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House Speaker Paul Ryan (R-Wis.) dismissed the idea of Congress funding extra Obamacare subsidies, called cost-sharing reductions, on April 25. "Obviously, CSRs, we're not doing that," Ryan said. "That's something separate that the administration does." (The Washington Post)

Now that House Republicans are officially refusing to fund extra Obamacare subsidies, theyre looking to the Trump administration to make the payments despite having sued the Obama administration for doing just that.

House Speaker Paul D. Ryan (R-Wis.) confirmed Wednesday morning that funding for the subsidies, which insurers say are necessary to tamp marketplace premiums down, wont be included in a government funding bill that lawmakers are trying to pass this week.

Obviously, were not doing that, Ryan said. Thats not in an appropriation bill. Thats something separate that the administration does.

[Republicans offer spending plan without border wall]

House Republicans, however, spent the previous few years suing the Obama administration for giving insurers the subsidies without consent from Congress, as part of their long-standing barrage against the Affordable Care Act. Their lawsuit, which has been upheld by a federal-district court, argues that the administration was overstepping its authority in making the payments, as they didnt have a permanent appropriation within the health-care law.

That lawsuit now puts them in an awkward position. Republicans control both Congress and the White House, but they have so far failed to replace Obamacareas promised. The public is likely to blame them for problems with the law going forward, including its premium hikes, addingpressure to ensure insurers get the payments.

The subsidies, called cost-sharing reductions, are an obscure but important part of the Affordable Care Act that emerged as a sticking point as Congress negotiates a bill to fund the government past Friday. Last week, President Trump threatened that Republicans wouldnt fund them if Democrats blocked funding for a border wall.

They are available to the lowest-income enrollees in the laws insurance marketplaces those earning 100 to 250 percent of the federal poverty level to help them afford extra costs beyond their monthly premium, like co-payments and deductibles.

Health-care experts say the Affordable Care Act is stable, but President Trump and congressional Republicans could push it over the cliff into a "death spiral." (Daron Taylor/The Washington Post)

Insurers must offer the discounts, regardless of whether they get reimbursed by the federal government. Theyre arguing that without those reimbursements, theyll be forced to dramatically pump up premiums for everyone to cover the costs. The Kaiser Family Foundation has estimated premiums for mid-level silver plans would rise by 19 percent on average without the payments.

Now that Congress has refused to fund the payments, the only way for insurers to get them next year is if the Trump administration pays them out anyway. The administration hasnt said whether it will do so, or whether it will appeal a district-court ruling upholding the House lawsuit, reflecting the high political stakes at play.

If insurers dont get the payments and hike premiums as a result, resulting in Americans dropping their health coverage, it could create a backlash against Republicans. Moderates who are vulnerable in 2018 are particularly worried about this outcome. And leading Republicans in Congress, including Energy and Commerce Chairman Greg Walden, have said the payments must be made.

But should his administration award the subsidies, Trump would appear to be propping up the health-care law that he had sharply criticized on the campaign trail.

[Trump must decide whether to support or undermine Obamacare]

Were Republicans moving forward on a sure path toward repealing and replacing big parts of the Affordable Care Act, Trump could argue he was protecting consumers in the interim. But that measure is currently in a holding pattern as Republicans have clashed over its aspects.

And if the Trump administration awards the subsidies and House Republicans dont criticize the move they risk looking hypocritical, since thats what they blasted President Barack Obama for doing.

Originally posted here:
House Republicans look to Trump to fund Obamacare subsidies. They used to sue Obama over this. - Washington Post