A powerful South Dakota Republican senator merits credit for throwing his support behind a key effort to stabilize the Affordable Care Act after the failed but disruptive congressional push to repeal it.
Early this week, South Dakota’s John Thune, the Senate’s third-ranking Republican, spoke out publicly in favor of funding a critical component of former President Barack Obama’s health care law: its financial assistance to consumers struggling with high health insurance deductibles and other expenses. While Thune didn’t sound overly enthusiastic, his pragmatic call to fund this consumer-friendly aid — known as “cost-sharing reductions,” or CSRs — clearly warns the Trump administration against taking action to undermine the insurance marketplace.
It’s a particularly timely message — one that Minnesota’s three influential GOP House members should echo — as Republican efforts to replace the ACA stall indefinitely. The inaction has stoked the ire of President Donald Trump, who campaigned on swiftly repealing “Obamacare.” There are understandable concerns that Trump appointees could pursue measures to sabotage the law to placate the angry Oval Office occupant.
The CSRs are one possible executive branch action for doing this, which is why Trump has aired the possibility of cutting off funding. But this ill-advised move would backfire. Insurers are legally required to provide this aid, with reimbursement from the federal government. If the industry doesn’t get paid, it passes along these costs through higher consumer premiums — a reality that Thune’s position reflects.
Other wrongheaded options for undermining the law include weak enforcement of the individual requirement to buy insurance or neglecting updates intended to make the Healthcare.gov website easier for insurance shoppers to use. Healthcare.gov serves consumers who live in states that did not set up their own marketplaces, as Minnesota did with MNsure. Reports this week that Healthcare.gov had mistakenly sent out discontinuation-of-coverage letters raised questions about website maintenance under Health and Human Services Secretary Tom Price.
Price’s agency also has authority over state innovation requests, often referred to as “waivers.” Minnesota has an important one pending. The state is awaiting approval of its new “reinsurance” program, which helps offset price hikes faced by consumers who buy insurance on their own instead of getting it through a job or public health program such as Medicare.
Minnesota’s congressional delegation has admirably advocated for this waiver. Every member of the state’s delegation — including Republican Reps. Erik Paulsen, Tom Emmer and Jason Lewis — signed a May 16 letter calling for expeditious federal approval.
Minnesota also has a unique stake in the debate over CSRs, which is why its three GOP representatives should join Thune in calling to fully fund them. The Obama law allowed the state to tap far more federal dollars for MinnesotaCare. The program serves more than 89,000 Minnesotans who make too much for Medical Assistance but still struggle to buy private insurance. Federal funding and enrollee-paid premiums now almost entirely cover MinnesotaCare costs.
The CSR money makes up a substantial part — $235 million over the next two years — of this federal funding stream. Cutting off CSR dollars could undermine the program’s financing. There’s debate in health wonk circles over whether funding for MinnesotaCare-like programs would be protected, but it’s unclear at best.
Paulsen, Emmer and Lewis need to take another step forward and protect MinnesotaCare, a program vital to so many in their home state.