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Speaker 1: With us to talk about the president's actions on health

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Speaker 1: insurance are Abby Gluck, the director of the Solomon Center

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Speaker 1: for Health Law at Yale Law School, and Zach Tracer,

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Speaker 1: Bloomberg News healthcare reporter. Zach, let's start with these costs

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Speaker 1: sharing payments that were being made to ensure. What were

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Speaker 1: they and what did the president do? Sure? So, these

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Speaker 1: are payments that go directly to insures, and they help

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Speaker 1: cover costs related to this provision in the law that

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Speaker 1: says the low income people essentially have UM reduced deductibles

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Speaker 1: and reduced copays and other kinds of out of POCAT

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Speaker 1: costs when they go to see a doctor. And there's

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Speaker 1: been this ongoing legal dispute over these payments since it's

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Speaker 1: been going back and forth in court. UM, and the

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Speaker 1: administration yesterday said look, you know, UM, well that you know,

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Speaker 1: we're done. We're we're not going to pay these payments anymore. UM.

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Speaker 1: The administration had been paying them, the Trump administration had

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Speaker 1: been paying them for about the last nine months. But

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Speaker 1: they changed their minds UM late last night and said

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Speaker 1: we're cutting these off. So abby. What is the likely

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Speaker 1: consequence of that? Um? You know, there's there's a couple

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Speaker 1: import consequent is first of all, we're very likely to

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Speaker 1: see a legal action filed by the state attorneys general

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Speaker 1: on The Attorney's General of New York and California put

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Speaker 1: out a press release last night saying that they were

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Speaker 1: going to intervene bring a direct lawsuit in the DUC

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Speaker 1: Circuit to challenge the administration stopping of those payments. Um,

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Speaker 1: it's also possible that we're going to see premiums rise

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Speaker 1: potentially as much as twenty percent for people in those

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Speaker 1: states who do not get insurance subsidies. Now, this is

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Speaker 1: a point that's really worth clarifying. The way the Affordable

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Speaker 1: Care Act works is that is subsidized insurance payments for

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Speaker 1: people below certain levels of the poverty line. When the

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Speaker 1: Trump administration cuts off those insurance payments, the subsidies are

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Speaker 1: going to go up. So the federal government and the

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Speaker 1: taxpayers are not going to save money from this action.

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Speaker 1: The government is going to wind up paying more in

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Speaker 1: subsidies because insurers are going to raise their premiums for everybody,

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Speaker 1: both those who can afford help insurance alone on those

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Speaker 1: who can't. So people who aren't subsidized are going to

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Speaker 1: pay more. Are people who are subsidized may pay the

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Speaker 1: same amount, but the federal government is going to pay more,

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Speaker 1: and some in stores are likely to pull out of

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Speaker 1: the markets from the increased cost to the system. Zach,

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Speaker 1: the the cost sharing subsidies aren't the only things that

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Speaker 1: the Trump administration is at least trying to change. What

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Speaker 1: does the president Executive Order do in addition to this

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Speaker 1: move on subsidies? For Zach, So, the the executive Order

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Speaker 1: just sort of starts a process of rulemaking and the

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Speaker 1: goal would be to offer, um, some some health insurance

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Speaker 1: options that are you know, less expensive, but also probably

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Speaker 1: health insurance options that will you know, cover less, that

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Speaker 1: will be less comprehensive for folks. You know, this is

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Speaker 1: this is all about creating choice, and the administration has

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Speaker 1: touted this idea of choice quite a bit. Um. You know.

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Speaker 1: The critics, of course, we'll say that this will lead

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Speaker 1: to h to undermining Obamacare and sort of harming the

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Speaker 1: c A markets. Abby, Um, what about insurers and what

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Speaker 1: will happen in with the executive order? They're going to

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Speaker 1: have agencies making up these different rules which we don't

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Speaker 1: know exactly what they are yet, and will it take

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Speaker 1: quite a bit of time. After the rulemaking, so that

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Speaker 1: it may not even affect insurers immediately. I think there's

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Speaker 1: going to be a short term effect, in a longer

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Speaker 1: term effect. In the short term UH. The order, just

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Speaker 1: like the president's threats for the last nine months to

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Speaker 1: turn off those CSR payments that you finally did last night,

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Speaker 1: all of those things have an effect on the stability

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Speaker 1: of insurance markets and the ways in which insurers planned

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Speaker 1: their rates for the future. You have to remember the

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Speaker 1: insures you've already filed most of their rates eighteen. They

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Speaker 1: have to plan these things far out in advance, so

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Speaker 1: they have to predict what might happen to the markets,

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Speaker 1: and so you might see increased UH predictions we're going

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Speaker 1: to happen to premiums going forward, But all in all

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Speaker 1: is contributing to an atmosphere instability and insecurity on the

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Speaker 1: part of the markets there are. There is going to

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Speaker 1: be It seems a formal common process, which is different

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Speaker 1: from the this administration has handled health care before. UM,

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Speaker 1: so they seem to want to go through the regular process.

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Speaker 1: I think we're going to see a very loud period

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Speaker 1: of comments. I think there are probably legal issues with

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Speaker 1: several of the of the ideas and that executive order,

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Speaker 1: it's unclear how they're actually going to accomplish what the

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Speaker 1: director of the agencies to do, and it's possible that

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Speaker 1: there are a long term people who work in these

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Speaker 1: agencies who might go back to the President and say,

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Speaker 1: you can't actually do some of these things that you're

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Speaker 1: proposing to do, and we may see some curtailment of

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Speaker 1: the goals and those in that order. Zach. You know,

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Speaker 1: the President and the Administration of announced that the executive Order,

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Speaker 1: in their view, is going to lower premiums for a

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Speaker 1: lot of people. To what degree can we assess whether that,

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Speaker 1: if it's all carried out, that's actually true. Who expencily

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Speaker 1: you're talking about, right, So take for example, one of

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Speaker 1: the pieces of that executive order, it's the idea to

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Speaker 1: extend the period of time in which you can get

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Speaker 1: a short term health insurance plan. Those are plans that

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Speaker 1: are designed to get you through a period perhaps of

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Speaker 1: no im lament. Under the Obama administration, those were three

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Speaker 1: month plans um you're exempt from the requirements of the

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Speaker 1: Affordable Care Act. So let's say you're young and healthy

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Speaker 1: and you think I don't really want a full insurance plan.

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Speaker 1: You take one of these new plans, which under the

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Speaker 1: executive order the President wants to extend for a full year.

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Speaker 1: You encourage those young, healthy individuals to exit the market,

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Speaker 1: take these cheap subprime plans, and weakens insurance markets overall,

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Speaker 1: because insurance markets need to have a mix of healthy

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Speaker 1: and unhealthy people to function properly. That's the way insurance

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Speaker 1: pooling works. Um. So you may get some benefit for

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Speaker 1: some young people, but I think some people would argue

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Speaker 1: that those cheap plans didn't do anybody good before the

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Speaker 1: Affordable Care Act, because if something happens, you're in trouble. Zachary,

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Speaker 1: the you know, Congress has been trying to first the

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Speaker 1: Republicans are trying to repeal and replace Obamacare. That didn't work.

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Speaker 1: There was some discussion that there were bipartisan talks going

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Speaker 1: on to try to fix some of the issues that

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Speaker 1: are now being targeted by the president. What's what's going

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Speaker 1: on in Congress right now about healthcare and what's likely

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Speaker 1: to happen in response to these actions. Well, these actions

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Speaker 1: may actually end up forcing some by partisan compromise. We've

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Speaker 1: seen some Republicans come out and say, you know, now

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Speaker 1: we were going to have to go and essentially authorized

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Speaker 1: these payments that that the President has cut off in

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Speaker 1: order to stabilize the insurance markets. Um. You've seen some

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Speaker 1: bypartisan efforts there. Um. You know, the president is that

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Speaker 1: he would like to revive this push to repeal Obamacare,

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Speaker 1: but it's not clear how that will go. You know,

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Speaker 1: obviously they want to do tax reform too abby. What

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Speaker 1: is likely to happen in terms of the numbers of

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Speaker 1: people covered in about thirty seconds because of the executive order? Yeah,

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Speaker 1: I think we don't know that because we haven't had

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Speaker 1: any kind of CBO report and be we have no

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Speaker 1: idea what they're actually going to do. For example, there

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Speaker 1: a third provision of that order that seems to allow

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Speaker 1: reduce restrictions on UM certain accounts provided by employers to

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Speaker 1: allot people to purchase inshrines. That is not at all

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Speaker 1: clear what I out of mind for that, So I

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Speaker 1: think it's hard to predict. I would be surprised if

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Speaker 1: it did not reduce coverage, especially among people who are

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Speaker 1: less healthy. We're talking about President Trump's actions yesterday on

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Speaker 1: the healthcare insurance market. One of them was to sign

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Speaker 1: an executive order allowing for more options in terms of

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Speaker 1: plans that individuals and businesses can sign up for. The

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Speaker 1: second was to say that the government is no longer

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Speaker 1: going to pay UH cost sharing subsidies to insurance companies

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Speaker 1: that use them to subsidize low income customers who are

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Speaker 1: getting health insurance from them. We're talking with Abby Gluck,

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Speaker 1: the director of the Solomon Center for Health Law at

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Speaker 1: Yale Law School, about the president's actions. Abby, you mentioned

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Speaker 1: earlier that there are some things the president did ordered

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Speaker 1: the government to do here that might not be legal

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Speaker 1: under Obamacare or perhaps some other statutes. What is it

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Speaker 1: that you've got in mind in terms of what might

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Speaker 1: be legally problematic? Well, um, you know, he had promised

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Speaker 1: a much more detailed executive order, and we've got something

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Speaker 1: very vague. I think, probably because they're not quite sure

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Speaker 1: what's legal and what's not under the law. What he

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Speaker 1: directed was extremely vague. So, for instance, he seems to

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Speaker 1: be asking his agency to explore expanding the ability of

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Speaker 1: small businesses to group together and what are qualities health

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Speaker 1: association plans um. But at the same time, the order

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Speaker 1: seems to imply that these plans would be exempted from

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Speaker 1: all of the Obamacare requirements. It's not quite clear how

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Speaker 1: that's legal, and that's not quite clear what they have

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Speaker 1: in mind. And my guess is that the administration itself

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Speaker 1: doesn't know what it has in mind, which is why

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Speaker 1: I put the order out and directed the Apartment, the

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Speaker 1: Department of Labor to look into it. Abby there these

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Speaker 1: subsidies are already being considered by a court. So how

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Speaker 1: is Trump able to just stop them when the court

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Speaker 1: hasn't ruled on them yet. That's a good question. So

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Speaker 1: the suit is not about whether the Affordable Care promises

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Speaker 1: the subsidies to the insurance industry. The statute says they

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Speaker 1: shall be paid, and nobody disputes that. The suit is

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Speaker 1: about whether the statute tells Congress to appropriate the funds

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Speaker 1: for those payments, and the argument is over that piece

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Speaker 1: of it. So the argument is whether the funds must

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Speaker 1: be appropriated if they have been appropriated automatically under the statute,

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Speaker 1: or whether there needs to be an additional appropriation, which

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Speaker 1: hasn't happened. The House brought the suit saying, hey, appropriations,

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Speaker 1: they'll start with us. We haven't approved the specific appropriation

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Speaker 1: for these payments. You can't make them. That's the suit

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Speaker 1: in the d C Circuit. It's important to see that

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Speaker 1: the DC Circuit allowed the payments to continue during dependency

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Speaker 1: of the lawsuit, didn't stop them, probably because it realized

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Speaker 1: how destabilizing stopping the payments would be. What the President

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Speaker 1: is doing now is saying, Okay, regardless of what happened

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Speaker 1: under this lawsuit, I'm looking at the statute myself, but

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Speaker 1: I don't think the money inappropriated, so I'm going to

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Speaker 1: turn them off. I'm going to use my executive authority

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Speaker 1: to turn them off. And that's why. Now you're going

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Speaker 1: to see an affirmative suit filed by the state Attorney's

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Speaker 1: General making the case that no, the President is not

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Speaker 1: allowed to turn these funds off, and that will probably

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Speaker 1: beloved together with the suit in the d C Circuit. Well,

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Speaker 1: might the health insurers who are supposed to get these

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Speaker 1: payments also sue abby, Yeah, they can sue in a

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Speaker 1: special process that exists for suing the government in a

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Speaker 1: special court called the Court of Federal Claims. Basically, um,

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Speaker 1: that's a separate process. A couple of years earlier last year,

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Speaker 1: there was a rumors rolling around that even if they

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Speaker 1: brought that student, they won. Somehow the federal government was

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Speaker 1: going to refuse to pay that out. But that's a

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Speaker 1: lawsuit for another day. Um. But there they are likely

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Speaker 1: to bring suit in that special court and they're likely

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Speaker 1: to win. And then there's a special fund called the

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Speaker 1: judgment fund that applies on the federal government loses a case,

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Speaker 1: and if everything goes according to the black Letter doctrine,

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Speaker 1: you would expect to see the insurance industry paid out

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Speaker 1: of the judgment fund. The bottom line being that taxpayers

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Speaker 1: don't save any money by having these funds shut off

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Speaker 1: by the president. In fact, they lose money because the

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Speaker 1: federal government's share of the subsidy requirements goes up. Abby.

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Speaker 1: Do you see anything possibly happening in Congress? Yeah? I

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Speaker 1: agree with Josh spoke earlier who said that this may

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Speaker 1: in fact spur some kind of part by partisan compromise.

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Speaker 1: You know, the senators are the ones who are going

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Speaker 1: to be hearing quite a bit from the entire insurance

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Speaker 1: industry and frankly the entire medical industry over the next

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Speaker 1: few days. Uh. Maybe this is a stunt by Trump

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Speaker 1: to try to push that kind of by part of

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Speaker 1: in action. I don't actually think that's what's motivating Trump.

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Speaker 1: I think he really wants to destroy the statute, But

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Speaker 1: I do think it's likely that in the face of

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Speaker 1: this chaos, say in our minds, to prevail, and this

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Speaker 1: could be just what's needed to push the Senate by

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Speaker 1: partisan agreement. Um. And I think a lot of people

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Speaker 1: certainly hope that that's what will occur. Well, Abby, it's

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Speaker 1: sort of an interesting dynamic if the send it in

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Speaker 1: the House both passed bills on a bipartisan basis to

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Speaker 1: restore these payments and fix some of the things that

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Speaker 1: they've been talking about in Obamacare, effectively reversing what the

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Speaker 1: President just did here. Is he likely to sign the bill? Well,

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Speaker 1: you might think from his tweets and such, he would

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Speaker 1: be towards the bill, but he's also leaked some other

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Speaker 1: statements over the past few days saying if they agreed

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Speaker 1: on something, he would sign it. And you know, there

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Speaker 1: was a rumor earlier this week that it called Senator

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Speaker 1: Schumer and invited him over to have a chat about

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Speaker 1: working at a deal. Um. And so you know, as always,

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Speaker 1: it's impossible for to predict with this president. Thanks, and

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Speaker 1: they may actually depend on the time of day. Well,

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Speaker 1: in about thirty seconds in the short term, What's the

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Speaker 1: thing we should have expect to happen immediately in the

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Speaker 1: Obamacare markets after these two actions by the President UM

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Speaker 1: potentially revisions in the race for although some of the

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Speaker 1: rates have already been set UM. I think that's probably

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Speaker 1: the only immediate reaction that we might see. We might

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Speaker 1: do some patake insurance commissioners calling in insurance industry to

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Speaker 1: talk about how they're going to deal with those rates. Well.

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Speaker 1: Our thanks to Abby Gluck, who is the director of

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Speaker 1: the Solomon Center for Health Law and a law professor

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Speaker 1: at Yale Law School, for being with us here today

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Speaker 1: on Bloomberg Law. Coming up, we're gonna go to Europe

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Speaker 1: on metaphorically speaking, and we're going to talk about why

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Speaker 1: Belgian regulators are seeking a court order about the way

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Speaker 1: that Facebook gets data from not just its customers, but

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Speaker 1: from people who are not actually using Facebook. Belgian regulators

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Speaker 1: are very upset that Facebook uh uses cookies and other

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Speaker 1: devices in order to find out what people are doing

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Speaker 1: so they can sell ads on Facebook to target folks

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Speaker 1: even if they're not using Facebook.