In light of an inability to urge Congress to successfully repeal and replace the Affordable Care Act, the White House is still weighing whether to end key subsidies that could send insurance exchanges into chaos.
"We said from the very beginning that we would look at that on a month by month basis," said Office of Management and Budget director Mick Mulvaney on CNN Wednesday. "That has not changed."
A slew of centrist lawmakers have worked this week on legislation to stabilize Obamacare exchanges, which have seen insurers leave markets across the country this year amid uncertainty of the landmark 2010 law’s future. The effort is a rebuke to President Donald Trump, who has repeatedly called for letting Obamacare implode to force a repeal and replace plan.
Trump has been at odds with the cost sharing reduction payments, which reduce out-of-pocket costs for low-income Obamacare plan enrollees.
Sen. Lamar Alexander (R-Tenn.), who chairs the key Senate Health, Education Labor and Pension Committee has been among many lawmakers who have called on the White House to continue making these payments.
However, Mulvaney left open the possibility of ending the subsidies as the White House moves soon to decide on what to do about the CSR payments, which he and the president have called insurance company bailouts.
"The way to fix that is not by bailing out the insurance companies. These cost sharing reduction payments are payments to the insurance companies in order to get them to support Obamacare in the first place," Mulvaney said. "The president’s attitude is fairly simple. If people are suffering, and they are, and they will continue to suffer because we have not repealed or replaced Obamacare, why shouldn’t insurance companies similarly suffer?"
To Mulvaney and the White House, who have called on Congress to not take up other legislation until the president’s health care agenda is taken care of, welcomed the proposed House legislation but said nothing will be stable unless Obamacare is repealed.
"If they [House] want to provide for the payments as part of a larger bill, that’s fine. We welcome that. We supported the House bill," Mulvaney said. "It’s not that we dislike these payments as part of a system to repeal Obamacare, but right now you don’t have that."
Continuing payments is a key indicator of whether exchanges can become more stable and whether millions can still get health insurance. Without the subsidies, insurers will either have to pull immediately out of the Obamacare exchanges, or hike rates at an average of 20 percent to make up for the lost subsidies.