Trump appears to back further away from bipartisan health-care push

President Trump appeared to distance himself further from a bipartisan Senate health-care effort on Wednesday, warning against "bailing out" insurance companies.

Trump's tweet was referencing Sen. Lamar Alexander, R-Tenn., who forged a deal with Sen. Patty Murray, D-Wash., that was released Tuesday and was greeted by ample GOP skepticism.

The president's Wednesday tweet was the latest in conflicting statements about the Alexander-Murray plan in the hours since it was released Tuesday afternoon.

The compromise would authorize payments to health insurers that help millions of lower-income Americans afford coverage in exchange for granting states greater flexibility to regulate health coverage under the Affordable Care Act.

Trump ended the payments, known as CSRs, last week, arguing they were illegal because they were not explicitly authorized under the ACA. He left it to Congress to decide whether to fund them.

Initially, on Tuesday, Trump said the Alexander-Murray proposal would "get us over this intermediate hump" and allow Republicans to later revisit efforts to aggressively undo the ACA. But later Tuesday, he was noticeably cooler to the idea, saying, "I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies."

Trump's sudden skepticism puts him in line with congressional Republicans, many of whom are not championing the plan. Senate Majority Leader Mitch McConnell, R-Ky., did not mention it in a speech opening Senate business Wednesday morning. On Tuesday, McConnell said he hadn't "had a chance to think about the way forward yet."

Key House Republicans have been outright hostile.

"None of our guys voted for Obamacare," Rep. Tom Cole, R-Okla., a close ally of House GOP leadership, said in an interview Tuesday. "They're not very interested in sustaining it."

But Democratic leaders have been supportive of the blueprint. Speaking on the Senate floor Wednesday, Senate Minority Leader Charles Schumer, D-N.Y., who discussed the prospect of a bipartisan deal with Trump less than two weeks ago, railed against the president for his about-face.

"The president doesn't know what he's talking about," Schumer said of Trump's suggestion that legislation authorizing the subsidies amounted to an industry bailout. "It helps people who are sick and need health care. It keeps their premiums low."

The minority leader described a commander in chief who constantly shifted positions, expressing a willingness to broker deals with Democrats only to be reined in by conservative Republicans.

"This president keeps zigging and zagging," Schumer said, noting that Trump had reassured both him and Alexander that he was open to a compromise that would keep the payments flowing. "Our only hope is maybe tomorrow, he'll be for this bill."

While Trump has repeatedly described cost-sharing payments as a "bailout" to insurers, the money directly covers the discounts low-income Americans covered under the Affordable Care Act receive for deductibles and other out-of-pocket costs. This group includes about 7 million Americans earning up to 250 percent of the federal poverty level.

Insurers are obligated to provide the discounts, which totaled roughly $7 billion this year and are estimated to reach $10 billion next year, even if the federal payments are cut off. According to the National Association of Insurance Commissioners, Trump's decision last week to halt the subsidies will cost insurance carriers more than $1 billion this year.

Facing the prospect for months that the Trump administration would cut off the payments, most insurers have opted to factor in this shortfall into their 2018 premium rates for all their customers. The cutoff in cost-sharing payments have translated into premium hikes ranging from 12 percent to 20 percent, according to several analyses.

The Alexander-Murray bill authorizes CSR payments for two years in exchange for granting states greater flexibility to regulate health coverage under the ACA. Those payments help offset deductibles and other out-of-pocket costs for low-income consumers who obtain insurance through the law; critics of Trump's decision to halt CSR payments said eliminating the subsidies would cause insurers to back out of marketplaces across the country.

The framework would also allow insurers to offer catastrophic insurance plans to consumers age 30 and older on ACA exchanges, while maintaining a single risk pool. It would shorten the time period for federal review of state waiver applications, expedite review for states in emergency circumstances and those with waiver proposals that have already been approved for other states, and allow governors to approve state waiver applications rather than requiring state legislative approval.