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UPDATED: Trump To Take ACA Cost-Sharing Subsidies Hostage To Force Negotiation

He's talking about holding his own voters hostage!

The latest Trump strongarm tactic on health care is intended to aim straight at the voters who voted for him, by making their copays and deductibles so expensive they can't afford them.

There are two different kinds of subsidies in the Affordable Care Act. One is the premium subsidy, which everyone knows about. The other is a less-known, but much more valuable subsidy to people who do not qualify for Medicaid but fall at the lower end of the income spectrum.

The second subsidy lowers the co-payments and deductibles for people, so that 90% of their costs are covered by insurance in some cases; 73% in others. It's a huge helper for those in the income brackets where Medicaid isn't an option, but those deductibles do serious damage.

Our Republican Congress has de-funded some of those subsidies, causing insurers to go to court to recover them. This is one of the primary reasons insurance costs have risen so much. Between cutting risk corridors and refusing to pay the subsidy costs, insurers are forced to raise prices to cover their losses. (No, I am not crying for the insurers here. But it's a fact.)

According to reports, Trump plans to use these subsidies as a weapon to force Democrats to bend and come to the table to negotiate the end of the Affordable Care Act.

As Greg Sargent notes, this is insane.

“Dems will want to come to the table,” and this will “force people to do something.” Missing from this explanation is why this would force Democrats to the table, and to what end he hopes this will occur. The basic problem is that Trump is asking Democrats to cooperate with him to bring about an outcome that would be worse than the one he is threatening them with.

The health-care bill Trump is championing would result in 24 million fewer people with health coverage. Those people are getting insurance both on the individual markets and through the Medicaid expansion, which would be phased out, resulting in 14 million fewer people on that program. But if Trump makes good on his threat to tank the individual markets, that might bump at least 10 million people from coverage, while leaving the Medicaid expansion in place (though it would do plenty of other damage as well). Thus, Trump is basically telling Democrats: “If you don’t give me the money, I’ll shoot only one hostage, rather than both of them.”


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This will not end well for Trump or Congress, should they take this tack. Floating this idea in the middle of a week with exceedingly contentious town halls will surely create even more energy against Republicans, and for the ACA.

Update: Ron Wyden seals that deal:

UPDATE 2: Dems are ready to make Republicans shut down the government over it. That's how to play, Dems!

Democrats plan to tie money promised to health insurers to offset Obamacare costs to the coming showdown over keeping the government running, a Democratic source said, following a threat from President Donald Trump Wednesday.

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