Donald Trump's decision to end a provision of the Affordable Care Act that benefited roughly 6 million Americans will do the most harm to many of the people responsible for his victory. Approximately 70 percent of individuals benefiting from cost-sharing subsidies live in states carried by Trump in November.
Key moderate Republican Susan Collins, who voted against the Obamacare repeal every step of the way despite intense pressure from her party, urged Trump on Sunday to back a bipartisan Senate effort to shield consumers from rising premiums after his abrupt decision to halt federal payments to insurers. Collins called the move "disruptive" and an immediate threat to access to health care.
"What the president is doing is affecting people's access and the cost of health care right now," said Collins of Maine, who has cast pivotal votes on health care in the narrowly divided Senate. "This is not a bailout of the insurers. What this money is used for is to help low-income people afford their deductibles and their co-pays."
"Congress needs to step in and I hope that the president will take a look at what we're doing," she added.
Her comments reflected an increasing focus Sunday on the bipartisan Senate effort led by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to at least temporarily reinstate the payments to avoid immediate turmoil in the insurance market, even as Trump signaled he wouldn't back a deal without getting something he wants in return.
The payments will be stopped beginning this week, with sign-up season for subsidized private insurance set to start Nov. 1.
"The president is not going to continue to throw good money after bad, give $7 billion to insurance companies unless something changes about Obamacare that would justify it," said Sen. Lindsey Graham, R-S.C., who golfed with Trump Saturday at the Trump National Golf Club in Sterling, Virginia.
"It's got to be a good deal," Graham said.
In his decision last week, Trump derided the $7 billion in subsidies as bailouts to insurers and suggested he was trying to get Democrats to negotiate and agree to a broader effort to repeal and replace former President Barack Obama's health care law, a bid that repeatedly crashed in the GOP-run Senate this summer.
The payments seek to lower out-of-pocket costs for insurers, which are required under Obama's law to reduce poorer people's expenses — about 6 million people. To recoup the lost money, carriers are likely to raise 2018 premiums for people buying their own health insurance policies.
Alexander and Murray have been seeking a deal that the Tennessee Republican has said would reinstate the payments for two years. In exchange, Alexander said, Republicans want "meaningful flexibility for states" to offer lower-cost insurance policies with less coverage than Obama's law mandates.
Still, congressional Republicans are divided over that effort. White House budget director Mick Mulvaney has suggested that Trump may oppose any agreement unless he gets something he wants — such as a repeal of Obamacare or funding of Trump's promised wall on the U.S.-Mexico border.
On Sunday, House Minority Leader Nancy Pelosi, D-Calif., described Trump's demand for a sit-down with congressional Democratic leaders as "a little far down the road." She noted the bipartisan effort in the Senate and said ultimately it will be up to a Republican-controlled Congress and executive branch whether the federal government can avert a shutdown by year's end.
The government faces a Dec. 8 deadline on the debt limit and government spending.
"We're not about closing down government. The Republicans have the majority," Pelosi said. "In terms of the health care, we're saying 'Let's follow what Sen. Murray and Alexander are doing."
Collins praised the Senate effort so far, which included public hearings by the Senate health and education committee. Still, she acknowledged a potentially tough road in reaching broader agreement.
"I hope we can proceed, but Democrats will have to step up to the plate and assist us," said Collins, who is a member of the committee. "It's a two-way street."
The scrapping of subsidies would affect millions more consumers in states won by Trump last year, including Florida, Alabama and Mississippi, than in states won by Democrat Hillary Clinton. Nearly 70 percent of the 6 million who benefit from the cost-sharing subsidies are in states that voted for the Republican.
Republican Gov. John Kasich of Ohio said Sunday his state had anticipated that the insurer payments would be halted but not so quickly. He called for the payments to be reinstated right away, describing a hit to Ohio — a state also won by Trump last November — for at least the "first two or three months."
"Over time, this is going to have a dramatic impact," Kasich said. "Who gets hurt? People. And it's just outrageous."
Nineteen Democratic state attorneys general have announced plans to sue Trump over the stoppage. Attorneys generals from California, Kentucky, Massachusetts and New York were among those saying they will file the lawsuit in federal court in California to stop Trump's attempt "to gut the health and well-being of our country."
Collins appeared on ABC's "This Week" and CNN's "State of the Union," Pelosi also spoke on ABC, Graham appeared on CBS' "Face the Nation," and Kasich was on NBC's "Meet the Press."