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Trump at center of lawmakers' attempts to determine the ACA's future | TribLIVE.com
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Trump at center of lawmakers' attempts to determine the ACA's future

The Washington Post
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Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, talks to reporters on Capitol Hill in Washington, Wednesday, Oct. 18, 2017.

WASHINGTON — President Trump became the subject of an unusual public lobbying campaign over the fate of the Affordable Care Act on Wednesday as Senate Democrats and a key Republican sought to salvage a bipartisan health deal while conservatives pressured the president to disavow the agreement.

In a morning tweet, Trump appeared to distance himself from the compromise, which would authorize payments to insurers that help offset millions of lower-income Americans' health costs in exchange for granting states greater flexibility to regulate coverage. But the president later told reporters that he was not closing the door on a deal altogether, and proponents of the plan developed by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., sought to keep him on board.

The convoluted campaign, in which Senate Minority Leader Charles Schumer, D-N.Y., insisted that a deal remained in reach even as he blasted the president's "zigging and zagging," underscored the unpredictable nature of dealmaking in Trump's Washington. With constantly shifting alliances, the city's key political players are jockeying to win the president's support one issue at a time.

For Senate Democrats, trying to sway Trump to back the plan carries potential risks and rewards. Working with a president despised by their base and prone to changing his mind could drag them into a political quagmire with unpredictable outcomes.

For conservatives who are pressing for a different deal or oppose the idea of propping up the Affordable Care Act, the moment presents a test of how much influence they have with the president, who has suggested a greater willingness to hash out deals with Democrats and become more and more frustrated with his own party.

For both sides, the president's conflicting signals have created a chaotic situation where even some of Trump's aides have found themselves scrambling to keep up with the latest developments.

He began the morning by warning that the new agreement might be tantamount to an insurance giveaway. "I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co's who have made a fortune w/ O'Care," Trump wrote on Twitter.

But shortly afterward, Alexander — who chairs the Health, Education, Labor and Pensions Committee and was encouraged by the president to pursue a deal — said in an interview that Trump expressed an openness to preserving it in a phone call Wednesday morning.

"He told me that he wanted to encourage me but that he will review it, as I would expect a president to do," Alexander said. "He may want to add something to it. It may come up as part of the end-of-the-year negotiations. We'll see."

Speaking later to reporters in the Cabinet Room, Trump praised Alexander's efforts, saying, "If something can happen, that's fine, but I won't do anything to enrich the insurance companies.

"They've been enriched by Obamacare like nothing anybody's ever seen before," the president added.

Although Trump has repeatedly described cost-sharing payments as a "bailout" to insurers, the money directly covers the discounts that low-income Americans on Affordable Care Act plans receive for deductibles and other out-of-pocket costs. This group includes about 7 million Americans earning up to 250 percent of the federal poverty level.

Insurers are obligated to provide the discounts, which totaled about $7 billion this year and are estimated to reach $10 billion next year, even if the federal payments are cut off. According to the National Association of Insurance Commissioners, Trump's decision last week to end the subsidies will cost insurance carriers more than $1 billion this year.

Facing the prospect for months that the Trump administration would cut off the payments, most insurers have opted to factor this shortfall into their 2018 premium rates for their customers. The cutoff in cost-sharing payments has translated into premium increases of 12 percent to 20 percent, according to several analyses.

Alexander suggested that he may tweak the language of the proposal to address Trump's concerns that insurers would benefit from the cost-sharing reduction payments. He added that during their Wednesday call, he told Trump that he was about to tell reporters, "They're underestimating your leadership on health care, because what you've done is you've created a bipartisan option for the Senate and for the country."

Alexander said the compromise already has language to ensure that the subsidy "benefits go to consumers, not to insurance companies," but he was open to making it stronger.

Schumer, for his part, alternated between attacking Trump's inconsistent policy positions and arguing for why the president and the deal's proponents agreed on a short-term health-care fix.

Trump ended the cost-sharing reduction payments, known as CSRs, last week, arguing that they were illegal because they were not explicitly authorized under the Affordable Care Act. He left it to Congress to decide whether to fund them.

Schumer, who discussed the prospect of a bipartisan deal with Trump less than two weeks ago when the president called him, said in a floor speech that the allegations of an insurance bailout show that "the president doesn't know what he's talking about."

"It helps people who are sick and need health care. It keeps their premiums low," Schumer said of the funding, adding that there is language in the agreement that bars insurers from pocketing the money.

During the negotiations, Democrats had proposed delaying the open enrollment period for Affordable Care Act plans, which is set to begin Nov. 1, for a month after the bill's enactment to ensure that firms could lower their 2018 premium rates to reflect the fact that the government would keep funding the subsidies. White House Domestic Policy Council Director Andrew Bremberg opposed that provision, Schumer said, but he added that Democrats are willing to insert stronger language to guarantee that insurers pass the payments on to their customers.

"We're all of the same mind," Schumer said of Trump, Senate Democrats and Alexander. "And we can do that."

In a brief interview Wednesday afternoon, Murray brushed aside the president's hostile rhetoric.

"This is not about the president. This is about just doing the right thing so the American people's rates don't go up, and that's where we're focused on," she said.

Asked whether she was willing to alter the terms of the agreement, Murray replied: "No. We have a deal; we're moving it forward."

Some Democrats said they have no reservations about trying to solve a problem that, in their view, was created by Trump and for which his party will be blamed if Congress takes no action.

"We know doing this will be good for the country," said Sen. Sherrod Brown, D-Ohio. "I hope that people here aren't that cynical, that (they think), 'Why would you do it just because it's good for the country?' "

But conservatives were already mobilizing to block the measure, which would authorize CSR payments for two years. The framework also would allow insurers to offer catastrophic insurance plans to consumers 30 and older on Affordable Care Act exchanges while maintaining a single risk pool. It would shorten the period for federal review of state waiver applications; expedite reviews for states in emergency circumstances and those with waiver proposals that have already been approved for other states; and allow governors to approve state waiver applications rather than require state legislative approval.

Susan B. Anthony List President Marjorie Dannenfelser, whose political action committee backs antiabortion candidates, described the proposal Wednesday as "an inadequate, shortsighted approach which fails to address the abortion funding problems created by the health care overhaul."

"Right now, nearly 900 health-care plans subsidized by taxpayer dollars cover abortion, forcing taxpayers to be complicit in the destruction of human life," she said. "In no way does the Alexander-Murray bill fulfill Republicans' campaign promise to repeal and replace the ACA."

A handful of Senate Republicans have expressed support for the plan, including Mike Rounds, S.D., John McCain, Ariz., and Bill Cassidy, La. But Senate Majority Leader Mitch McConnell, Ky., has not committed to bringing it up for a floor vote, and some GOP senators questioned Wednesday why they should keep funding the subsidies.

"Well, I don't want to just vote to put paint on rotten wood," Sen. John Neely Kennedy, R-La., told reporters. "I just want to understand what the benefits are. I understand the money going out the door."

Several key House Republicans said they don't see how the bill would win passage in their chamber.

Many senior White House officials oppose the bill, according to administration officials and Republicans who have been briefed on the matter. At times, Trump's aides have been sidelined as he has conferred with Alexander, according to one Republican, fueling confusion about the state of negotiations.

The bipartisan plan does enjoy support among patient rights groups, although they have raised concerns about whether the flexibility it offered could raise health-care costs. On Wednesday, the American Cancer Society Cancer Action Network endorsed it.

"This deal offers important, immediate action to stabilize the individual insurance market," said the group's president, Chris Hansen. "Restoring $106 million per year in outreach and education programming would help to reduce public confusion over the law and ensure more people who need health coverage get it."

Even as elected officials and interest groups debated in Washington how to handle cost-sharing payments, attorneys general from 18 states and the District of Columbia filed a motion in the U.S. District Court for the Northern District of California seeking a temporary restraining order and a preliminary injunction that would require the administration to continue making the payments to insurers. The attorneys general argued that the court order was needed "to prevent immediate and irreparable harm to the plaintiff states and the millions of Americans who benefit from affordable health coverage under the ACA."

While Schumer made no predictions as to whether the bipartisan agreement would actually make it to Trump's desk, he held out hope that the president could serve as an ally in the end.

"This president keeps zigging and zagging," Schumer said on the floor. "Our only hope is maybe tomorrow, he'll be for this bill."