Health and Science

Another government shutdown over Obamacare? Only if Trump wants it.

Sarah Kliff
Senate Minority Leader Charles Schumer (L) (D-NY) looks on as House Minority Leader Nancy Pelosi (D-CA) speaks to reporters during a news conference at the U.S. Capitol.
Getty Images

Health care wonks are mysteriously, reliably attracted to things in groups of three.

You have Obamacare's "three-legged" stool that economists constantly discuss. House Speaker Paul Ryan spent the past few months talking about his "three-pronged" approach to Obamacare repeal and replace.

So it only makes sense that this week's fight over whether to fund Obamacare's cost-sharing reduction subsidies — and possibly cause a government shutdown in the process — has three distinct factions at odds.

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Think of this week's debate over the Obamacare subsidies, which help insurers offer discounts on deductibles and copays for low-income Americans, as a negotiation between three teams: congressional Democrats, congressional Republicans, and the White House. We already know a little bit about what each team wants to get out of any sort of budget deal.

Congressional Democrats want to get Obamacare's cost-sharing subsidies funded. House Minority Leader Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) have been quite clear on this: It is a key priority to get the Obamacare subsidies appropriated in this upcoming budget. Ideally, Democrats want a permanent appropriation for these subsidies, which come out to about $8 billion annually. Realistically, they'd likely settle for an appropriation that lasts through 2018, which would do a good deal to reassure health insurers that are deciding whether to sell on the Obamacare marketplaces next year.

Congressional Republicans seem to want to fund the Obamacare cost-sharing subsidies too. Every indication we've had from top House Republicans is that they understand ending the cost-sharing subsidies would blow up the Obamacare marketplaces — and they are not in the mood for that sort of chaos. Here's an important section from a recent article in the New York Times on the topic:

Two influential Republicans — Representatives Tom Cole of Oklahoma, the chairman of the Appropriations subcommittee responsible for health spending, and Greg Walden of Oregon, the chairman of the Energy and Commerce Committee — said Congress should appropriate money for the cost-sharing subsidies.

"I don't think anybody wants to disrupt the markets more than they already are," Mr. Cole said in an interview. "It's a very unstable market."

Asked if he thought Congress should provide the money, Mr. Cole said, "My personal opinion is yes."

Likewise, Mr. Walden said last month, "I will do everything I can to make sure that the cost-sharing reduction payments get made." That, he said, is "an obligation we have not only to the insurers," but also to consumers, and "we cannot leave them high and dry."

We don't know where the Freedom Caucus, the most conservative Republicans who want Obamacare repealed altogether, stands on the issue. But given that Democrats support the subsidies, the far-right wing just doesn't have as much leverage here.

The White House wants ... well, we don't really know. Traditionally you'd expect a Republican White House to be playing on the same team as a Republican Congress. And they might well be! But the Trump administration certainly hasn't made it clear whether it shares legislators' views that the subsidies ought to continue.

Instead, the administration has put out confusing statements that waffle on whether they want to continue this part of Obamacare — or are jonesing for a big fight. They pushed back on a New York Times article reporting that they supported continuing these subsides.

"The administration is currently deciding its position on this matter," Health and Human Services spokesperson Alleigh Marré said at the time. "We have not been contacted by Democrats to help save Obamacare, perhaps because they consider Obamacare to be a losing cause. Democrats need to help solve this failed Obamacare plan."

There was a cryptic Trump tweet on the topic over the weekend.

@realdonaldtrump: ObamaCare is in serious trouble. The Dems need big money to keep it going - otherwise it dies far sooner than anyone would have thought.

And one White House official who talked to the New Yorker's Ryan Lizza certainly seemed to be girding for conflict:

"This is going to be high-stakes poker," the White House official said. When I asked if a shutdown was likely, the official paused for several seconds. "I don't know," the official said. The official added, "I just want my wall and my ICE agents."

The big unknown on the larger Obamacare repeal-and-replace battle is whether congressional Republicans can come to an agreement on which policies they support.

But this fight is different. The big question is whether congressional Republicans and the White House want the same things out of the upcoming budget bill. And that will determine not only if this Obamacare program gets funded but also if the government stays open.