Health subsidy demand jams up shutdown fight

Health subsidy demand jams up shutdown fight
© Greg Nash

Democrats’ demand that ObamaCare subsidies be wrapped into a must-pass spending package is complicating GOP efforts to prevent a government shutdown at the end of next week.

Speaker Paul RyanPaul RyanFive fights for Trump’s first year Sunday shows preview: Trump stares down 100-day mark Ryan: Focus is on keeping government open, not healthcare MORE (R-Wis.) has signaled no plans to include the subsidies in a bill to keep the government open, but President Trump’s recent threat to withhold the subsidies to insurers has led several top Republicans to intervene.

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The GOP critics warn that eliminating the subsidies would upend insurance markets and steal coverage from their most vulnerable constituents.

Some, such as House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), have even suggested they’d support the Democrats’ push to include the money in the upcoming spending package.

“Chairman Walden has said that we need to consider funding the program — in a lawful manner — to prevent disruption for patients caused by ObamaCare,” a committee spokesperson said this week, not ruling out the option of doing it this month.

Rep. Tom Cole (R-Okla.), who leads the House Appropriations subcommittee overseeing health spending, has also said Congress should set aside the funds.

“I don’t think anybody wants to disrupt the markets more than they already are,” Cole told The New York Times last week. When asked if he thought Congress should appropriate the funds, Cole replied, “My personal opinion is yes.”

At issue are subsidies the federal government pays under ObamaCare to insurers that are known as cost-sharing reductions (CSR). The payments provide a financial buffer so insurers can lower healthcare costs for low-income patients.

House Republicans have sued the executive branch over the payments, arguing that they are unconstitutional because Congress never provided a specific appropriation for them.

A federal court ruled in favor of the GOP last year, but the Obama administration appealed the ruling. The Trump administration has not decided whether to continue the payments or whether to push the case.

The issue puts Ryan and the Republicans in a difficult spot.

On one hand, they’re still fighting to dismantle ObamaCare — a law they’ve railed against for seven years — and that effort includes sponsorship of the lawsuit challenging the payments. On the other, they don’t want to suffer the political blowback if their actions spike costs and erode coverage for the millions of patients newly insured under ObamaCare.

Compounding their dilemma, if Republicans agree to provide the CSR money, they’d likely kill their own legal challenge, which hinges on the argument that Obama was spending the money illegally because Congress hadn’t appropriated it.

Trump last week acknowledged the political risks surrounding any move to cancel the subsidies, conceding that his proposition may backfire on Republicans.

“That’s part of the reason that I may go the other way,” he told The Wall Street Journal. “The longer I’m behind this desk and you have ObamaCare, the more I would own it.”

Democratic leaders sense they have leverage in the fight. Without congressional action, the government will shut down on April 29, and the Republicans will likely need the Democrats’ help in both chambers to pass a government spending bill. In that sense, the fate of the CSR funding may hinge on the question of whether Democratic leaders want to play hardball and risk taking blame for a potential shutdown.

In a conference call Tuesday, Senate Minority Leader Charles SchumerCharles SchumerPriebus: I believe the government will stay open So what if banks push fancy cards? Give consumers the steak they want Ted Cruz: Warren could beat Trump in 2020 MORE (D-N.Y.) said the negotiations “seem to be going very well” and that he’s optimistic Democrats will succeed in securing the CSR funding.

“I’m not going to get into details, but we’re working hard to get that provision in,” he said.

A spokeswoman for the House Appropriations Committee didn’t rule out whether the payments would be included in the spending package, saying that all items are under negotiation.

Still, GOP leaders are indicating that they have no intention of providing new funding language that essentially props up ObamaCare. Instead, they say they’re confident the Trump administration won’t follow through on the president’s threat to withhold the subsidies.

Ryan acknowledged at a press conference last month that taking away the payments would destabilize the health insurance market. He indicated the payments should continue while the lawsuit is still being fought in the courts.

“While this lawsuit is running its course, the administration is exercising their discretion with respect to CSRs. Our plan A here is to repeal and replace ObamaCare and have that transition occur where these markets are stabilized. And that’s what we hope to achieve,” Ryan said.

House Ways and Means Committee Chairman Kevin BradyKevin BradyMnuchin: Trump orders take aim at Dodd-Frank, tax regs Tax reform hearing appears to be delayed GOP under pressure as tax reform deadline slips MORE (R-Texas) has also been cold to the idea that Congress should fund the subsidies directly. A Brady spokesperson said Tuesday that the Texas Republican has faith in the administration “to stabilize Obamacare’s collapsing marketplace” while Republicans continue their drive to repeal and replace it.

“Moving forward, Members of Congress and the administration are committed to upholding our Constitution’s separation of powers,” the spokesperson said.

But including the funds to keep a key provision of ObamaCare running despite unified control of Congress and the White House could be a tough vote for Republicans, who’ve pledged to repeal the law.

Complicating the math for GOP leaders, the conservative bloc in the House has historically been opposed to big spending packages. And that same group, which was largely responsible for the Republicans’ failure last month to pass a repeal bill, will likely balk at any effort to bolster the same ObamaCare law they’re vowing to dismantle.

The Hill contacted more than 20 offices of lawmakers in the House Freedom Caucus asking if they’d support a spending package with the payments included. None offered a response.

The Freedom Caucus has not yet established a public stance making specific demands for the spending package. Most members said before departing for the April recess that they either wanted to see the bill before taking a position or that it wasn’t the best legislative vehicle for pushing conservative policies like cutting federal funds for Planned Parenthood.

It’s possible lawmakers will have to approve a temporary spending patch to avoid a shutdown at the end of next week. That would both give themselves more time to negotiate a larger package immediately upon returning from the two-week recess and add pressure to pass the longer-term bill the following week.

The House is only scheduled to be in session for two weeks upon returning from the April break before adjourning for another recess on May 4. Waiting until closer to that date would up the pressure on lawmakers to pass a spending package to avoid canceling or delaying the next recess. 

Peter Sullivan contributed.