Trump pushes back on Senate's deal to fund CSRs

White House
It's unclear whether a newly reached bipartisan deal on healthcare will win the support of the White House.

Mere hours after he seemed to voice support for the Senate’s new bipartisan agreement to fund cost-sharing reduction payments, President Donald Trump now says he won’t support “bailing out insurance companies.”

Trump tweeted his latest position Wednesday morning, noting that he is still supportive of the architect of the deal—Sen. Lamar Alexander, R-Tenn.,—and “of the process.”

During a press conference on Tuesday, Trump indicated the White House was involved in the agreement between Alexander and Sen. Patty Murray, D-Wash., saying “this is a short-term deal, because we think ultimately block grants going to the states is going to be the answer.”

And on Monday, the president seemed to offer support for Alexander and Murray’s endeavors by saying his decision to end CSR payments helped get Republicans and Democrats talking about a bipartisan deal on healthcare.

In a speech on the Senate floor Tuesday, Alexander also noted that he and Trump recently discussed the bipartisan negotiations, with the president encouraging him to come to an agreement with Democrats.

Trump’s tweet did not indicate that he plans to veto any bill that results from Alexander and Murray’s accord.

Seemingly in response to the president’s shifting position, Alexander tweeted later Wednesday morning that he is working with Trump on making the bipartisan deal “even stronger.”

What the agreement entails

Besides the two years of funding for CSR payments that insurers, providers and other policy experts have long lobbied for, the Alexander-Murray agreement offers concessions to both Democrats and Republicans.

It would offer states more flexibility to use the Section 1332 waivers to propose innovative individual market reforms as well as streamline the waiver process, Alexander explained in remarks on the Senate floor Wednesday.

The proposal would also allow individuals of all ages to access high-deductible, low-premium copper plans, and directs the Centers for Medicare & Medicaid Services to write regulations that encourage interstate health insurance compacts, he said.

Crucially, the flexibility offered to states does not erode the ACA’s guardrails such as essential health benefits and protections for enrollees with pre-existing conditions, Murray noted in her own speech on the Senate floor.

In a nod to Democrats, the measure also includes $106 million in ACA enrollment outreach funding for 2018 and 2019, according to a report from Talking Points Memo. Both senators stressed that their is Congress' best shot at stabilizing the ACA marketplaces.

“In my view, this agreement avoids chaos," Alexander said.

Barriers in Congress

Even without the uncertainty over whether Trump will support it, the Alexander-Murray agreement faces a tough road in the path to passage. For one, conservatives are already lining up against it.

In an interview Wednesday on MSNBC’s “Morning Joe,” North Carolina Rep. Mark Walker, head of the Republican Study Committee, said he is “strongly against” the deal.

“These bailouts continue to fund up and prop up the insurance companies,” he said. “People are hurting under Obamacare; the insurance companies are not.”

House Speaker Paul Ryan, R-Wisc., is also not convinced.

“The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare," Ryan spokesman Doug Andres told Bloomberg on Wednesday.

Senate Majority Leader Mitch McConnell, meanwhile, has remained light-lipped about the measure. At a Tuesday press conference right after the Alexander-Murray deal was announced, he told reporters that “we haven’t had a chance to think about the way forward yet.”

Even if both Ryan and McConnell get on board and whip up enough support in their respective caucuses to pass an ACA stabilization measure, much will depend on how long that process takes, noted Julius Hobson, a healthcare lobbyist and attorney with the Washington, D.C., law firm Polsinelli.

There is little margin for error, as some insurers are already asking state regulators to increase their premiums in 2018 because of the president’s decision to end CSR payments, he pointed out.

“We still have instability in the market at the moment, and it’s not going to be settled until the president signs something,” Hobson said.