On Thursday morning, President Donald Trump announced an executive order that would make it easier for small businesses to pool together in group insurance plans, an idea that experts have warned could lure healthier enrollees away from the Obamacare market place and into skimpier plans. By Thursday night, Trump had announced another blow to Obamacare: He would no longer make what are known as cost-sharing reduction payments
, funding the federal government gives to insurers to reduce health care costs of low-income people.
For months, Trump has been threatening to cease the payments, but even congressional Republicans have privately acknowledged that stopping them could throw the health care system into chaos.
Now, Republican leaders in Congress will have to decide if they are willing to step in to partially salvage a law they have spent seven years campaigning against.
Without CSR payments, insurers can leave the marketplace and raise premiums on consumers in future. Now that Republicans control both legislative branches and the White House, there are concerns that the GOP could share the brunt of the blame for skyrocketing costs.
But fixing the law also brings with it political risks. Repealing and replacing the Affordable Care Act was the party's signature campaign promise, and many Republicans view allocating CSR payments or propping the law up in any way as little more than throwing money at a health care system they never wanted in the first place.
In the wake of Trump's decision Thursday to stop CSR payments, there is now more pressure than ever on Sens. Lamar Alexander, a Republican from Tennessee, and Patty Murray, a Democrat from Washington, to find consensus on a compromise bill they've been working on. The two senators have been working behind the scenes for weeks to find a compromise that would fund CSR payments for two years in exchange for more state flexibility. But the Trump administration warned Friday in an interview with Politico that Trump was not interested in supporting a bipartisan deal struck by the two of them.
"Instead of saying what we might support, I'd say I'm pretty sure what we won't support, which is just a clean Murray-Alexander bill," Director of the Office of Management and Budget Mick Mulvaney told Politico in the interview
. "The President has said pretty clearly that he's willing to talk to just about anybody about repealing and replacing ... but if the straight-up question is: Is the President interested in continuing what he sees as corporate welfare and bailouts for insurance companies? No."
On Friday, a Democratic Senate aide told CNN that the negotiations were ongoing but that there had not been a final deal and that questions still remained about whether GOP leadership would back efforts to allocate CSR payments.
On Friday, Senate Minority Leader Chuck Schumer told reporters on a conference call that Senate Democrats would do everything they could to restore the insurance payments, even warning that if a deal could not be found before the December spending deadline that Democrats could use it as a vehicle to restore CSRs.
"I think we are going to have a very good opportunity in the omnibus to get this done in a bipartisan way if we can't get it done sooner," Schumer said.