The Fart of the Deal

The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!

— Donald J. Trump (@realDonaldTrump) October 13, 2017

It's so hard to imagine what Trump believes he's doing, but it looks as if he may, personally, be enjoying the brainfart idea of a "deal" where he would show those stupid Republican Senators how a real businessman president gets shit done, just as he did in the immigration case in his Chinese dinner with Schumer and Pelosi on September 13, although it currently seems he didn't, because "The White House" didn't ("The White House" is now informing us that its "principles" rule out the concessions Trump made to the Democrats and require various new anti-immigrant brutalities that Democrats can't accept, another instance where we see Trump doesn't have authority to speak for the White House and thus no effective power to make a deal in the first place).

In the same way, it's not clear what "The White House" intends with yesterday's moves on health care provision, or whether it has any singular view of what it's doing. Unlike in national security and foreign policy issues, there aren't any generals in charge, and HHS doesn't even have a secretary at the moment, Tom Price having taken a very expensive charter flight clear out of office.

But I want to point out that the Executive Order to create worthless catastrophic insurance of the pre-ACA type for the individual market, policies for people without children or pre-existing conditions that will have attractive-looking premiums because their coverage will be so thin (in clear violation of ACA's intent), is another one of those Trump EOs that doesn't actually do anything, merely asks somebody to try to do something, in the plaintive tone of one of the imperial tweets—

The executive order has no force of law itself. It instead asked three federal agencies to consider possible new regulations that could help achieve certain goals. It is not clear what those rules will say. Generally, issuing new regulations takes several months, including a period of public comment. (Margot Sanger-Katz, NYT)

So it can't start taking effect for at least a year while they write up new regulations—meaning that if they do it as fast as possible premiums for people in the individual market with kids or pre-existing conditions will be spiking in fall 2018, in the middle of Congressional elections that are already looking really difficult for Republicans.

And its ability to do what it says it wants to do (which is just as horrible as everyone is saying, a pure act of vandalism) through legal challenges, congressional town meetings, and the extraordinary ineptness of the Trump operation, has to be questioned.

As for canceling cost-sharing reduction (CSR) payments to insurers (which Trump seems to believe is some kind of exquisite way of torturing the insurance companies, rather than the consumers who will be forced to make up the difference in higher premiums and co-pays), the White House didn't say when that would take effect. "Top officials" at HHS came out later last night to that it would be immediate, but Zeke Emanuel speaking on NPR didn't seem to believe it; he thought the whole thing might conceivably be meant to signal a bargaining posture to Schumer and Pelosi.

In fact it is unlikely that it can take effect immediately since the legal case on the CSRs took a turn in favor of the effort by the 17 states and DC at the beginning of August in the DC appeals court:

In its three-page ruling, the appeals court allowed the states to join the case because there was “sufficient doubt” about whether the administration would protect their rights. 

The states have showed “a substantial risk” that an end to the subsidy payments “would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the States will have to provide health care,” the court said.

New York Attorney General Eric Schneiderman, in a Wednesday press call, said he believed the appeals court has jurisdiction to issue an order barring Trump from cutting off the cost-sharing payments, but that he and his peers would tailor their response to address whatever course of action the president took. (Bloomberg, August 2)

Schneiderman (and California's AG Xavier Becerra) were ready with their own statement after last night's announcement:

NY AG Eric Schneiderman says he'll sue if Trump scraps ACA cost-sharing subsidies. pic.twitter.com/fDhheCTmCS

— Kyle Griffin (@kylegriffin1) October 13, 2017

So it's really not over yet, and Trump victory in destroying the ACA is very far from assured. Meanwhile, the structural reality of breakdown in the Republican caucuses in House and Senate that led to September's bipartisan budget deal hasn't changed. If "The White House" wants to get serious and do something useful instead, it knows Chuck's and Nancy's numbers.