President Donald Trump and Speaker of the House Paul Ryan have said they are willing to let Obamacare “implode,” but doing so tacitly lets a potentially unconstitutional program continue.
Under the leadership of former Speaker John Boehner, the House filed suit against the Obama administration in 2014, claiming it was illegally reimbursing marketplace insurers for a little known feature of Obamacare: cost-sharing reductions (CSRs).
Insurers are required under the current system to provide CSRs to low and moderate income individuals who participate in the exchanges. To make consumers put more “skin in the game,” Obamacare effectively raised deductibles to levels that are tough for many Americans to meet without some financial support. CSRs were instituted to help insurers with the costs of the deductibles patients can’t otherwise meet.
How the program works is rather straightforward: Insurers cover the cost of the patient’s deductible and the federal government reimburses the provider for what they pay out.
Boehner, along with House leadership, felt that CSRs required an annual appropriation approved by Congress. The House argued that because Congress had never explicitly appropriated the funds for those payments, the administration’s actions were unconstitutional. After nearly two years of deliberation, Senior Judge of the U.S. District Court for the District of Columbia Rosemary M. Collyer concluded the House’s claim had legal standing and allowed the case move forward on May 12, 2016.
The Obama administration then appealed the decision. The case remains open, with no definitive ruling. Republicans have pushed back the court date twice. In February, Trump and Ryan got a hold approved until May 22.
A troubling result of the appeal and numerous Republican-led delays is that CSRs are still funded as they were when the Obama administration first appealed.