On Wednesday night and early Thursday morning, President Trump injected a new and to some puzzling argument into the debate over the effort to fund the government through the end of the fiscal year and the need to continue paying health insurance companies subsidies under the Affordable Care Act. Specifically, he started tweeting about Puerto Rico.
The Caribbean island, a U.S. territory that is home to 3.5 million natural-born American citizens, hadn’t been one of the major issues in a fight over whether the government would shut down when the current spending resolution expires after Friday. The big sticking points had been whether Democrats would concede Trump funding for his border wall, and whether Trump would agree to continue funding risk-sharing payments that compensate insurers for underwriting policies for their most expensive customers.
Things seemed to be moving toward a solution on Wednesday. The administration had dropped its insistence on funding for the border wall, and the White House was assuring Democrats that the subsidies would continue to be paid. Politicians and pundits alike were confident that there would be no government shutdown. Congress would pass a one-week continuing resolution before nailing down a final spending bill for the rest of 2017.
But then came Trump on Wednesday evening, rage-tweeting at Democrats about aid to Puerto Rico.
Democrats are trying to bail out insurance companies from disastrous #ObamaCare, and Puerto Rico with your tax dollars. Sad!— Donald J. Trump (@realDonaldTrump) April 26, 2017
And again on Thursday morning.
The Democrats want to shut government if we don't bail out Puerto Rico and give billions to their insurance companies for OCare failure. NO!— Donald J. Trump (@realDonaldTrump) April 27, 2017
He appeared to be reacting to reports that negotiators in Congress had been working on a deal to provide funding to help prop up Puerto Rico’s failing Medicaid system. Health and Human Service Secretary Tom Price had reported to the Senate on Wednesday that the system will need an infusion of about $900 million from the federal government in order to continue providing services through June of 2018.
The territory’s troubled Medicaid system was one of the elements of its government that was not touched by legislation passed last year by Congress to help Puerto Rico dig itself out of an extraordinary hole of debt. The legislation granted the territory relief from creditors’ lawsuits, which expires at the end of this month. It also created an avenue for the territory to file for bankruptcy, something many expect it could be forced to do.
While the law passed last year didn’t touch Medicaid, it wasn’t because there were no problems to fix. Congress had already stepped in with extra funding when the Affordable Care Act was passed in 2010, but regulators have been warning about the system’s continued financial weakness. Now they say as many as a million Puerto Ricans are in danger of losing their health care if it collapses.
Under federal rules, the island does not receive the same kind of Medicaid funding as U.S. states. While there are no limits on payments for states under the federal matching assistance percentage guidelines, there is a cap on funding for Puerto Rico. This is partially because of the structure of the territory’s health care delivery system, which has a large state-run component.
Despite Trump’s tweets, it’s not clear that Democrats have threatened to walk away from a spending deal if funding for Puerto Rico isn’t included. And it’s not clear they’re the only ones pushing for it in the first place. Support for funding the island’s Medicaid program at levels more similar to U.S. states’ has bipartisan support in Congress.
In a letter to Senate Majority Leader Mitch McConnell earlier this week, Florida senators Marco Rubio and Ben Nelson, a Republican and a Democrat, respectively, urged support for the measure and warned that the territory is “facing a Medicaid cliff that will have far-reaching consequences for both the island and the continental United States.” Other members of Congress from both parties also support providing relief to the island’s Medicaid system.
If Trump, for whatever reason, decides that he won’t sign a spending bill that includes funding for Puerto Rico -- and his thundering “NO!” in this morning’s tweet suggests that’s what he’s thinking -- he could find himself in a fight with more than just Democrats.