Trump States Hit Hardest if Obamacare Cost-Sharing Help Ends
But funding subsidies is tough choice for Republicans
By ERIN MERSHON and JOE WILLIAMSCQ Roll Call
The constituents with the most to lose if Congressional Republicans cut funding to Obamacare overwhelmingly live in the parts of the country that President Donald Trump won in last year’s election.
The controversial health program aimed at reducing out-of-pocket costs is part of the 2010 health overhaul Republicans have long opposed. An analysis of the Americans at risk is part of the pitch insurers are making on the Hill as they pressure newly empowered Republicans to keep so-called cost-sharing reductions, which help insurers reduce copays and deductibles for about 6.3 million low-income Americans in the individual insurance market.
Some insurers are circulating a “heat map” that highlights for lawmakers exactly which voters would be impacted by the disappearance of the subsidies, according to congressional aides, lobbyists and others. More than a million people in Florida alone receive the subsidies, and more than two-thirds of the health care exchange populations in Mississippi, South Carolina and Alabama rely on them. In another 29 states, more than half the people relying on the exchanges set up by the health law get the extra help.
“Where are the people who are getting the biggest benefit from the CSR program? They’re in Trump country,” said Bill Pierce, a senior director at APCO Worldwide.
The industry’s main lobbying arm, America’s Health Insurance Plans, said its officials did not make the map. Several other lobbyists and aides declined to comment on its provenance.
But AHIP called the subsidies “an essential piece of stabilizing the market on a temporary, transitional basis.” Insurers, who would be required by statute to keep reducing copays and deductibles even if the offsetting subsidies disappeared, could break their contracts to participate in the marketplaces mid-year if the funding evaporated.
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Funding the subsidies won’t be easy for Republicans, who spent the last several years fighting the payments at every turn. Republicans argue that the payments were never authorized by Congress in an appropriations statute — and that the Obama administration’s decision to fund them was an illegal violation of the executive branch’s authority.
House Republicans sued the Obama administration over that funding decision and so far, have won in federal court, which explains why the subsidies are in jeopardy. A federal judge stayed the decision until Feb. 21 to give the incoming Trump administration time to decide whether to continue the Obama administration’s appeal or perhaps to settle the case some other way with House Republicans. Should Trump drop the appeal, the subsidies would disappear immediately without congressional action.
But there are signs Republicans may fund the subsidies before that happens. Several lobbyists said they expect the funding to be authorized, despite a $20 billion price tag for 2017 and 2018 alone. The issue even came up at last week’s roundtables with GOP governors, with state officials like Gov. John Kasich, R-Ohio, pressing Congress to fund the subsidies, according to an aide familiar with the meetings.
Even the key House committees — both of which launched sprawling oversight investigations into the validity of the subsidies and even subpoenaed and deposed Obama administration officials on the issue — are now signaling they won’t let the funding disappear.