Ha ha ha. A couple of years ago, as part of his jihad against Obamacare, Donald Trump decided to end something called Cost Sharing Reductions. These were payments made to insurers to offset the cost of covering low-income customers.
This is exactly the kind of dick move you’d expect Trump to make. But there’s a catch. Trump is also an idiot, so he hadn’t bothered to read a report from the CBO explaining that, on net, eliminating CSR would end up costing the government more and making insurance more affordable. Over a ten-year period, CBO projected that it would add $194 billion to Obamacare spending. I guess no one else in the White House had read the CBO report either. But I had, and on that basis I decided I was all in favor of killing off CSR.
You’ll never believe what happened next: the CBO was right! Through an arcane practice called “silver loading,” premiums became cheaper for almost everyone and coverage became broader. Did Trump ever notice that his act of malice had backfired? There’s no telling. After all, it involves complicated stuff like numbers and dollar signs, which he’s never been good at.
However, after two years, apparently someone has finally noticed that people are benefiting from this, and naturally that can’t be tolerated. On Thursday, CMS, run by the reptilian Seema Verma, who has never met a helpful program that she likes, released its annual Notice of Benefit and Payment Parameters (NBPP). It recommended re-funding CSR, and Andrew Sprung has a question:
Is this not the first time the Trump administration has explicitly (or at least formally) called for a Congressional appropriation to fund CSR the old way — by reimbursing insurers directly for providing it? That seems significant to me, and raises the question of whether last year’s Alexander-Murray legislation, purporting to strengthen the ACA marketplace, might be revived in a divided Congress.
Given that we now know the benefits of repealing CSR, Sprung makes an obvious suggestion: if Trump wants to bring it back to life, Democrats need to demand that they get something of equal value in return. Maybe that would be more generous reinsurance funding. Maybe it would be more generous premium subsidies. Or maybe it would be a simple deal to cap premiums all the way up to 500-600 percent of the poverty level (the current cap ends at 400 percent of the poverty level).
Would Trump actually be willing to negotiate this? Since it would end up helping people via Obamacare, I’d guess not. But you never know. It’s worth a try.
