President Donald Trump boards Air Force One at Joint Base Andrews in Maryand, Oct. 11, 2017. Trump is expected to issue an order on Thursday relaxing health care standards on small businesses that band together to buy health insurance and to allow the sale of other health plans that skirt the health law’s requirements. (Tom Brenner/The New York Times)
Photo: TOM BRENNER
Photo: TOM BRENNER

Lastest Trump assault on Obamacare: no more sanctions

If Senate won’t act, he will, president vows.

With a Republican-controlled Congress unable to repeal Obamacare, President Donald Trump is moving forward on a series of steps that he hopes will unravel the Affordable Care Act.

The latest came at 10:30 Thursday night, when Trump announced that he would end the $7 billion in cost-sharing reduction payments to insurance companies under the law. The subsidies help insurance companies pay the costs for low-income people He made that announcement just hours after a White House ceremony where he announced a series of orders aimed at loosening the requirements of the 2010 health care law.

“If the Senate can’t provide Americans with relief, then I’ll take matters into my own hands,” he said in a fundraising missive to supporters shortly after signing an executive order Thursday in the White House.

In a statement late Thursday, the White House press secretary called the cost-sharing subsidies “unlawful” and “yet another example of the previous administration abused taxpayer dollars and skirted the law to prop up a broken system.”

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House Democratic Whip Steny Hoyer, D-Md., said Trump was undermining bipartisan attempts to improve the system.”

“Not content to harm Americans with pre-existing conditions with his executive order earlier today, this President is now acting spitefully to raise premiums on millions of Americans and force a collapse of our health insurance marketplaces,” he said. “The President seems to forget that he and his party will be held accountable for any changes that occur in our health care system on his watch.”

Democratic National Committee chair Tom Perez was more blunt. “Donald Trump is gambling with American lives,” he said.

But House Speaker Paul Ryan, R-Wisc., defended the move, saying Congress never appropriated the dollars to pay for the subsidies. “Today’s decision by the Trump administration to end the appeal of that ruling preserves a monumental affirmation of Congress’s authority and the separation of powers,” he said.

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Earlier Thursday, Trump directed his administration to consider expanding access to low-cost, short-term insurance not subject to Obamacare requirements such as the mandate to cover essential health benefits — including hospitalization, prescription drugs, maternity care and substance-abuse treatment — or regulations that require insurance companies to cover people regardless of their medical history.

Trump’s administration argues that loosening such restrictions would create far cheaper options for those seeking insurance.

His executive order also relaxes regulations on association health plans, which allow small-employer groups and individuals to band together to buy health insurance. The expansion of such plans could allow U.S. employers to form insurance groups across state lines, which Republicans say would lower costs.

Finally, it directs Trump’s Cabinet to consider expanding access to Health Reimbursement Arrangements — tax-free, employer-funded accounts reimbursing employees for health-care expenses.

“With these actions, we are moving toward lower costs and more options in the health-care market and taking crucial steps towards saving the American people from the nightmare of Obamacare,” Trump said in a ceremony where he was flanked by lawmakers, Vice President Mike Pence and other supporters.

Trump said his actions will cost the federal government “virtually nothing, and people will have great, great health care.”

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Larry Levitt, a senior vice president for the Kaiser Family Foundation, tweeted: “President Trump’s executive order aspires to do a lot. If it fulfills its aspirations, it would undermine (Obamacare) significantly. A big if.”

Levitt also wrote, “Likely losers with the executive order: People with pre-existing conditions. Winners: Healthy people (and their small employers), lawyers.”

People on different sides of the polarized debate did agree that it will take months for the federal bureaucracy to turn Trump’s broad-brush goals into actual policies.

To supporters, Trump’s order opens new insurance alternatives at potentially lower prices, helping to follow through on a campaign promise to undo Obamacare that Republicans have made since the law was passed in 2010.

To detractors, the move was repeatedly described with one word: sabotage.

“Instead of employing backdoor tactics meant to undermine important health-care protections, President Trump should come to the table with members of both parties to pursue meaningful health-care reform that benefits Ohioans,” said Sen. Sherrod Brown, D–Ohio.

Brown argued that the expanded association plans would limit access to such benefits as maternity services and emergency care and destabilize the Obamacare market by flooding the insurance market with skimpier plans.

“If the system deteriorates, make no mistake about it, the blame will fall squarely on the president’s back,” said Senate Minority Leader Chuck Schumer, a New York Democrat.

Brown and others — including Ohio Gov. John Kasich — had argued for a bipartisan solution to shoring up the Obamacare markets. Sen. Patty Murray, D-Wash., and Sen. Lamar Alexander, R-Tenn., engaged in bipartisan talks that were thwarted by GOP Senate leaders.

In a joint statement early Friday, House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer said Trump’s actions indicate that he is “walking away from the good faith, bipartisan Alexander-Murray negotiations and risking the health care of millions of Americans.”

U.S. Rep. Tim Ryan, D-Niles, was especially critical of Trump’s actions.

“Since he first announced his campaign for the presidency, I’ve heard President Trump falsely claim dozens of times that the Affordable Care Act was collapsing. Today, I am in disbelief that the president would so blatantly sabotage America’s health-care system in order to make that falsehood a reality. His executive order will create a loophole that would allow insurers to sell watered-down insurance plans that do not cover essential health benefits like pregnancy coverage, mental-health care, and cancer screenings. It dismantles coverage protections for people with pre-existing conditions and further disadvantages the sick and middle class.”

While Democrats decried Trump’s action, Republicans such as Rep. Jim Jordan, R-Urbana, said Trump was “doing what voters sent him here to do.”

“Today’s executive order on health care will start to give everyday Americans the relief they need from soaring premiums,” Jordan said, while calling on Congress to fully repeal Obamacare.

“Obamacare added a tangled mess of bureaucracy, mandates and regulations to our health-care system,” said Columbus area Rep. Pat Tiberi, R-Genoa Twp., adding that those on the Obamacare exchanges have been paying more for lower quality care.

“The president is taking a necessary step by instructing his administration to do what they can under current law to restore the free market, lower costs and improve access to quality care.”

Sen. Rob Portman, R-Ohio, said he wants to review the specifics of the order before taking a stand, “but it’s clear Ohioans need more affordable options and flexibility to get the care they need.”

The Kasich administration also said it needs more time before issuing an opinion.

Trump’s executive order follows complaints that his administration has drastically cut back on programs aimed at educating people about their health-care options ahead of the Obamacare open-enrollment period, which begins Nov. 1 and ends Dec. 15.

On Thursday, Ohio’s Democratic House delegation — Reps. Joyce Beatty of Jefferson Township, Marcia Fudge of Cleveland, Marcy Kaptur of Toledo and Ryan — sent a letter to Center for Medicare and Medicaid Services Administrator Seema Verma complaining about cuts in services and outreach programs designed to enroll citizens in Obamacare.

“Individuals will now be without the help they need to enroll in health-care plans even though every American is required to have health insurance under current law and face tax consequences if they fail to obtain coverage,” the group wrote.

Michael Dulman of the Washington Bureau and The Associated Press contributed to this story.

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