Targeting certain provisions of the Affordable Care Act (ACA) may be the best way to weaken the legislation after the failure of repeal and replace, a longtime opponent of former President Barack Obama's health care law argues.
Sally Pipes, director of the conservative Pacific Research Institute, says to start with the cost-sharing reduction (CSR) program, a provision in the ACA aimed at helping those in low and middle incomes, and compensates insurers approximately $7 billion annually.
"The CSR subsidies, I believe they should be ended," Pipes told Patient Daily.
Pipes argues that these transfers are unconstitutional and believes President Donald Trump should immediately cease payments, although he has pledged to continue the program through at least this month.
Pipes claims these money transfers, paid directly to insurers from the federal government, violate the Constitution because the money was never explicitly appropriated by Congress. Rather, these payments are authorized solely by an Obama-era executive order and are paid to insurers so individuals earning up to 250 percent of the federal poverty line and below will have to pay less out-of-pocket costs for their health care.
This argument has been championed by House Republicans, who sued the Obama administration over the payments in 2014. House Republicans won their suit, but the case is on hold pending appeal, allowing the payments to continue at the discretion of the president.
Pipes emphasizes Republican political concerns, saying that they would be blamed for any rise in premiums if the CSR is taken away, and the Congressional Budget Office (CBO) assesses premiums will increase if the payments cease.
In a report published this week, the CBO estimated premiums for those eligible for the subsidies would rise by 20 percent and it would end up costing the federal government $194 billion over the next 10 years due to associated subsidies the government would be forced to make.
Still, Pipes is skeptical of these reports and emphasizes the political ramifications for Republicans in Congress if the payments continue.
"Republicans may be nervous about CSR and Medicaid expansion, but they may not be re-elected because they promised to repeal at any price — and did not," she says.
Pipes says other fixes could be taken to pare back "Obamacare," including shortening the open enrollment period and scrapping the medical-device tax.
But Congress, she says, can act by introducing legislation to scrap the individual employer mandate, allowing people to use health savings account funds and buy insurance across state lines.
Currently, the House Freedom Caucus is pushing for the re-introduction of the 2015 repeal bill passed in both the House and Senate.
"Everything is up in the air," Pipes says.
For now, CSR payments will continue.