Thread by @ASlavitt

.@somuchweirdness suggests I explain how Trump stopping CSR payments actually effects ppl.

Because I always listen, will tweet that soon.1/

CSR payments reduce the size of deducts & co-pays for low income exchange consumers.

Insurers who participate must continue 2 pay them.2/

In the remainder of 2017, insurers will pay them as required-- approx $2 billion+-- but govt won't pay them back as promised. 3/

While it's cute to call it an insurer "bailout", its no more a bailout than the govt paying back a govt bond is to a saver. 4/

Everyone who calls it a bailout knows it's notning more than a talking point. Insurers will make the pmt 4 2017 & sue to recover. 5/

In 2018, CSR payments must still be made AS LONG AS A POLICY IS BEING OFFERED.

So the first question is what will insurers do? 6/

Insurers in ~38 states will likely stay. They were allowed 2 increase premiums on the rest of their policies 2 make up 4 no govt funding.7/

(I will explain how it works so skip ahead if you like. Will also get to what happens in the ~12 states soon.)

The amount of subsidies in ACA policies ⬆️ as the "silver plan" increases. In 38 states, insurers were able 2 ⬆️ premiums in those plans.8/

So in those 38 states, lower income buyers get a subsidy bump that keeps the costs the same & even makes other plans seem cheaper. 9/

All Trump did was load the cost of paying the CSR payments 2 places: consumers wout subsidies & the Federal government. 10/

The CBO estimated that Trump's maneuver just cost the Federal taxpayer $200 billion. And middle class families a 20% rate hike. 11/

Yes, cutting CSR payments is a double middle class tax increase. A good way to usher in Trumpcare.

#ThanksTrump

In these 38 states, one would hope the insurers stay. But losing $2B+ because the govt reneged on a promise could cause them not to.13/

Now there are ~7 states (check me @LouiseNorris) where states haven't allowed rates to increase for the govts action. 14/

There are 2 states-- Indiana and Colorado-- that didn't permit rate increases to all go to the silver plan. There are a few I don't know.15/

If they don't change-- these 9 states are ones where plans could pull out or consumers could pay more. 16/

To summarize:
1- Trump chose to do this, didn't have to
2- Did it at a time to create most damage
3- if insurers leave, hurts everyone 17/

Summary-
4- Taxpayers definitely get hurt. The deficit gets worse.
5- Bad 4 middle income buyers
6- Bad 4 competition 18/

On an ongoing basis this just makes insurance more expensive, unless Congress addresses (payment reduces premiums & the deficit. 19/

There is a sideshow ? of if this gets addressed by Congress, but his has been long enough so will hit that later but I will say this...20/

This is a problem of Trump's making & effects his constituents the most.

Don't expect the Dems to give him a Mexico wall to fix this. 21/