The GOP's Obamacare problem

Politico

4 days ago

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With help from Carmen Paun and Erin Schumaker
Driving the Day
KILLING THE BUZZ? Republicans might unwittingly undermine the growing popularity of a first-term Trump policy that encourages Obamacare sign-ups, Kelly reports.
In 2019, the first Trump administration finalized a rule permitting employers to offer their workers a tax credit to purchase health insurance on the Affordable Care Act exchange in lieu of offering them a group plan. Few employers initially took up the offer, but the high costs and administrative burden that come with providing traditional group plans have lately prompted more companies to adopt the arrangements, health insurance brokers told POLITICO.
Republicans favor the policy, called Individual Coverage Health Reimbursement Arrangements, because it promotes individual choice in health coverage. Democrats don't mind it either because it bolsters Obamacare. And employers are growing more interested: ICHRA adoption has surged more than 1,000 percent since 2020, according to an HRA Council report.
But major obstacles threaten its course.
Why it matters: Changes to the ACA in Republicans' recently enacted megabill, the expiration of enhanced federal Obamacare subsidies at year's end and a new Trump administration marketplace rule could lead to fewer young and healthy people in the ACA market and higher premiums. The blend of federal policies could make offering ICHRAs much less attractive for employers, policy experts said.
'For that to be a viable option for the employer to do, the individual market has to be a sustainable, viable market to send your workers to,' said Cori Uccello, a senior health fellow at the American Academy of Actuaries.
Key context: Republicans argue the new policies, some of which crack down on ACA enrollment verification, are necessary to address widespread broker and enrollment fraud, even if the changes mean a less stable marketplace with higher premiums.
'I don't think we want a structure where there's millions of people who are receiving subsidies that they don't qualify for,' said Brian Blase, president of the right-leaning Paragon Health Institute and a former Trump adviser who was one of the architects of the ICHRA policy.
An earlier version of the GOP megabill that passed the House would have codified the ICHRA policy into statute and offered tax incentives to employers choosing to adopt the arrangements.
The provisions were ultimately stripped from the final version of the bill, but Blase and other ICHRA proponents still hope Congress will pass the provisions in a future spending bill or a bipartisan standalone health care package. And state lawmakers nationwide are promoting the policy, too, introducing and passing legislation to incentivize uptake.
Even so: Policy experts said the efforts are ill-fated, given the spate of Republican-led policy changes expected to weaken the Obamacare marketplace and increase premium costs over the next few years.
'ICHRAs are only going to be as attractive as the individual market is attractive,' said Ellen Montz, a managing director with advisory firm Manatt Health and a former Centers for Medicare and Medicaid Services official during the Biden administration.
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In Congress
CHRISTINE GETS A VOTE — A key Senate committee will vote today on whether to advance President Donald Trump's nomination of Dr. Brian Christine to serve as one of the highest-ranking HHS officials.
Christine, a men's sexual health doctor and a longtime GOP donor, faced the Senate Health, Education, Labor and Pensions Committee last week for a confirmation hearing to be assistant HHS secretary for health. During the hearing, Christine positioned himself as a 'main street doctor' with a direct link to the patient experience, noting his alignment with the Make America Healthy Again movement to combat chronic disease and his opposition to gender-affirming care.
He received little pushback from Republicans on the HELP Committee and endured an expected probe from Democrats — who tried to make him answer for HHS Secretary Robert F. Kennedy Jr.'s fringe views or Trump's Medicaid cuts.
Why it matters: If confirmed by the full Senate, Christine would be charged with overseeing the uniformed public health service and helping carry out Kennedy's public health agenda. The assistant secretary for health advises the HHS secretary and recommends policy related to public health matters like disease prevention, vaccine programs and health disparities.
What's next: If the committee approves Christine's nomination today, it will advance to the full Senate floor for a vote.
PUBLIC OPINION ON THE BBB — Nearly half of Americans believe the GOP's recently enacted 'big, beautiful bill' will hurt them, according to a new poll from health policy think tank KFF.
About a quarter of adults — including more than half of Republicans — believe the law will help them, according to the poll. People identifying as supporters of President Donald Trump's Make America Great Again movement were over five times more likely to say the law will help their families than hurt them. The remaining quarter said they don't expect to be affected by the law.
Background: The One Big Beautiful Bill Act includes key components of Trump's domestic agenda, like tax cuts and border security, and is estimated to reduce health care spending by more than $1 trillion, with most of those cuts coming from Medicaid, the health insurance program serving more than 70 million low-income Americans.
The Congressional Budget Office has estimated that about 10 million people could lose health insurance as a result of the changes in the megabill, which also includes changes to the Affordable Care Act.
Two-thirds of Medicaid enrollees said the law will hurt their families, according to the poll.
The survey was conducted from July 8 to 14, online and by telephone, among a nationally representative sample of 1,283 U.S. adults.
In the States
'MAHA WINS' IN IDAHO — Health Secretary Robert F. Kennedy Jr. held an event with Idaho's Republican Gov. Brad Little on Wednesday to celebrate new initiatives in the state his office dubbed 'MAHA wins,' Carmen reports.
The measures include the Agriculture Department approving the state's waiver to allow Idaho to exclude soda and candy from items that can be purchased with Supplemental Nutrition Assistance Program benefits. They also touted a bill the governor signed into law in April barring businesses, schools and other entities from restricting entry, services or employment based on requirements to be vaccinated or undergo certain medical tests or treatments.
'I'm very happy to be here in Idaho, which is the home of medical freedom, home of good health,' Kennedy said.
Why it matters: The Idaho visit is part of a tour Kennedy has embarked on across Republican-led states to highlight state legislation in line with his Make America Healthy Again movement.
Today, he'll visit the Nez Perce Tribe in Lenore, Idaho, where he'll discuss with tribe leaders 'the importance of preserving traditional foods and the role they play in combating chronic disease,' according to HHS.
At the Agencies
MICROSOFT HACK HITS NIH — The National Institutes of Health is among the victims of a breach of Microsoft's SharePoint collaboration software, HHS confirmed to POLITICO on Wednesday, Erin reports.
'The Department and its security teams are actively engaged in monitoring, identifying and mitigating all risks to our IT systems posed by the Microsoft SharePoint vulnerability,' HHS spokesperson Andrew Nixon said in a statement.
'At present, we have no indication that any information was breached as a result of this vulnerability,' Nixon said. 'HHS takes the protection of our information, systems and networks seriously, and are handling this issue with the utmost diligence and care.'
Big picture: Microsoft first reported the widespread cyberattack, which has impacted dozens of organizations globally, on Saturday. On Tuesday, the company confirmed in a blog post that three Chinese hacking groups, known as Violet Typhoon, Linen Typhoon and Storm-2603, were among those behind the attack.
Multiple federal agencies are believed to have been breached, while more have yet to be fully investigated.
The SharePoint breach is considered severe because it lets hackers remotely access Microsoft users' self-hosted versions of the service. Once inside, hackers can go deeper into the users' networks to access sensitive material. Versions of the software hosted on the cloud are not vulnerable to the attack.
The Washington Post first reported that NIH was involved in the breach.
OZ ON THE HILL — Centers for Medicare and Medicaid Services Administrator Mehmet Oz defended the One Big Beautiful Bill Act's steep Medicaid cuts during a closed-door meeting with House Ways and Means Democrats and Republicans today, framing them as efforts to curb 'waste, fraud and abuse,' POLITICO's Robert King reports.
The $1 trillion in health spending reductions projected by the CBO — mostly cuts from Medicaid — sparked skepticism from Democrats, who warned of coverage losses, especially under new work requirements for some able-bodied adults.
Oz argued that those losing Medicaid could shift to other insurance, while critics said most affected already work and predicted enrollment drops tied to red tape. CMS did not return a request for comment on the roundtable.
Names in the News
Tony Dieste has been named chief marketing officer at health care technology company Doc.com. Dieste is the founder and chair of Dieste, Inc.
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