Marco Rubio and Obamacare: Taxpayer hero or healthcare saboteur?

April 01--Depending on your point of view, U.S. Sen. Marco Rubio is a hero who saved taxpayers $2.5 billion by killing an Obamacare bailout for insurers or a saboteur who kicked down a load-bearing wall and wants to blame the architect when the roof collapses.

How the public sizes up the role of players like Florida's GOP senator matters a lot right now as Republicans try to figure out what to do next. After the breakdown of a House replacement plan in March, they find themselves under pressure this month to decide whether to take action to stabilize ACA marketplaces before insurers start filing their 2018 plans in May.

There is talk of trying again on a comprehensive makeover of the health law. But if millions of people wind up paying up more or priced out of coverage just in time for mid-term elections, count on the blame game to hit high gear. Will folks chalk it up to inherent flaws in Obamacare? Or GOP monkey wrenches like the one from Rubio?

"To now claim it would have worked just fine if only the Obama Administration could have taken more money out of taxpayers' pockets in order to bail out big insurance companies is laughable," Rubio spokeswoman Christina Mandreucci said.

Except it wasn't a bailout, insurers said. It was "risk-corridor" funding, deliberately designed in the crucial early years of the marketplace to cushion health insurers against uncertain risks as they agreed to cover millions of new customers under new rules. In effect, it was a government promise that Rubio and colleagues broke, changing the rules in the middle of the game, as many in the industry saw it.

The CEO of one of Florida's largest health insurers, Pat Geraghty of Florida Blue, said at a Palm Beach County Business Development Board event in 2014 that the risk corridor was a Republican idea used in President George W. Bush's 2003 Medicare prescription drug law.

"Sen. Rubio and I had this tug of war," Geraghty said. Rubio's argument, he believed, was "unfair."

Insurers including Preferred Medical Plan Inc. of Coral Cables specifically cited the loss of risk-corridor funding as a reason they dropped out of the ACA marketplace.

A string of insurer pullouts meant consumers had fewer choices. Risk calculations changed. Rates rose. In Florida, the average approved premium increase was 19.1 percent for 2017, about double the previous year's rise.

Mandreucci said "premiums were skyrocketing and insurers were leaving the market well before Sen. Rubio blocked the Obama Administration from bailing out insurance companies."

It is certainly true not every insurer's departure was tied to the issue. Cigna cited addiction treatment fraud in Florida for its pullout, for example.

In any case, Rubio proudly took credit for blocking the $2.5 billion in presidential debates last year.

"When they passed Obamacare, they put a bailout fund in Obamacare," Rubio said in February 2016. "All these lobbyists you keep talking about, they put a bailout fund in the law that would allow public money to be used, taxpayer money, to bail out companies when they lost money. We led the effort and wiped out that bailout fund."

Now what?

"Floridians know Obamacare is still broken because many lost a health care plan they would have preferred to keep, and most have been hit with massive increases in their premiums, " Rubio said after the House failed to find the votes to overhaul the health law March 24. "Seven years after Obamacare became law, about three of every four counties in Florida have only one or two insurance providers to choose from on the exchange. After the political drama clears, Obamacare will only get worse, which is why we must take the time to get repeal and replace done right."

Unless and until GOP factions agree on what "done right" means, though, the choices remain politically uncomfortable all around. Trump has said Obamacare will "explode" in a "very bad year."

Some insurers still in the marketplace say they will consider staying but they could use answers pretty soon -- as in the next few weeks. They have to make decisions to file for the 2018 marketplace starting in May. Molina Healthcare, for example, said two things would help: The administration and Congress could guarantee "cost-sharing" funding to make coverage more affordable for lower-income consumers and enforce the individual mandate that requires people to buy insurance or pay a penalty.

For what it is worth, the Congressional Budget Office did not see a "death spiral" for the Affordable Care Act marketplace, even under a House bill that dramatically cut subsidies for many low-income and older consumers. It even projected a long-term decrease in premiums compared to original Obamacare if insurers were allowed to offer skimpier plans and tax credits got more attractive for younger and higher-income people.

But doing anything that appears to enshrine or even help Obamacare temporarily remains anathema to many Republicans who vowed to repeal and replace it.

The trouble is, letting Obamacare slide or actively helping it get worse -- such as by blocking government assistance that brings down costs for consumers -- risks upsetting millions of voters in both red and blue states.

It may or may not work to refer complaints to former president Obama, but he won't be on the 2018 ballot.

Democrats "own" Obamacare, Trump insisted, because they failed to support the House rewrite. Then again, so did members of his own party's Freedom Caucus. Trump called out several by name last week and tweeted at them to "get on the team."

Convoluted and tricky? You bet. Maybe call it a political risk corridor.

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