Obamacare's biggest challenge right now has nothing to do with the for-now failed Republican bid to repeal and replace it. It's President Trump's threats to undermine obscure but important payments that help millions of Americans afford their health care.
The Affordable Care Act has aided millions in purchasing private health insurance through billions of dollars of federal spending. Much of that is in the form of tax credits, which reduce the premiums that many people pay every month for their coverage.
A lesser-known piece of the law helps make health care even more affordable for lower-income people: cost-sharing reductions, or CSRs, which help make copays and deductibles cheaper for people who got insurance through Obamacare.
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Right now those subsidies are facing a huge threat. Trump could cut off those payments, which would disrupt Obamacare's insurance markets and maybe cause them to collapse entirely. Insurers would either need to increase premiums or they could pull out of the market altogether over the uncertainty.
Trump is threatening to do just that. In the days after Senate Republicans failed to pass a bill to repeal or replace the health care law, the president tweeted that he was prepared to cut off the cost-sharing subsidies.
@realDonaldTrump: If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!
@realDonaldTrump: If ObamaCare is hurting people, & it is, why shouldn't it hurt the insurance companies & why should Congress not be paying what public pays?
Politico reported that the Trump White House could make a decision about paying the subsidies going forward as soon as this week. There is some momentum in Congress to act on the issue, which would remove Trump's leverage, but for now the president can still sabotage the law if he chooses.
So Obamacare isn't out of the woods yet. Even if the law stays on the books, Trump and the Republicans who now control the federal government still have an opportunity to undercut it or hold it hostage to try to force Democrats to compromise on a new health care plan. The cost-sharing subsidies — an intricate part of the law nonetheless made vulnerable by a legal challenge — gave them that chance.