Tag Archives: Obamacare

Maryland judge to weigh Obamacare case

FILE PHOTO: A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake/File Photo

By Sarah N. Lynch

(Reuters) – Days after a judge in Texas declared that the Obamacare healthcare law is unconstitutional, Maryland’s Democratic attorney general on Wednesday will pursue his request that another judge rule the opposite way.

The lawsuit brought by Maryland Attorney General Brian Frosh also seeks to challenge President Donald Trump’s appointment of Matthew Whitaker as acting attorney general, another bone of partisan contention.

Frosh is asking U.S. District Judge Ellen Hollander in Baltimore to declare that the 2010 health law, known as the Affordable Care Act, is lawful in a bid to counter attempts by the Trump administration to undermine it.

Hollander will weigh the Whitaker claim along with the government’s motion to dismiss the case on the grounds that Maryland does not have legal standing to bring the case.

On Friday, a judge in Texas ruled that the entire healthcare law was unconstitutional following revisions to the tax code by the Republican-controlled Congress last year, which removed the tax penalty for failing to buy health insurance. Trump, who has worked for years to undermine Obamacare, on Twitter called the Texas judge’s decision “a great ruling for our country.”

The Texas judge ruled in favor of 20 states, including Texas.

The original lawsuit by the 20 states prompted Maryland to sue the federal government over then-U.S. Attorney General Jeff Sessions’ refusal to defend the portions of the Obamacare law being challenged in Texas.

Trump forced Sessions out of office in early November and named Whitaker to replace him as acting attorney general.

In response to that, Maryland asked Judge Hollander to issue an injunction barring Whitaker from serving, saying his appointment violated both the Constitution and a federal law that governs the line of succession at the Justice Department.

Then on Dec. 7, Trump nominated William Barr to become attorney general on a permanent basis. He would replace Whitaker, pending Senate review, likely in early 2019.

Maryland has asked Hollander to issue a declaratory judgment upholding Obamacare’s constitutionality.

If Hollander rules on whether Obamacare is constitutional, her decision could potentially be at odds with the decision in Texas. That could create a conflict among lower courts of the sort the U.S. Supreme Court often likes to tackle.

(Reporting by Sarah N. Lynch; Editing by Kevin Drawbaugh and James Dalgleish)

U.S. House gives final approval to tax bill, delivers victory to Trump

President Trump celebrates with Congressional Republican on the South Lawn of the White House.

By David Morgan and Amanda Becker

WASHINGTON (Reuters) – The Republican-controlled U.S. House of Representatives gave final approval on Wednesday to the biggest overhaul of the U.S. tax code in 30 years, sending a sweeping $1.5 trillion tax bill to President Donald Trump for his signature.

In sealing Trump’s first major legislative victory, Republicans steamrolled opposition from Democrats to pass a bill that slashes taxes for corporations and the wealthy while giving mixed, temporary tax relief to middle-class Americans.

The House approved the measure, 224-201, passing it for the second time in two days after a procedural foul-up forced another vote on Wednesday. The Senate had passed it 51-48 in the early hours of Wednesday.

“We are making America great again,” Trump said, echoing his campaign slogan at a White House celebration with Republican lawmakers. “Ultimately what does it mean? It means jobs, jobs, jobs.”

Trump, who emphasized a tax cut for middle-class Americans during his 2016 campaign, said at an earlier Cabinet meeting that lowering the corporate tax rate from 35 percent to 21 percent was “probably the biggest factor in this plan.”

It was uncertain when the bill would be signed. White House economic adviser Gary Cohn said the timing depended on whether automatic spending cuts triggered by the legislation could be waived. If so, the president will sign it before the end of the year, he said.

The administration expects the waiver to be included in a spending resolution Congress will pass later this week, a White House official told reporters.

BUSINESS FRIENDLY

In addition to cutting the U.S. corporate income tax rate to 21 percent, the debt-financed legislation gives other business owners a new 20 percent deduction on business income and reshapes how the government taxes multinational corporations along the lines the country’s largest businesses have recommended for years.

Millions of Americans would stop itemizing deductions under the bill, putting tax breaks that incentivize home ownership and charitable donations out of their reach, but also making tax returns somewhat simpler and shorter.

The bill keeps the present number of tax brackets but adjusts many of the rates and income levels for each one. The top tax rate for high earners is reduced. The estate tax on inheritances is changed so far fewer people will pay.

Once signed, taxpayers likely would see the first changes to their paycheck tax withholdings in February. Most households will not see the full effect of the tax plan on their income until they file their 2018 taxes in early 2019.

In two provisions added to secure needed Republican votes, the legislation also allows oil drilling in Alaska’s Arctic National Wildlife Refuge and removes a tax penalty under the Obamacare health law for Americans who do not obtain health insurance.

“We have essentially repealed Obamacare and we’ll come up with something that will be much better,” Trump said.

Democrats were united in opposition to the tax legislation, calling it a giveaway to the wealthy that will widen the income gap between rich and poor, while adding $1.5 trillion over the next decade to the $20 trillion national debt. Trump promised in 2016 he would eliminate the national debt as president.

“PILLAGING”

“Today the Republicans take their victory lap for successfully pillaging the American middle class to benefit the powerful and the privileged,” House Democratic leader Nancy Pelosi said.

Opinion polls show the tax bill is unpopular with the public and Democrats promised to make Republicans pay for their vote during next year’s congressional elections, when all 435 House seats and 34 of the 100 Senate seats will be up for grabs.

“Republicans will rue the day they passed this bill,” Senate Democratic leader Chuck Schumer told reporters. “We are going to continue hammering away about why this bill is so unpopular.”

U.S. House Speaker Paul Ryan defended the bill, saying support would grow for after it passes and Americans felt relief. “I think minds are going to change,” Ryan said on ABC’s “Good Morning America” television program.

A few Republicans, a party once defined by fiscal hawkishness, have protested the deficit-spending encompassed in the bill. But most voted for it anyway, saying it would help businesses and individuals while boosting an already expanding economy they see as not growing fast enough.

In the House, 12 Republicans voted against the tax bill. All but one, Walter Jones of North Carolina, were from the high-tax states of New York, New Jersey and California, which will be hit by the bill’s cap on deductions for state and local taxes.

Despite Trump administration promises that the tax overhaul would focus on the middle class and not cut taxes for the rich, the nonpartisan Tax Policy Center, a think tank in Washington, estimated middle-income households would see an average tax cut of $900 next year under the bill, while the wealthiest 1 percent of Americans would see an average cut of $51,000.

The House was forced to vote again after the Senate parliamentarian ruled three minor provisions violated arcane Senate rules. To proceed, the Senate deleted the three provisions and then approved the bill.

Because the House and Senate must approve the same legislation before Trump can sign it into law, the Senate’s late Tuesday vote sent the bill back to the House.

Graphic: Republican tax bill’s tax brackets and rates – http://tmsnrt.rs/2BJnrIV

Graphic: U.S. debt level since 1950 – http://reut.rs/2B3Yl3C

(Reporting by David Morgan and Amanda Becker; Additional reporting by Richard Cowan, Roberta Rampton, Gina Chon and Susan Heavey; Writing by John Whitesides; Editing by Jeffrey Benkoe and Bill Trott)

Nearly 1.5 million people signed up for Obamacare plans so far: officials

Nearly 1.5 million people signed up for Obamacare plans so far: officials

WASHINGTON (Reuters) – More than 800,000 people signed up for Obamacare individual health insurance plans in the second week of open enrollment, U.S. government health officials said on Wednesday, bringing the total number of sign-ups to nearly 1.5 million so far.

There is particular scrutiny of how Affordable Care Act programs are faring after a year in which President Donald Trump has sought to undermine Obamacare, especially after his fellow Republicans in Congress failed to pass legislation to repeal and replace the law.

More people have signed up for Obamacare plans in the first two weeks of 2018 open enrollment than in the same time period last year, and the sign-ups include about 345,000 new consumers, according to the latest figures from the U.S. Centers for Medicare and Medicaid Services.

But the Trump administration halved the 2018 open enrollment period to six weeks, slashed the Obamacare advertising budget by 90 percent and cut funding for groups that help people enroll in Obamacare insurance, so it is still unclear whether there will be the same level of participation as in years past.

The Congressional Budget Office has forecast that 11 million people will buy plans in 2018, 1 million more than were enrolled in 2017.

Republicans, who control the White House, Senate and U.S. House of Representatives, failed this summer to push through legislation to overturn the 2010 law, former Democratic President Barack Obama’s top domestic policy achievement.

Repealing Obamacare has long been a goal of Republicans and it was one of Trump’s main election campaign promises. Frustrated by inaction in Congress, the president has taken steps through executive and regulatory actions to undercut the law, and has promised to let the healthcare program “implode.”

Republicans including House Speaker Paul Ryan have said they will try again next year to repeal the law, which has extended health insurance coverage to 20 million more Americans but which has long been seen by Republicans as costly government overreach.

The Senate this week added a repeal of Obamacare’s individual mandate, the requirement that most Americans purchase health insurance or else pay a penalty, to its version of an overhaul of the U.S. tax code that is working its way through Congress.

(Reporting by Yasmeen Abutaleb; Editing by Frances Kerry)

Senate Finance chairman revises tax plan to end Obamacare mandate

Senate Finance chairman revises tax plan to end Obamacare mandate

WASHINGTON (Reuters) – The head of the U.S. Senate Finance Committee proposed major changes to a Republican tax reform plan, adding a repeal of Obamacare’s health insurance mandate and making corporate tax cuts permanent while ending individual cuts in 2025.

In a statement late on Tuesday, committee chairman Orrin Hatch said the proposed changes would also slightly lower some individual tax rates and includes a repeal of the alternative minimum tax but only through 2025, when it would be reinstated.

The 226-page amendment comes as the Senate continues to craft its version of tax reform alongside the U.S. House of Representatives, which is finalizing its own bill. The two plans must be reconciled and merged into a final plan that can pass both chambers before it goes to President Donald Trump to sign into law.

Republicans, who control Congress and the White House but have yet to pass any major legislation, are eager for a legislative victory ahead of the 2018 midterm elections and are pushing hard to pass tax cuts by the end of the year.

It was not immediately clear how many of Hatch’s colleagues will support the plan in the Senate, where Republicans hold a slimmer 52-48 majority than in the House.

Democrats have dismissed the Republican plans as giveaways to corporations and the wealthy that would swell the nation’s deficit. If Democrats remain united in opposition, Republicans cannot lose more than two senators from their ranks and still have enough votes to pass tax legislation.

The inclusion of the healthcare provision, however, could add to the uncertainty, given that Republicans earlier this year failed to make good on their pledge to repeal and replace former President Barack Obama’s 2010 healthcare overhaul.

Hatch’s changes would end one of the more unpopular provisions in Obama’s Affordable Care Act that require Americans to obtain health insurance or pay a penalty. The nonpartisan Congressional Budget Office estimated that the change would increase the number of uninsured by 13 million people by 2027.

“By scrapping this unpopular tax from an unworkable law, we not only ease the financial burdens already associated with the mandate, but also generate additional revenue to provide more tax relief to these individuals,” Hatch said in a statement.

But several key moderate Republicans, including Senators Susan Collins and John McCain, expressed uncertainty on Tuesday over tying the tax bill to the healthcare provision details.

Hatch’s plan would also expand access to deductions for so-called “pass-through” businesses and increase the child tax credit to $2,000 from the earlier proposed $1,650, Hatch said. The current tax credit for children is $1,000.

(Reporting by David Alexander; Editing by Jeffrey Benkoe)

Maine governor will not expand Medicaid, ignoring voters

Maine governor will not expand Medicaid, ignoring voters

By Gina Cherelus

(Reuters) – Maine Republican Governor Paul LePage said on Wednesday he will not expand the state’s Medicaid program under Obamacare, ignoring a ballot initiative widely backed by voters, calling it “ruinous” for the state’s budget.

Maine looked set to become the first state in the nation to expand Medicaid by popular vote.

About 60 percent of voters in Maine approved the ballot proposal in Tuesday’s election, according to the Bangor Daily News newspaper.

Republicans in Washington have failed several times to pass legislation that would dismantle former President Barack Obama’s signature healthcare law.

LePage said he will not implement the expansion until it is fully funded by the Maine legislature.

“Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget,” LePage said in a statement. “I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled.”

LePage said a previous Medicaid expansion in Maine in 2002 had created $750 million in debt to hospitals and took resources away from vulnerable people.

Maine has been prominent in the nation’s healthcare debate. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare. Collins did not immediately respond to a request for comment on LePage’s decision.

Maine voters were asked to approve or reject a plan to provide healthcare coverage under Medicaid for adults under age 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

If implemented, about 70,000 additional state residents would be eligible for the Medicaid program, local media reported, in addition to the roughly 268,000 people who are currently eligible.

(Reporting by Gina Cherelus in New York; Editing by Daniel Wallis and Jeffrey Benkoe)

Voters in Maine approve expansion of Medicaid under Obamacare

Voters in Maine approve expansion of Medicaid under Obamacare

By Brendan O’Brien

(Reuters) – Voters in Maine on Tuesday approved a ballot initiative to expand the state’s Medicaid program under Obamacare, sending a clear signal of support for the federal healthcare law to lawmakers in the state and Washington D.C.

The approval of the ballot question in Maine comes after Republicans in Washington failed several times over the last few months to pass legislation that would dismantle the Affordable Care Act, former President Barack Obama’s signature healthcare law.

Maine has recently figured prominently in the nation’s debate on how to reform healthcare. U.S. Senator Susan Collins, a moderate Republican from Maine, helped block her party’s efforts to repeal Obamacare this year, which angered President Donald Trump.

Maine, which becomes the first U.S. state to approve Medicaid expansion by ballot initiative, is one of 19 states that has not expanded Medicaid under the Affordable Care Act.

About 60 percent of voters in Maine approved the ballot initiative, according to the Bangor Daily News newspaper.

Tuesday’s ballot asked Maine voters to approve or reject a plan to provide healthcare coverage under Medicaid for adults under the age of 65 with incomes at or below 138 percent of the federal poverty level, which in 2017 is about $16,000 for a single person and about $22,000 for a family of two.

The state’s Republican governor, Paul LePage, staunchly opposes expansion of federal health care insurance, vetoing legislation to do so on several occasions.

“I’ve said it before, “free” is very expensive to somebody,” LePage said in a radio address last week.

About 70,000 residents in Maine would be eligible for the state’s Medicaid program when and if state officials certify the results of the election. Lawmakers could vote to repeal or alter the referendum, much like they have recently for several citizen-initiated referendums, the Bangor Daily News reported.

“It is now the responsibility and the duty of the governor and the legislature to fully and faithfully implement this law,” the state’s Speaker of the House, Sara Gideon, said in a statement.

The Legislature’s Office of Fiscal and Program Review in Maine estimated that expansion of Medicaid would cost the state about $55 million and bring in about $525 million of federal money to the state each year, according to the Bangor Daily News.

(Reporting by Brendan O’Brien in Milwaukee; Editing by Nick Macfie)

Iowa pulls request to opt out of Obamacare requirements

Iowa pulls request to opt out of Obamacare requirements

By Susan Cornwell

(Reuters) – Iowa on Monday withdrew a request to waive some Obamacare rules to help shore up its struggling healthcare insurance market, marking a setback in efforts by Republican-governed states to sidestep requirements of the Obama-era law.

With open enrollment for the Affordable Care Act – better known as Obamacare – set to start in just over a week, the state announced it would no longer wait to hear if federal officials would approve its request aimed at cutting individual healthcare insurance premiums and widening coverage.

The withdrawal prompted a leading U.S. Senate Republican to urge Congress to approve a bipartisan fix to Obamacare, which President Donald Trump has vowed to scrap.

Iowa was viewed as a test case by some for other states that submitted similar, if far less-reaching, waivers and of how the Trump administration would respond to such requests.

Iowa Governor Kim Reynolds said the law had not been flexible enough to accommodate the state’s request.

“Ultimately, Obamacare is an inflexible law that Congress must repeal and replace,” the governor said in a statement, adding that premiums under Obamacare had increased by 110 percent for Iowans since 2013.

Iowa sought the waiver after its individual healthcare marketplace shrank to only one insurer for next year, Minnesota-based Medica.

Some of the state’s requests were similar to provisions included in Republican repeal and replace bills this year. For instance, the waiver sought to replace Obamacare’s income-based tax credits with flat age-based credits and eliminate insurer payments that Trump cut off earlier this month.

Senator Lamar Alexander, Republican of Tennessee, said the move by Iowa demonstrated the need for repairs to Obamacare that he and Democratic Senator Patty Murray have proposed aimed at stabilizing insurance markets. It would also provide states more flexibility in reshaping some parts of Obamacare.

Trump has sent mixed signals over whether he would support the bipartisan fix. Senate Majority Leader Mitch McConnell said on Sunday that he was willing to bring up the proposal for a vote but needed to know where Trump stood.

Alexander said the bipartisan repair proposal would allow the federal government to approve Iowa’s waiver.

Alexander told reporters that the Congressional Budget Office, a nonpartisan scorekeeper, would soon announce its analysis of the bipartisan repair legislation, possibly on Tuesday.

(Reporting by Susan Cornwell,; additional reporting by Yasmeen Abutaleb and Amanda Becker in Washington; Editing by Andrew Hay)

Obamacare whiplash leaves states, insurers with dueling price plans

FILE PHOTO: U.S. President Donald Trump smiles after signing an Executive Order to make it easier for Americans to buy bare-bone health insurance plans and circumvent Obamacare rules at the White House in Washington, U.S., October 12, 2017. REUTERS/Kevin Lamarque/File Photo

By Caroline Humer

NEW YORK (Reuters) – President Donald Trump’s reversals in the past week on maintaining Obamacare subsidies to insurers are sowing new confusion over what kind of health insurance will be available to consumers, and at what price, when enrollment for 2018 begins in two weeks.

Trump said last week his administration would stop paying billions of dollars in subsidies that help insurers give discounts to low-income households, one of several moves to dismantle the signature healthcare law of his Democratic predecessor, Barack Obama.

Since then, Trump has alternately supported, and dismissed, an effort by Republican and Democratic senators that would reinstate the subsidies for two years, until a broader replacement to the 2010 Affordable Care Act, commonly known as Obamacare, can be negotiated.

“We are worried that consumers on (Obamacare) plans will be confused by all the back and forth and proposed policy changes and that this will cause them to not seek out assistance,” said Bryna Koch, special projects coordinator at the Arizona Center for Rural Health, which helps consumers choose and sign up for individual health plans offered under Obamacare.

Trump, who promised during his election campaign to repeal and replace Obamacare, which he has called a “disaster,” has said the subsidies amount to a bailout for insurance companies.

By law, health insurers must still offer the discounts on deductibles, co-pays and other out-of-pocket costs, even if the government stops reimbursing them. Insurers say they do not profit from the subsidies.

Anticipating Trump’s move, insurers proposed higher prices on monthly premiums in 2018 to recoup the money. In all but a handful of states, they submitted two sets of premium rates – a lower rate to use if the subsidies remained, and a higher rate to use if the funding was cut.

LAST WORD ON SUBSIDIES?

The fate of the subsidies remained in limbo on Thursday. A senior White House aide said that Trump would demand steps toward repealing Obamacare in any healthcare legislation, comments that cast doubt on the prospects for the bipartisan effort to shore up insurance markets.

A California court is expected to consider on Monday a request by Democratic attorneys general to keep the subsidies flowing until a legal challenge to Trump’s decision is resolved.

If the funding is not restored when 2018 enrollment opens on Nov. 1, many consumers will see premium rates that are on average 20 percent higher than they would have been otherwise.

Even before Trump’s decision on the subsidies, the Congressional Budget Office said the Republican president’s policies to roll back Obamacare enrollment efforts would lead to 4 million fewer people signing up for insurance in 2018 than previously forecast. The CBO still expects 11 million people to sign up for next year – an increase from this year’s enrollment of 10 million.

The federal government has already halted a subsidy payment to the insurance industry for October. But leading insurers are not yet sure whether that is the last word.

Anthem Inc Chief Executive Officer Joseph Swedish told Reuters he could not yet predict how ending the subsidies or restating them through “potential congressional action” would affect pricing next year. Anthem has submitted premium rates that account for the subsidies being cut.

Should the subsidies be restored at any time after Nov. 1, insurers may be able to revert to the lower monthly premium rates, or provide rebates for consumers.

“A midyear change in premiums would be highly unusual, but this would be the right thing to do,” said Marc Harrison, CEO of Intermountain Healthcare, a Utah-based health plan and hospital chain. “Intermountain Healthcare would pursue this.”

Washington state’s insurance regulator said it would allow insurers to change rates as soon as practical – even the next month – if lawmakers reinstate the funding, an approach backed by the National Association of Insurance Commissioners. But that could run up against federal government objections.

The Affordable Care Act does not allow for changes to premium rates after they have been finalized, an official for the U.S. Department of Health and Human Services said. At the same time, the administration is working to approve higher rates in several states that did not take into account Trump’s cut in subsidies for 2018.

(Additional reporting by Yasmeen Abutaleb in Washington; Editing by Michele Gershberg and Peter Cooney)

U.S. Senate backers of Obamacare deal seek support but prospects unclear

U.S. Senate backers of Obamacare deal seek support but prospects unclear

By Yasmeen Abutaleb and Richard Cowan

WASHINGTON (Reuters) – Proponents of a bipartisan deal struck by two U.S. senators to stabilize Obamacare sought on Wednesday to win Republican support for the measure, which would restore subsidies to health insurers that President Donald Trump has scrapped.

With 2018 health insurance markets facing potential chaos, Republican Senator Lamar Alexander and Democratic Senator Patty Murray were hoping to build broad support for a short-term fix for former President Barack Obama’s signature healthcare law.

Their proposal would meet some Democratic objectives, such as reviving subsidies for Obamacare and restoring $106 million in funding for a federal program that helps people enroll in insurance plans.

In exchange, Republicans would get more flexibility for states to offer a wider variety of health insurance plans while maintaining the requirement that sick and healthy people be charged the same rates for coverage.

The Trump administration said last week it would stop paying billions of dollars to insurers to help cover out-of-pocket medical expenses for low-income Americans, part of the Republican president’s effort to dismantle the 2010 Affordable Care Act, known as Obamacare.

Trump and other Republicans have disparaged the payments to insurers as a “bailout” but the president on Tuesday indicated support for the efforts by Alexander and Murray as a one- or two-year fix while work continues to unwind the law.

While the two senators’ proposal has broad Democratic support, it is unclear how many Republicans will endorse it and whether Senate Majority Leader Mitch McConnell and House of Representatives Speaker Paul Ryan will allow a vote on the plan.

It also remained unclear how fully Trump supported the plan and whether he would sign it into law.

Republican Senator Susan Collins, a moderate who helped kill earlier efforts to repeal and replace the healthcare law, said she backed efforts to shore up Obamacare, but that it remained unclear if there would ultimately be enough support.

“Now, the White House is sending conflicting messages,” she told CNN in an interview on Wednesday, adding that the insurer payments had been “mischaracterized” as a boon for the industry.

Collins said she did not know if McConnell would schedule a vote but that “if it comes to the floor, I think the votes are there.” She said it also could win House approval if Trump “reiterates his support.”

Republicans, describing Obamacare as ineffective and a massive government intrusion in a key sector of the economy, have sought for seven years to repeal and replace it. Scrapping the law was also a top Trump campaign pledge. But the party, which has controlled the White House and Congress since January, has so far failed to make good on its promise.

Democrats have fought to defend Obamacare, which extended health insurance to 20 million Americans.

(Reporting by Yasmeen Abutaleb; Editing by Peter Cooney and Bill Trott)

U.S. states sue to block Trump Obamacare subsidies cut

U.S. President Donald Trump smiles after signing an Executive Order to make it easier for Americans to buy bare-bone health insurance plans and circumvent Obamacare rules at the White House in Washington, U.S., October 12, 2017. REUTERS/Kevin Lamarque TPX IMAGES OF THE DAY

By Yasmeen Abutaleb and Dan Levine

WASHINGTON/SAN FRANCISCO (Reuters) – Eighteen U.S. states sued President Donald Trump’s administration on Friday to stop him from scrapping a key component of Obamacare, subsidies to insurers that help millions of low-income people pay medical expenses, even as Trump invited Democratic leaders to negotiate a deal.

One day after his administration announced plans to end the payments next week, Trump said he would dismantle Obamacare “step by step.”

His latest action raised concerns about chaos in insurance markets. The subsidies cost $7 billion this year and were estimated at $10 billion for 2018, according to congressional analysts.

“As far as the subsidies are concerned, I don’t want to make the insurance companies rich,” Trump told reporters at the White House. “They’re making a fortune by getting that kind of money.”

Trump’s action took aim at a critical element of the 2010 law, his Democratic predecessor Barack Obama’s signature domestic policy achievement. Frustrated by the failure of his fellow Republicans who control both houses of Congress to repeal and replace Obamacare, Trump has taken several steps to chip away at it.

Democrats accused Trump of sabotaging the law.

Democratic attorneys general from the 18 states as well as Washington, D.C., filed a lawsuit in federal court in California later on Friday. The states include: California, Connecticut, Delaware, Kentucky, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia and Washington state.

The states will ask the court to force Trump to make the next payment. Legal experts said the states were likely to face an uphill battle in court.

“His effort to gut these subsidies with no warning or even a plan to contain the fallout is breathtakingly reckless,” New York Attorney General Eric Schneiderman said. “This is an effort simply to blow up the system.”

The new lawsuit would be separate from a case pending before an appeals court in the District of Columbia in which 16 Democratic state attorneys general are defending the legality of the payments.

If the subsidies vanish, low-income Americans who obtain insurance through Obamacare online marketplaces where insurers can sell policies would face higher insurance premiums and out-of-pocket medical costs. It would particularly hurt lower-middle-class families whose incomes are still too high to qualify for certain government assistance.

About 10 million people are enrolled in Obamacare through its online marketplaces, and most receive subsidies. Trump’s action came just weeks before the period starting on Nov. 1 when individuals have to begin enrolling for 2018 insurance coverage through the law’s marketplaces.

The administration will not make the next payment to insurers, scheduled for Wednesday, U.S. Attorney General Jeff Sessions said.

Senate Democratic leader Chuck Schumer expressed optimism about chances for a deal with Republicans to continue the subsidy payments.

“We’re going to have a very good opportunity to get this done in a bipartisan way” during negotiations in December on broad federal spending legislation, “if we can’t get it done sooner,” Schumer told reporters.

Trump offered an invitation for Democratic leaders to come to the White House, while also lashing out at them. “We’ll negotiate some deal that’s good for everybody. But they’re always a bloc vote against everything. They’re like obstructionists,” Trump told reporters.

The Senate failed in both July and September to pass legislation backed by Trump to repeal Obamacare due to opposition by a handful of Republican senators. One of them, Susan Collins, a moderate Republican from Maine who had been contemplating running for governor next year, on Friday said she planned to remain in the Senate and would use her voice in reforming the healthcare system.

SHARES OF INSURERS, HOSPITALS FALL

Hospitals, doctors, health insurers, state insurance commissioners and patient advocates decried Trump’s move, saying consumers will ultimately pay the price. They called on Congress to appropriate the funds needed to keep up the subsidy payments.

Shares of U.S. hospital companies and health insurers closed down on Friday after the subsidies announcement. Centene Corp <CNC.N> closed down 3.3 percent and Molina Healthcare <MOH.N> closed down 3.4 percent. Among hospital shares, Tenet Healthcare <THC.N> finished 5.1 percent lower and Community Health Systems <CYH.N> declined 4.0 percent.

The nonpartisan Congressional Budget Office has estimated that erasing the subsidies would increase the federal deficit by $194 billion over the next decade because the government still would be obligated under other parts of Obamacare to help lower-income people pay for insurance premiums.

Trump, who as a candidate last year promised to roll back the law formally called the Affordable Care Act, received applause for his latest action during an appearance on Friday before a group of conservative voters.

“It’s step by step by step, and that was a very big step yesterday,” Trump said. “And one by one, it’s going to come down, and we’re going to have great healthcare in our country.”

Earlier on Twitter he called Obamacare “a broken mess” that is “imploding,” and referred to the “pet insurance companies” of Democrats.

Republicans for seven years had vowed to get rid of Obamacare, but deep intra-party divisions have scuttled their efforts to get legislation through the Senate, where they hold a slim majority.

Since taking office in January, Trump threatened many times to cut the subsidies. Health insurers that planned to stay in the Obamacare market prepared for the move in many states by submitting two sets of premium rates to regulators: with and without the subsidies.

The National Association of Insurance Commissioners said the change would drive up premium costs for consumers by at least 12 to 15 percent in 2018 and cut more than $1 billion in payments to insurers for 2017.

The White House announced the cut-off just hours after Trump signed an order intended to allow insurers to sell lower-cost, bare-bones policies with limited benefits and consumer protections.

Republicans have called Obamacare an unnecessary government intrusion into the American healthcare system. Democrats have said the law needs some fixes but noted that it had brought insurance to 20 million people.

(Additional reporting by Lawrence Hurley, Justin Mitchell, Steve Holland, Makini Brice, Jeff Mason and Susan Heavey in Washington, Megan Davies in New York, Brendan O’Brien in Milwaukee, and Divya Grover in Bengaluru; Writing by Will Dunham; Editing by Lisa Von Ahn and Leslie Adler)