Trump appears to back further away from bipartisan health-care push

President Donald Trump appeared to distance himself further from a bipartisan Senate health-care effort Wednesday, warning against "bailing out" insurance companies.

"I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co's who have made a fortune w/ O'Care," Trump wrote on Twitter. He was referring to Sen. Lamar Alexander, R-Tenn., who forged a deal with Sen. Patty Murray, D-Wash., that was released Tuesday and was greeted by ample GOP skepticism.

The president's tweet Wednesday was his latest conflicting statement about the Alexander-Murray plan.

The compromise would authorize payments to health insurers that help millions of lower-income Americans afford coverage in exchange for granting states greater flexibility to regulate health coverage under the Affordable Care Act.

Trump ended the payments, known as CSRs, last week, arguing that they were illegal because they were not explicitly authorized under the ACA. He left it to Congress to decide whether to fund them.

Initially, on Tuesday, Trump said the Alexander-Murray proposal would "get us over this intermediate hump" and allow Republicans to later revisit efforts to aggressively undo the ACA. But later Tuesday, he was noticeably cooler to the idea, saying, "I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies."

Alexander, who has repeatedly emphasized that he had been empowered by the president to forge the agreement, said in an interview that Trump did not close the door to the deal in a phone call Wednesday morning.

"He told me that he wanted to encourage me but that he will review it, as I would expect a president to do," the senator said. "He may want to add something to it. It may come up as part of the end-of-the-year negotiations. We'll see."

Although Trump has repeatedly described cost-sharing payments as a "bailout" to insurers, the money directly covers the discounts that low-income Americans covered under the Affordable Care Act receive for deductibles and other out-of-pocket costs. This group includes about 7 million Americans earning up to 250 percent of the federal poverty level.

Insurers are obligated to provide the discounts, which totaled about $7 billion this year and are estimated to reach $10 billion next year, even if the federal payments are cut off. According to the National Association of Insurance Commissioners, Trump's decision last week to end the subsidies will cost insurance carriers more than $1 billion this year.

Facing the prospect for months that the Trump administration would cut off the payments, most insurers have opted to factor this shortfall into their 2018 premium rates for all their customers. The cutoff in cost-sharing payments has translated into premium increases of 12 percent to 20 percent, according to several analyses.

Speaking to reporters in the Cabinet Room on Wednesday, Trump praised Alexander's efforts, saying, "If something can happen, that's fine, but I won't do anything to enrich the insurance companies."

"They've been enriched by Obamacare like nothing anybody's ever seen before," the president added.

In a tweet Wednesday, Alexander suggested that he may tweak the language of the proposal to address Trump's concerns that insurers would benefit from the cost-sharing reduction payments.

"He and I absolutely agree that CSRs should benefit consumers and not insurance companies," Alexander tweeted. "The Alexander-Murray agreement has strong language to do that, and I will work with the president to see if we can make it even stronger."

Trump's increasing skepticism puts him in line with congressional Republicans, many of whom are not championing the plan. Senate Majority Leader Mitch McConnell, Ky., did not mention it in a speech opening Senate business Wednesday morning. On Tuesday, McConnell said he hadn't "had a chance to think about the way forward yet."

Key House Republicans have been outright hostile.

"None of our guys voted for Obamacare," Rep. Tom Cole, Okla., a close ally of House GOP leaders, said in an interview Tuesday. "They're not very interested in sustaining it."

But Democratic leaders have been supportive of the blueprint. Speaking on the Senate floor Wednesday, Minority Leader Charles Schumer, N.Y., who discussed the prospect of a bipartisan deal with Trump less than two weeks ago, railed against the president for his about-face.

"The president doesn't know what he's talking about," Schumer said of Trump's suggestion that legislation authorizing the subsidies amounted to an industry bailout. "It helps people who are sick and need health care. It keeps their premiums low."

The minority leader described the commander in chief as someone who constantly shifts positions and expresses a willingness to broker deals with Democrats but then is reined in by conservative Republicans.

"This president keeps zigging and zagging," Schumer said, noting that Trump had reassured him and Alexander that he was open to a compromise that would keep the payments flowing. "Our only hope is maybe tomorrow, he'll be for this bill."

The Alexander-Murray bill would authorize CSR payments for two years. Those payments help offset deductibles and other out-of-pocket costs for low-income consumers who obtain insurance through the law; critics of Trump's decision to halt CSR payments said eliminating the subsidies would cause insurers to back out of marketplaces across the country.

The framework would also allow insurers to offer catastrophic insurance plans to consumers age 30 and older on ACA exchanges, while maintaining a single risk pool. It would shorten the period for federal review of state waiver applications, expedite review for states in emergency circumstances and those with waiver proposals that have already been approved for other states, and allow governors to approve state waiver applications rather than requiring state legislative approval.

On Wednesday, a major patients' rights group, the American Cancer Society Cancer Action Network, endorsed the new bipartisan proposal even as it cautioned that it would monitor whether the new flexibility it offered could raise health-care costs in some instances.

"This deal offers important, immediate action to stabilize the individual insurance market," said the group's president, Chris Hansen. "Restoring $106 million per year in outreach and education programming would help to reduce public confusion over the law and ensure more people who need health coverage get it."

The Washington Post's John Wagner and Jordan Frasier contributed to this report.