David Nather asked-- and answered-- an interesting question over at Axios yesterday, namely Who loses if Trump cuts off health insurer payments? The answer is the map. The darker the color, the worse off the inhabitants of the state. And, obviously, worst off are folks in the Trump-backing states of the Old Confederacy plus the GOP political hellholes of Idaho and Utah. If Trump decides to cut off subsidies to the poorest Americans who are getting healthcare through the Affordable Care Act this is what ensues:
• Insurers have to keep providing the subsidies anyway-- they just won't be reimbursed. That's why they'd respond by raising premiums for next year by as much as another 20%.• In Iowa, Medica-- the last ACA insurer standing-- says it would raise its premiums another 12% to 20% for next year if the payments end, per the Des Moines Register.• About 5.9 million people get the subsidies-- about 57% of everyone who's enrolled in ACA private insurance coverage, according to the Centers for Medicare and Medicaid Services.• They're heavily concentrated in red states, and especially in the south, as you can see from this map by our visuals editor, Lazaro Gamio. (We ran this map back in April, and now that the payments are under threat again, we thought it was time for an encore.)• The move would end up costing the federal government more money, rather than saving money, because the ACA tax credits would adjust to cover the higher premiums. The Kaiser Family Foundation predicts a net increase of $2.3 billion in federal costs next year.• But anyone who doesn't qualify for the tax credits would have to eat the extra costs.• The White House will point out, correctly, that Congress didn't fund the payments and that it could end the uncertainty at any time by doing so.• Now that the repeal bill-- which would have funded the payments for two years-- has collapsed, most Republicans won't want to provide the funding on its own. But some are reluctantly acknowledging they may have no choice. "I think we're going to have to do that," Senate Finance Committee chairman Orrin Hatch told Reuters.
Maine isn't among the very worst off if Trump pulls the plug-- but close. And, as you know, the state's senior senator, Susan Collins played a pivotal role in stopping TrumpCare dead in its tracks. Yesterday there was a big pro-Collins rally in downtown Lewiston, over in a Trumpier part of the state than solidly blue Portland. The background noise in her TrumpCare role is about her running for governor. A poll in the Bangor Daily News yesterday indicates strong enthusiasm for her.But that doesn't include any support from Trump's local hitman, current Maine governor Paul LePage. According to reporter Michael Shepherd at the same newspaper, "LePage looks to be leading a Republican civil war against U.S. Sen. Susan Collins’ 2018 gubernatorial bid before anyone’s sure she’ll declare one and as she sits at the center of the national health care debate. The governor railed against the moderate Republican senator at a Saturday pig roast put on by the Somerset County Republican Committee in Canaan, where an attendee said LePage repeatedly mentioned working to defeat Collins if she runs for governor next year." Trump appears to be afraid of Collins for some weird reason and he has the deranged LePage doing his dirty work for him.
[Collins] has said she’d make a decision on running by the fall. Few in Maine politics are certain she’ll declare one besides LePage, who said in a Thursday radio interview that he thinks she’s planning on it.“If the Republican base-- which is the 290,000 people that voted for me (in his 2014 re-election)-- tell her, ‘We don’t want you; you’re not winning the primary,’ she’ll back down,” he said in a video provided by the attendee at the Canaan event under conditions of anonymity.That line got some applause from the crowd of Republican diehards who love LePage, whose political ascent began with a 2010 primary win over six opponents. But years of polling data indicate that his push at Collins might not resonate much outside his sphere of loyal conservative supporters.LePage, who scored an approval rating of 47 percent in the latest round of state-by-state polling from Morning Consult, has a far more limited base than Collins, who may be Maine’s most popular politician, regularly registering approval ratings in the mid- to high-60s. A 2014 poll during her last re-election campaign saw her pulling more support from Democrats than from Republicans.But Collins has always maintained relationships to party loyalists by helping lower-level politicians win elections. LePage is no exception to that.Days before the 2014 election where both were up for re-election, Collins showed up at LePage’s Blaine House food drive, was greeted with a hug and said she had unwavering support for the governor and praised him for “his emphasis on jobs and the economy.”Their relationship has soured since the 2016 election. LePage became an early Trump endorser in February 2016, while Collins said she wouldn’t support Trump that August. After Trump won Maine’s 2nd Congressional District and the election, he said she was “done in Maine.”In April, Collins gave a radio interview where she weighed her options for 2018, saying her goal would be to “heal the state” if she ran, a likely jab at LePage’s divisive tenure. After that, LePage said he didn’t know her well enough to know whether she’d be a good governor.LePage’s former health and human services commissioner, Mary Mayhew of South China, is the only Republican in the gubernatorial race so far.Mayhew led LePage’s opposition to Medicaid expansion, while Collins suggested in June that Maine consider following Indiana’s conservative approach to expansion under the federal health care law. Mayhew was in Washington ear li er this month pushing for repeal of the Affordable Care Act.LePage’s position on various Republican Obamacare repeal efforts changed alongside their proposals. In March, he opposed a House bill for not going far enough in scaling back the current law, but he supported it after changes were made, including a quicker Medicaid expansion phase-out.He also told reporters at the White House in June that he opposed a Senate bill because it didn’t go far enough. Later that day, he released a statement saying he generally supported repeal efforts. That bill failed and was different than the “skinny repeal” bill considered in the key vote Friday.Mayhew and Collins could be the official foils if the senator gets in, but as he always seems to be in Maine politics, LePage will be front and center in any battle that materializes.
Last night, LePage attacked both Collins and Maine's other senator, Angus King (I) in a Wall Street Journal OpEd for their opposition to TrumpCare. "When it comes to providing affordable health care to the people of Maine, Sens. Susan Collins and Angus King are worse than out of touch-- they are downright dangerous," he wrote. "Sadly, this is no surprise from senators who are more comfortable cutting deals in the polished marble corridors of Washington than meeting with Mainers struggling to make ends meet... Ms. Collins and Mr. King have ignored these ideas, since they are more interested in preening for the cameras than in making real progress. Though they seem unwilling to deliver on their promises of better care, at least they have given Mainers a clear sense of their priorities."