Tuesday :: Oct 17, 2017

Trump Sandbags Ryan on ACA Compromise

by Deacon Blues

Whether he knew it or not, the moment Donald Trump acted last week to stop payment of cost sharing subsidies for working-class health plan enrollees in Obamacare marketplaces, he was throwing a grenade onto the desk of House Speaker Paul Ryan. Yes, yesterday the media was overly fixated on Trump's humiliation of Senate Majority Leader Mitch McConnell at the impromptu press availability and missed the obvious: absent was Paul Ryan from the "see, we're all friends after all" charade.

Over the weekend, Trump signaled to GOP Senator Lamar Alexander that he wanted him and ranking member Patty Murray to finish their work on a short-term compromise that would continue the subsidies for the next two years in exchange for providing states with flexibility for their own experiments to create local market solutions. And today, Murray and Alexander did just that: reach agreement on such a compromise that seemingly has Trump's support.

It needs to be mentioned that Murray didn't give anything away here: the Affordable Care Act already provides for what are known as Section 1332 waivers, whereby the federal Center for Medicare and Medicaid Services (CMS) can review and approve state proposals for local market, non-national alternatives to the ACA. The roadblock of late hasn't been the law, but the lack of responsiveness by Trump's own CMS to recent applications since the new team took over. Democrats are wise to "trade" something already in the law for a 2-year extension of the subsidies, knowing one important thing: the House GOP will never go along with it.

Paul Ryan and the Freedom Caucus have already said they will not agree to any extension of the subsidies and instead want to blow up the ACA immediately through a full repeal and conversion of Medicaid to block grants now. Now, Trump meets with McConnell yesterday, wherein the Alexander/Murray effort was certainly a discussion topic, and a day later a deal is announced that Trump seemingly supports, with this additional "not now, Paul" from the president today:

"The solution will be about a year or two years. And it will get us over this intermediate hump," Mr. Trump said Tuesday during a news conference in the Rose Garden.
"It is a short-term solution," he said, adding that the long-term solution is to issue "block grants" to states to help people buy private insurance.

Trump just kneecapped House Republicans on their demands for an immediate detonation of Medicaid and the ACA, and he is now daring Ryan and the House GOP caucus to go against him and harm their own constituents in advance of the midterms. I wonder what Steve Bannon thinks of all this.

It is a given that Trump will need "Chuck and Nancy" to get this out of the Senate with several GOP senators along for the ride, and over to the House as the burning manure bag on Ryan's doorstep. Ryan also knows that Nancy might be able to round up over 185 votes for this, and would only need thirty more from Ryan's caucus to take this issue off the table for the midterms. But Ryan will have to make a choice now between bad outcomes: go against his president and prevent the compromise while harming red state Trump voters in the process, or going along with Nancy and losing his speakership.

Couldn't happen to a nicer guy. And let's give some props to the dealmakers here.

Update: Trump has already gone schizo on the deal, signaling his typical mental instability.

Deacon Blues :: 12:41 PM :: Comments (1) :: TrackBack (0) :: Digg It!