Not repealing Obamacare among 'worst legislative failures in modern history'
By Jay Steinmetz
Oct 20, 2017 | 6:00 AM
President Donald Trump is poised to halt billions in subsidy payments to insurance companies that help cover medical costs for millions of low-income Americans. (Oct. 13, 2017) (Sign up for our free video newsletter here http://bit.ly/2n6VKPR)
New York Attorney General Eric Schneiderman describes the consumer impact of President Trump's decision to end federal payments to health insurers as if one were buying a car and having to pay extra for the wheels.
He's filed a partisan legal challenge to the president's move, joined by Maryland Attorney General Brian Frosh and other attorneys general in over a dozen states and the District of Columbia.
For the sake of accomplishing something that resembles improving health care coverage, let's hope the latest legal challenge from various attorneys general is based on more than childish analogies.
To some, say a federal judge, the car comparison might actually be construed as one where the wheels are taken from one car owner, the American taxpayer, without their knowledge and put on another's vehicle. Here is why: The Affordable Care Act requires subsidies to insurance companies in an attempt to hold down costs in the individual market. Others describe the payments, formally known as cost-share reduction subsidies, as nothing more than a taxpayer bailout for insurance companies. Not to be confused with tax credits for lower income individuals to purchase policies, the subsidies are additional government spending directed to health insurers to make the law, known as Obamacare, financially viable.
The problem is that Congress has not appropriated money for cost share reduction subsidies, but the Obama administration dispersed this money to insurance companies anyway. Federal Judge Rosemary Collyer ruled last year that such reimbursements violated the Constitution. Her finding was the result of the Republican-led House of Representatives' 2014 lawsuit challenging the payments. The state attorneys general case rests on finding another federal judge sympathetic to their arguments where they demand an injunction to stop the Trump administration from ending the payments.
Never-ending lawsuits. The Affordable Care Act has been before the Supreme Court on issues ranging from how to provide contraceptive coverage to whether states must expand Medicaid. Add to that district and circuit cases. Dockets in the federal court system are clogged with cases across the political spectrum.
Meanwhile, expect higher premiums and fewer choices as everyone but politicians waits for some kind of relief from a health care law that is falling apart. As Obamacare fails, with insurers leaving the business and double-digit premium increases every year, politicians fiddle around the edges.
Let's put this latest legal challenge from attorneys general in its proper context. The individual market comprises just 6 percent of health insurance coverage. Employers provide 61 percent, and Medicare and Medicaid cover the rest.
My Baltimore-based company has 140 healthy employees, yet in order to be competitive, we offer only adequate coverage hoping people will choose their spouse's plan, saving the company money. With 20 percent of Baltimore residents working for the government, we stand a solid chance of an employee being able to be covered under a public-sector plan provided by their spouse — the same plans politicians receive.
Therefore, fewer than half of our employees use our health insurance. One might think this solves our insurance needs. Not so.
To keep health insurance costs from spiraling out of control, we have changed providers four times since Obamacare was enacted seven years ago. Changing providers is horribly disruptive to people's lives. Moreover, we have jacked up deductibles to levels unheard of several years ago. Despite scrambling to find the best coverage at the lowest cost and raising deductibles, my company's premiums per employee have jumped 173 percent since 2010. Instead of focusing on the job-killing impact of providing employer-based coverage, politicians cling to partisan approaches to health care policy.
Democrats passed Obamacare on a party-line vote in 2010. As for Republicans, their inability to repeal and replace the Affordable Care Act under Donald Trump is one of the worst legislative failures in modern history. Perhaps even worse, Annapolis is not immune to the dysfunction in Washington D.C. Witness the partisan gridlock confirming Maryland Health Secretary Dennis Schrader. At a time when Maryland could be devising its own solutions to health care, such as launching the nation's first "all-payer" rate-setting system in the 1970s, we have a health secretary in total limbo for nearly a year.
There is only one way to prevent a financial collapse in health care: Democrats and Republicans must work together. Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington state attempted just that in developing a bipartisan deal to authorize insurance subsidy payments. But the plan's future is uncertain.
Please take note attorneys general, including you, Mr. Frosh: If you want to help, then urge your congressional delegation to do their jobs.