After nearly the entire Iowa GOP establishment had been sucking up to him for more than a year, President Donald Trump instructed the head of the Centers for Medicare and Medicaid Services to deny our state’s request for a waiver designed to shore up the individual health insurance market.
Trump’s intervention reflects his contempt not only for the thousands who stand to lose insurance coverage, but also for Iowa Republican leaders who have promoted, defended, and enabled him.
The Washington Post’s Juliet Eilperin dropped this bombshell scoop last night.
Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no. […]
It was a Wall Street Journal article about Iowa’s request that provoked Trump’s ire, according to an individual briefed on the exchange. The story detailed how officials had just submitted the application for a Section 1332 waiver — a provision that allows states to adjust how they are implementing the ACA as long as they can prove it would not translate into lost or less-affordable coverage.
Iowa’s aim was to foster more competition and better prices. The story said other states hoping to stabilize their situations were watching closely.
Trump first tried to reach Price, the individual recounted, but the secretary was traveling in Asia and unavailable. The president then called Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the agency charged with authorizing or rejecting Section 1332 applications. CMS had been working closely with Iowa as it fine-tuned its submission.
Responding to the Washington Post story, the Iowa Insurance Division’s spokesperson told the Des Moines Register’s Tony Leys that regulators are “still hoping to get approval soon” for the “stopgap” plan. The president has been known to change his mind abruptly, so perhaps he won’t insist on CMS officials following his August directive.
Still: the news underscores Trump’s commitment to making “Obamacare” fail, even if his sabotage causes some 20,000 Iowans to lose insurance coverage in 2018.
Eilperin’s reporting also reveals an embarrassing fact: Iowa’s top Republicans have no clout with this president.
Governor Kim Reynolds has repeatedly said the stopgap plan is her top priority. She personally raised the issue with Trump during his June visit to Iowa. She pushed for approval while meeting with top federal administrators in July. She described the plan favorably in exclusive comments to the Trump-aligned Breitbart website last month.
Senators Joni Ernst and Chuck Grassley also have been lobbying for CMS to approve the waiver. Ernst vouched for Trump’s national security credentials during a high-profile speech at the Republican National Convention. She invited the presidential nominee to headline her “Roast and Ride” fundraiser and stuck with him after the release of a videotape on which he bragged about assaulting women.
Grassley has been making excuses for Trump all year, normalizing his decision to fire the FBI director and helping him deflect the growing evidence of Russian collusion with his presidential campaign.
None of it mattered. Trump read a Wall Street Journal article and felt compelled to stop Iowa from taking steps to stabilize the insurance market.
Meanwhile, the Environmental Protection Agency is moving forward with obscure rule changes that would weaken the Renewable Fuel Standard and, in turn, Iowa’s biofuels industry. Only weeks ago, Trump called Grassley, ostensibly to reassure him that he’s pro-ethanol. Shortly before the 2016 Iowa caucuses, Governor Terry Branstad helped Trump by trashing his main rival, Ted Cruz, specifically over federal policy on ethanol.
Republican Party of Iowa chair Jeff Kaufmann has riled up many a crowd with high-decibel praise for Trump, on one occasion scolding a GOP senator who had dared to criticize Dear Leader.
“We had Sen. Ben Sasse from Nebraska, he crosses the Missouri River, and in that sanctimonious tone talks about what he doesn’t like about Donald Trump,” Kaufmann said. “You know what, Sen. Sasse? I really don’t care what you like. We love Donald Trump. And if you don’t love him, I suggest you stay on your side of the Missouri River.”
At this writing, Kaufmann has not spoken about his beloved president’s efforts to undermine our state’s insurance market. Reynolds and Grassley released statements indicating they are still working to get the stopgap plan approved, with no comment on Trump working against that goal. Imagine their sustained outrage if a Democratic president told a bureaucrat to reject Iowa’s waiver request.
I will update this post as needed, but my guess is Trump’s Iowa apologists will try to pretend that August phone call from the White House to CMS never happened.
UPDATE: Representative David Young (IA-03) tap-danced around the issue during the October 6 edition of Iowa Public Television’s “Iowa Press” program.
Young: Well, every state is almost in a corner on this right now. I’m hopeful that the administration will move sooner rather than later at making a decision. I hope it’s favorable. Iowans, folks from different states, the leaders, the governors, the insurance commissioners, they need to have certain flexibilities and some autonomy in dealing with their populations, their different innovations in each state on how you deliver health care. But we need to act on this. Both sides of the aisle have come down to the conclusion that the current law is not stabilized and it’s not working and I think states have a role in this. And if the administration is balking on this for political expediency I don’t think that’s right.
[Kathie] Obradovich: Not just balking, there have been allegations that the administration is actively undermining and if they were to deny this waiver that that might be an example of that. Do you feel like that’s going on?
Young: It has been a slow walk and it’s time to speed up. I hope it has not been undermined. It’s time to act because people are suffering. Where do those 72,000 people in Iowa go if they don’t have access to the individual insurance market?
Kathie Obradovich sought comment from several prominent Republicans:
Republican Party of Iowa Chairman Jeff Kaufmann’s response to the Washington Post article blamed Obamacare for Trump’s apparent efforts to undermine the program and accelerate its collapse.
“Democrats created Obamacare. Democrats own Obamacare. Obamacare is failing Iowans, collapsing right before our eyes, and no matter how much they try to deflect blame, they own this abysmal failure. Period,” Kaufmann said in a written statement. […]
Regarding Iowa’s waiver request, [Ernst] suggested Trump’s attitude could be discounted in light of his displeasure over the GOP’s failure to repeal Obamacare.
“I think the president’s disappointed that we weren’t able to do anything on the overall repeal-replace with Obamacare and so I think again, that it was just an immediate reaction to something that he heard and I don’t put any stock, necessarily, in that,” Ernst said in a phone interview on Friday. “I want to see what the actions are.”
For an Iowa Republican senator to say she puts little stock in the president’s words is rather extraordinary.
Several readers objected that the stopgap plan is bad policy, so the decision to reject it would be correct on the merits. Along these lines, Seth Chandler argued at Forbes, “Many ACA proponents are terming the denial of the waiver request as yet another example of ‘sabotage’ of that law. And, yet, nothing could be further from the truth. It was Iowa who sought to sabotage the ACA with its waiver plan.”
My point here was not to advocate for the stopgap plan–only to observe that Iowa Republican loyalty to Trump has delivered nothing. During her October 10 press conference, Reynolds said she has “asked for a conversation” with Trump on this issue.
“We were actually on the phone yesterday, my team was, talking with (Centers for Medicare and Medicaid Services Administrator) Seema Verma about the stopgap proposal and where we’re at and what we need to do,” Reynolds said Tuesday. “So our indication is they’ve been very receptive. They continue to work with us.”
Some experts have speculated that middle-income Iowans may sue to block the stopgap plan, because it would “eliminate protections against excessive out-of-pocket spending.” Brianne Pfannenstiel reported for the Des Moines Register on October 10, “Reynolds brushed off concerns about a lawsuit, saying people often disagree with public policy.”
Not so fast, governor. Abby Goodnough reported for the New York Times the same day,
Mr. [Timothy] Jost and other supporters of the law say Iowa’s proposal does not meet the requirements for so-called innovation waivers, including that the coverage they provide must be at least as comprehensive and affordable as Obamacare plans, because poorer people would face higher deductibles and other out-of-pocket costs. That, they say, leaves the plan open to almost-certain legal challenges.
Seemingly acknowledging that problem, Mr. Ommen has tweaked Iowa’s proposal – including with a supplemental filing to the Trump administration on Thursday [October 5] – to preserve subsidies that reduce out-of-pocket costs for roughly 21,000 low-income Iowans.
Meanwhile, Trump’s Environmental Protection Agency administrator, Scott Pruitt, announced on October 9,
“I would do away with these incentives that we give to wind and solar,” he said, referring to wind’s production tax credit and solar’s investment tax credit.
“I’d let them stand on their own and compete against coal and natural gas and other sources, and let utilities make real-time market decisions on those types of things as opposed to being propped up by tax incentives and other types of credits that occur, both in the federal level and state level,” he continued.
OCTOBER 16 UPDATE: Your unintentional comedy for the day is this news release from the governor’s office.
Gov. Reynolds sends letter to President Trump; expresses “deep concern” about EPA direction on RFS
(DES MOINES) – Gov. Kim Reynolds sent a letter to President Donald Trump on Monday expressing her deep concern about the direction the Environmental Protection Agency (EPA) appears to be taking on the Renewable Fuel Standard (RFS). Three Midwestern governors, Kansas Gov. Sam Brownback, Missouri Gov. Eric Greitens and South Dakota Gov. Dennis Daugaard, signed on to Gov. Reynolds’ letter.
“Two weeks ago, the EPA requested comment on whether it should further reduce the total, advanced and biomass-based diesel volumes beyond the recently proposed (and ill-advised) cuts to the 2019-19 RFS volumes,” Gov. Reynolds said. “This action is concerning and runs counter to the president’s repeated commitment to the RFS and rural America. The stated purpose of the RFS is to grow demand for biofuels—to push the industry to innovate—and I encourage the EPA to remember that when finalizing the volume levels.
“There’s no question there are ample American feedstocks and U.S. capacity to justify a much larger biodiesel number under the law,” she continued. “The RFS revitalized our rural communities, bringing jobs and hope. Every 500 million gallons of increased biodiesel production support roughly 16,000 good-paying jobs in rural America.”
Gov. Reynolds has long championed biofuels, along with all renewable fuel sources. She recently testified in Washington, D.C., before the EPA about the RFS. Click here to read her testimony.
Click here to read the letter to President Trump.
Trump doesn’t care about the governor’s “deep concern.” He already got what he wanted out of Iowa’s Republican establishment.