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Trump faces public pushback, lawsuits for ending ACA out-of-pocket subsidies

President Donald Trump's decision to stop payments made under the Affordable Care Act, or ACA, that help eligible Americans cover their out-of-pocket costs for prescription drugs and doctor visits was met with public pushback and at least one multiparty lawsuit, with the threat of others to follow.

In an Oct. 13 court filing, the Trump administration told the U.S. Court of Appeals for the District of Columbia Circuit that the U.S. Department of Health and Human Services had halted the ACA's cost-sharing reduction payments, or CSRs.

The agency had been making the payments to insurers on a month-by-month basis to cover the deductibles and copayments for about 7 million low- and moderate-income Americans.

U.S. Attorney General Jeff Sessions claimed that Congress had never formally appropriated the funds — an assertion the attorneys general from 18 states and the District of Columbia are disputing in a lawsuit filed the same day.

The White House and HHS revealed late on Oct. 12 that Sessions had determined in a legal opinion in what he said was the "best interpretation of the law" that the agency's funds could not be used for the CSRs.

The disclosure about the CSRs came the same day that Trump signed an executive order aimed at unraveling portions of the ACA.

The Congressional Budget Office, or CBO, and insurance groups have warned that without the CSRs, healthcare insurance premiums would rise by 20% in 2018 for many Americans who get their coverage through the ACA marketplace.

The CBO's August analysis also said ending the payments would increase the U.S. deficit by $194 billion over the next decade.

Lawsuits, lawsuits, lawsuits

Trump's action sparked an immediate lawsuit from the attorneys general of California, New York and 16 other states and the District of Columbia challenging the move.

"Taking these legally required subsidies away from working families' health plans and forcing them to choose between paying rent or their medical bills is completely reckless," charged California Attorney General Xavier Becerra, a former Democratic congressman. "This is sabotage, plain and simple."

In a statement, Becerra said he and the other attorneys general in the suit, which was filed in the U.S. District Court for the Northern District of California, would "fight vigorously" to ensure Americans, "as taxpayers, receive the healthcare the law provides."

Trump's effort to "gut the subsidies with no warning or even a plan to contain the fallout is breathtakingly reckless," New York Attorney General Eric Schneiderman told reporters during an Oct. 13 briefing.

"The Affordable Care Act is law of the land. It has been challenged and upheld. The cost-sharing reduction payments are an integral part," Schneiderman said. "The law says they have to make the payments."

He said the Trump administration was making a "very technical argument" that even though there is an appropriation for the ACA, there should be separate language for the specific CSR provision.

"To single out the cost-sharing reduction payments is to take a key piece out of the entire system that will make the whole system fall apart," Schneiderman said.

In a blog posting, University of Michigan law professor Nicholas Bagley said he anticipated many more lawsuits to be filed.

Public opinion

In the court of public opinion, Trump already is coming out the loser, new polling figures from the nonpartisan Kaiser Family Foundation show.

Most Americans, 69%, said they wanted Congress to continue paying the CSRs as part of a bipartisan marketplace deal that would give states more flexibility in the types of plans sold, according to Kaiser.

The poll also showed that seven in 10 Americans, or 71%, think Trump and his administration should do what they can to make the ACA work. One in five, or 21%, however, said the Trump administration should do what they can to make the law fail so it can be replaced later.

Overall favorability of the ACA increased over the past month with about half of the public holding favorable views of the law, while 40% viewed it unfavorably, Kaiser reported.

Bipartisanship

In a joint statement, Republican Gov. John Kasich of Ohio and Democratic Gov. John Hickenlooper of Colorado said Trump's decision to eliminate CSRs would "result in confusion and higher health insurance costs for many Americans."

They called on Congress to immediately fund the CSRs through 2019 to "prevent wholesale chaos in our health insurance industry."

A group of bipartisan lawmakers, dubbed the Problem Solvers Caucus, agreed, telling their colleagues on Capitol Hill it was time to "step up to stabilize the healthcare marketplace" and adopt the group's plan, which includes taking the CSRs out of Trump's hands and putting them under Congress' control.