Health Reform

Will Pass
Price’s resignation paves the way for a bipartisan solution to stabilize health
care markets.
Bruce Japsen 10-1-17, Health Care Contributing Writer at Forbes, “Bipartisan Push
Intensifies To Fix Obamacare With Price Gone,” October 1, Forbes, retrieved at:
https://www.forbes.com/sites/brucejapsen/2017/10/01/bipartisan-push-intensifies-to-
fix-obamacare-with-price-gone/#3fdd595c7a9c

With Dr. Tom Price’s resignation as U.S. Health and Human Services Secretary, the
effort to improve the individual health insurance market under the Affordable
Care Act may gain bipartisan momentum.

Price was an obstacle to stabilizing the ACA's exchanges and spent years while
in Congress on unsuccessful repeals of the law. Price’s acting replacement, Dr. Don
Wright, is seen as an establishment figure having worked for former Presidents George
W. Bush and Barack Obama in various administrative health roles.
Price resigned Friday in the wake of mounting furor over his sticking taxpayers with $1
million in bills for private charters and military jet travel. President Trump, who
accepted his resignation Friday, was also reportedly upset Price couldn’t guide Congress
to a repeal of the ACA.
Still, Republican Speaker of the House of Representatives Paul Ryan said Price’s "vision
and hard work were vital to the House’s success passing our health care
legislation.” The Senate’s third effort to repeal the ACA died last week without a vote.
Critics saw Price as a divisive partisan who was working to undermine the ACA, which
expanded health insurance coverage to more than 20 million Americans.
“Throughout his brief time leading the Department of Health and Human Services, Tom
Price has repeatedly abused the public trust and betrayed the agency’s mission to
improve Americans’ health care,” Senate Finance Committee Ranking Member Ron
Wyden (D-Oregon) said Friday. “I hope that his resignation will mark the beginning of a
new chapter for the Trump administration’s health care agenda. Tom Price’s
replacement needs to be focused on implementing the law as written by Congress and
keeping the president’s promise to bring down the high cost of prescription drugs.”

Meanwhile, reports emerged late last week as Price was resigning that could bring
bipartisan legislation forward to shore up the ACA’s individual market. One
Senate proposal would allow health insurers to sell skimpier benefit packages at a lower
price while at the same time paying key Obamacare subsidies through at least next
year. The legislation is furthest along in the Senate from Republican Lamar Alexander of
Tennessee and Democrat Patty Murray of Washington.
“We appreciate the work that Senators Alexander and Murray are doing, and we look
forward to working with leaders of Congress to make coverage and care more affordable
for 2018 and beyond,” America’s Health Insurance Plans said Friday. AHIP represents
Anthem, Centene, Molina Healthcare and many Blue Cross and Blue Shield plans that
will offer coverage on the ACA’s public exchanges in 2018.
Health insurers have lobbied for the so-called CSRs to keep their customers from paying
20 to 25% rate increases. CSRs help purchasers of subsidized silver plans with their co-
payments and deductibles and President Donald Trump hasn't committed to funding
them other than a month-to-month basis.
CSRs are key, but researchers at the Urban Institute also see other reforms lawmakers
should consider to expand the risk pool and get more Americans to sign up for coverage
such as eliminating “non-ACA complaint health plans.
“Noncompliant plans are currently still permitted and effectively discriminate against
people with health problems,” Urban Institute researchers Linda Blumberg and John
Holahan said in a new analysis funded by the Robert Wood Johnson Foundation. “These
plans operate outside the ACA’s uniform nongroup risk pool and enroll healthier people
with low expected health care needs.”

Exactly how the legislation would make it through Congress is unclear but some groups
see multiple paths given what’s ahead on the legislative calendar that will
need Democratic and Republican votes.
For example, the Advanced Medical Technology Association (AdvaMed), which is
working to permanently rid the industry of the ACA’s 2.3% tax on device sales, said
legislative language it wants could be added on to a five-year funding extension for the
Children’s Health Insurance Program (CHIP). The CHIP program has bipartisan
support and will be voted on yet this fall. AdvaMed represents hundreds of medical
device makers, including Johnson & Johnson, Medtronic and Stryker.

Another option is a standalone bill to fix Obamacare’s markets though that could
have trouble winning over enough Republicans. “The American people did not send us
here to bail out insurance companies,” Sen. Ted Cruz, (R-Texas) said in a Washington
Examiner report. “They sent us here to repeal and replace Obamacare.”

A third potential option would be to include the Obamacare fix in an “omnibus”

spending bill that packages appropriations and related bills into one single bill that
would need to pass both houses of Congress, likely by the end of this year.
 Now Key
Congressional action is the only way to offset Trump’s recent decision to end
ACA subsidies and stabilize insurance markets.
Dylan Scott 10-12-17, policy reporter for Vox covering health care and other domestic
policy, “Report: Trump plans to pull Obamacare subsidies in another attack on health
law,” October 12, Vox, retrieved at: https://www.vox.com/policy-and-
politics/2017/10/12/16070724/trump-cost-sharing-reductions-pulled

President Trump has reportedly decided to cut off crucial Obamacare subsidies
that help reduce health care costs for lower-income Americans, according to Politico, a
serious attack on the stability of the health care law’s insurance markets.

Trump has been threatening to end the payments — know as cost-sharing reduction
subsidies or CSRs — for months, but is finally following through after Republicans in
Congress once again failed to repeal and replace Obamacare late last month.

Politico reported late Thursday that Trump had decided to end the payments. The
move comes as the Trump administration is also cutting funding for Obamacare
outreach and pursuing new regulations to blow holes in the law, changes that collectively
threaten a program through which millions of Americans purchase
insurance.

The cost-sharing payments, which were created as part of the health care law but were
then the subject of a lawsuit from House Republicans, help compensate health insurers
for lowering the copays and deductibles that their lower-income customers must pay.
A federal judge has found the payments to be illegal without any further congressional
action. Both Republicans and Democrats in Congress have expressed an
openness to funding the subsidies, which would remove Trump’s ability to
nix them, but no action has yet been taken.

Some health insurers had already increased their premiums for Obamacare plans in
2018 by as much as 20 percent because of Trump’s threats to cut off the payments. A
permanent end to the subsidies could imperil the law’s marketplaces in the long
term and lead to even bigger price hikes in future years.

Health plans could potentially sue the Trump administration to force the payments to be
made, as they have on earlier occasions when Republicans sought to cut off federal
funding provided under Obamacare. States have also taken steps to prepare for the
possibility Trump would pull the payments, and most 2018 rates have already been
finalized. So premiums might not be immediately affected any more than they already
have been.

But Trump is nonetheless introducing even more uncertainty to Obamacare’s

future. As Vox has covered in great detail, a lawsuit filed by House Republicans three
years ago gave him that opening.

CSRs, a crucial piece of Obamacare, were the target of a GOP lawsuit

Under Obamacare, people who earn too much for Medicaid but are still low-income —
up to 250 percent of the federal poverty line, about $30,000 for one person — receive
cost-sharing reductions for their private insurance. The federal government makes
those payments to the health insurer to lower the out-of-pocket costs, the deductible and
copayments, that those people have to pay for their health care. The less money people
make, the more help they receive.

More than half of people who buy individual insurance through Obamacare
got this help. About 12 million people bought health insurance through Obamacare’s
insurance markets this year, and 7 million of them qualified for CSRs, according to the
Kaiser Family Foundation.

The impact is substantial: A person who doesn’t qualify for a CSR and buys a typical
Obamacare plan could have to pay as much as $3,609 for a deductible before her plan
starts to cover her health care. But a person who qualifies for the most generous CSR —
whose income is at the poverty line or only a little above it — could have to pay only $255
before the coverage kicks in.
Last year, CSR payments cost the federal government $7 billion, which means that, on
average, CSRs lowered out-of-pocket costs by about $1,000 for each person.
Republicans targeted them in a 2014 lawsuit, arguing that though Obamacare had
created the subsidies, Congress needed to approve them in a separate spending bill and
had not done so before the Obama administration started making the payments. That
made the payments unconstitutional, according to House Republicans.
The Obama administration argued that Obamacare had permanently funded the CSR
payments and so it did not need any additional authority from Congress to make the
payments. It also argued that regardless of the facts of the case, the House didn’t actually
have the ability to bring a case because it wasn’t harmed by the cost-sharing reduction
payments, a legal concept known as “standing.”
Rosemary Collyer, the judge hearing the case and a Republican appointee, first ruled in
September 2015 that the House did in fact have standing to sue the administration over
the payments. She then sided with the House in May 2016, deciding that the CSR
payments could not be made without further congressional approval.
However, she suspended the decision so that the Obama administration could appeal,
allowing the payments to continue until the case is fully resolved. The Obama
administration appealed the ruling in July 2016 to the US District Court of Appeals in
Washington. But litigation moves slowly, and the case didn’t advance much further in
the next six months. Then Trump was elected.

Congress could approve the CSR payments, mitigating Trump’s move

Even without the CSR payments, insurers would still be required to reduce cost sharing,
but they would now have to do it without the government’s help. They have said they
will raise premiums dramatically to make up the lost revenue.

The irony is that if plans do raise premiums, the federal government would be on the
hook for much of those costs. The government absorbs premium increases through the
tax credits that help people afford coverage. The law is designed to keep premiums
manageable for people, so it falls on the government to cover any excess increases.

Or, perhaps more likely, plans could eventually drop out of the market
altogether.

The empty spots on Obamacare’s map have been filled in in recent weeks, but if insurers
decide to leave the market, either now or later, thousands of Americans could be
left without plan options as a result of Trump’s action.

“If I were an insurer, I’d just take my marbles with me and focus on other more
profitable lines of business,” Larry Levitt at the Kaiser Family Foundation told me.
Health insurers could sue to force the federal government to make the payments,
as they’ve done for other Obamacare funding streams plugged up by Republicans.
Several industry sources indicated before Trump’s decision that would be a potential
course for insurers to take, though no final decisions had yet been made.

But there is a quicker course to fix the issue. Congressional Republicans know the
consequences of this move, and they have talked for months about approving the
payments themselves and removing the risk that the White House would nix the
CSRs and send the insurance market into chaos.
Now, following the failure of Senate Republicans to repeal the law, an increasing
number of them are turning toward a bipartisan health care solution — one
that is likely to include funding for CSRs. Top Senate Republicans and Democrats
had neared an agreement on an Obamacare fix package which would fund the
payments, but they have not yet finalized a deal that could be brought up for a vote.

But the underlying point is that if Congress were to act, Trump would no longer
have the option to cut off the CSR payments as an attack on the health care law.

It’s the largest and quickest internal link to market collapse.

Paige Winfield Cunningham 10-13-17, healthcare reporter at The Washington Post,
“The Health 202: Trump moves from firing shots at Obamacare to all-out war,” October
13, The Washington Post, retrieved at:
https://www.washingtonpost.com/news/powerpost/paloma/the-health-
202/2017/10/13/the-health-202-trump-moves-from-firing-shots-at-obamacare-to-all-
out-war/59dfa6ae30fb041a74e75d29/?utm_term=.28e159ba3c13

But the Trump administration is injecting turbulence into the Obamacare

marketplaces by cutting off the payments just as insurers are finalizing their 2018
plan offerings. Losing the approximately $7 billion in annual payments, which
reimburse insurers for discounting deductibles and co-payments for the lowest-income
enrollees, is grounds for insurers to back out of their federal contracts to even sell
plans next year. The administration had been making the payments on a month-to-
month basis, prompting complaints by insurers about a lack of certainty as they tried
to plan ahead.
The six-week ACA enrollment period for 2018 is scheduled to start Nov. 1,
allowing around 11 million Americans to shop for private, subsidized coverage on
Healthcare.gov and other state-run marketplaces. Many of them were already facing
higher premiums and fewer plan options -- and the administration's move could
worsen the situation. Insurers have said halting the CSRs would be the single
greatest step the administration could do to undermine the marketplaces.

"Millions of Americans rely on theses benefits to afford their coverage and care," Kristine
Grow, spokeswoman for America's Health Insurance Plans, emailed me late last night
after the announcement came out.
 AT: Trump Bluffing
Not bluffing---Trump thinks he can just pin it on Congress.
Aaron Blake 10-13-17, senior political reporter, “Trump is setting up the GOP-led
Congress to fail,” October 13, The Washington Post, retrieved at:
https://www.washingtonpost.com/news/the-fix/wp/2017/10/13/trump-is-setting-up-
congress-to-fail/?utm_term=.33ef3c5d44ed
As The Post's Amy Goldstein and Juliet Eilperin note, Trump previously resisted the urge
to take this step, because “administration officials warned him such a move would cause
an implosion of the ACA marketplaces that could be blamed on Republicans.”
That's entirely possible, and it certainly is the big risk Trump is taking in making this
decision. But we also have plenty of evidence that the only voters Trump cares
about — the Republican base — are quite willing to blame Congress rather than
Trump for bad outcomes. A Marist College poll conducted in July, when Republicans
were still trying in vain to replace Obamacare, showed 50 percent of Republicans would
blame Democrats if it didn't pass, despite Republicans having majorities in both the
House and Senate. Only 20 percent said they would blame Republicans, while only 6
percent blaming Trump.

We've seen before how Trump has been more than happy to blame Congress —
up to and including congressional Republican leaders — when things go wrong. He
targeted Senate Majority Leader Mitch McConnell (R-Ky.) when the Senate failed to do
what the House did and pass its own version of an Obamacare replacement. He
also blamed both McConnell and House Speaker Paul D. Ryan (R-Wis.) for the debt
ceiling “mess” that eventually led Trump to cut a deal with Democrats. And he has
attacked McConnell for not lowering the threshold for passing bills in the Senate from 60
votes to a bare majority.

All along the way, Congress's numbers have plummeted back near historic lows,
thanks to Republicans souring on it. And so have the poll numbers of Republicans who
ran afoul of Trump, including McConnell. Trump's numbers, meanwhile, remain
largely static. It's clear what side is winning this battle for the GOP base right now,
and it's decidedly Trump.

If Trump has shown anything, it's that he loves to lay blame and is prepared to lay it
upon just about anybody else. Lurking behind all of that is his apparent desire to
consolidate his own power and make himself the only thing that his supporters can rely
upon. He has no loyalty to the Republican Party, and I wouldn't be the first to
suggest that he's threatening to rip it apart.
This very much could play into that. In laying these things at Congress's feet, Trump
could either force Congress into an unprecedented amount of action in the
months ahead, in which case he'll likely take credit for whatever results they
produce, or usher in its failure, in which case he'll simply blame them and make
life even more hellacious for the party whose nomination he commandeered in 2016.
 2AC Health Reform
Won’t pass---nowhere close to a deal now.
Sam Baker 10-13-17, health care editor at Axios, “Trump takes a sledgehammer to the
ACA,” October 13, Axios, retrieved at: https://www.axios.com/trump-aca-
sledgehammer-2496114772.html
The fix: Congress can solve this. University of Michigan law professor Nicholas Bagley,
an expert on this issue, told me that if Congress appropriates the money for these
subsidies, they would begin flowing again immediately. The problem is, Republicans
aren't in the mood to do that without some big concessions from Democrats
— and the Senate bipartisan talks aren't anywhere close to a deal.