Trump’s health care order heralds new battles on Capitol Hill

WASHINGTON - President Donald Trump's decision late Thursday to cut off crucial health care subsidies for insurance companies once again has torn open the festering debate over the Affordable Care Act, increasing the potential for a government shutdown next month and ensuring the issue will be central in next year's midterm elections.

The move to end cost-sharing subsidies on behalf of low-income patients could spike premiums for those who purchase insurance on the individual market.

While Trump and Republican allies argued that former president Barack Obama's signature health care reform law is fundamentally flawed, Democrats called the move an act of sabotage and pledged a fight.

'Republicans in the House and Senate now own the health care system in this country from top to bottom, and their destructive actions, and the actions of the president, are going to fall on their backs,” Senate Minority Leader Charles Schumer, D-N.Y., said Friday. 'The American people will know exactly where to place the blame when their premiums shoot up and when millions lose coverage.”

The Democratic attorneys general of 18 states - including Iowa's - vowed Friday to sue Trump to force him to make the next payment. Legal experts, though, said the states are likely to face an uphill battle.

Under the Affordable Care Act, cost-sharing reductions are federal payments made to insurers that help eligible consumers afford their deductibles and other out-of-pocket expenses.

The costs of these payments were at $7 billion in fiscal year 2017 and could hit $10 billion in 2018 and $16 billion by 2027, the Congressional Budget Office reported.

The cost-sharing reductions are different from the subsidies consumers receive to help cover premiums. Most Obamacare enrollees still will qualify for those.

The future of cost-sharing reductions has been a question mark for some time. The U.S. House sued the Department of Health and Human Services Secretary under Obama, challenging the legality of the payments without an explicit appropriation, according to the Kaiser Family Foundation. A judge ruled for the House, but that was appealed and payments were let to continue.

Iowa's GOP senators said Friday that Trump's order forces Congress to review the payments.

'Senators (Lamar) Alexander (R-Tennessee) and (Patty) Murray (D-Washington) have been working on bipartisan legislation that would fund the payments legally and make other reforms, but there's concern that the Senate minority leader will shut down any forward movement on a bipartisan bill like he has to date,” said Sen. Chuck Grassley.

But Politico reported Friday that it was Trump himself who would not support a congressional deal allowing the payments to resume - unless he got something in return, like money for his proposed border wall.

'The president has said pretty clearly that he's willing to talk to just about anybody about repealing and replacing (Obamacare),” White House budget director Mick Mulvaney told Politico. 'But if the straight-up question is: Is the president interested in continuing what he sees as corporate welfare and bailouts for the insurance companies? No.”

Ahead of a Dec. 8 deadline for funding the government, Schumer declined to draw a hard line when asked if Democrats would oppose a spending bill that did not include the cost-sharing.

'I think we're going to have a very good opportunity in the (next spending bill) to get this done in a bipartisan way if we can't get it done sooner,” he said.

Democrats can block any spending bill from passage in the Senate, where a 60-vote supermajority is needed to pass most major legislation. In the House, Democrats frequently have provided the majority of the votes for bills keeping the government open - giving them some leverage.

Key conservatives, however, warned that any attempt to continue the subsidies would be met with resistance.

Rep. Mark Walker, R-N.C., chairman of the conservative Republican Study Committee, said the only way he and other conservatives could stomach an extension would be as a bridge to a new health care system.

'This may create enough energy and buzz to say, ‘Okay, we've got to get back to the drawing board and do something pretty quick here,'” Walker said.

The Washington Post, Reuters and Chelsea Keenan of The Gazette contributed to this report.