating 8 years earlier, especially when it would take about 5 minutes to fix the problem.
Hell, the House Republicans are so terrified about the fallout if the above were to happen that they've even asked the court WHICH RULED IN THEIR FAVOR to delay the final ruling until the larger healthcare/ACA debate has been worked out:
To buy President-elect Donald Trump time to craft an Affordable Care Act replacement, House Republicans have asked a federal appellate court to delay considering the Obama administration's appeal in a case that could end some payments to health plans and throw the individual insurance market into chaos.
The House Republicans' general counsel filed a motion Thursday to temporarily hold in abeyance all briefings in the appeal of a federal district court's May ruling in House v. Burwell that the Obama administration illegally compensated insurers for reducing low-income enrollees' cost-sharing responsibilities. A U.S. District Court judge nominated by President George W. Bush unexpectedly held that the payments were unconstitutional because Congress had not appropriated the money.
...If those cost-sharing reduction payments were eliminated, as House Republicans have sought, insurers either would have to sharply raise premiums or exit the ACA exchange markets, since the law requires them to reduce cost-sharing burdens for eligible members in silver plans.
The incoming Trump administration and congressional Republican leaders have promised to quickly repeal most of the ACA. But some Republicans and health policy experts fear that any hasty, drastic moves would crash the individual insurance markets. They warn that ending the cost-sharing reductions without any replacement system might panic insurers by causing them to lose lots of money.
That's right: The GOP is scrambling to reverse THEIR OWN LAWSUIT because they just realized what a disaster winning it would cause (again, just like a "win" in King v. Burwell would have been a couple of years back).
But this is Donald Trump we're talking about. All bets are off.
UPDATE: BY REQUEST (seriously...someone in the comments asked me to add this): Feel free to help support my work here.