Idaho's Obamacare customers will face an average 27 percent premium increase next year because of too many sick customers.

The state's insurance regulator announced the final rates Friday. The announcement comes as many states are grappling with double-digit rate increases for a variety of reasons that include a sicker-than-expected population and questions about whether the federal government will continue to pay insurer subsidies.

Idaho's silver plans, which are the most popular of Obamacare's three plan options, will rise an average 40 percent. The premiums for the lowest tier bronze plans will increase 8 percent, and gold plans 9 percent.

Idaho pegged the increase to higher medical claims for insurers on the individual market, which includes Obamacare's exchanges and is used by people who don't get insurance through work. It showed that claims for 2016 totaled $563 million, but the state's six insurers brought in only $494 million in premiums.

"Large rate increases may be needed when the prior year's premiums is not sufficient to pay for health claims and administrative costs and fees," Idaho's insurance regulator said.

The regulator does not approve the final rates. It can decide if the rate increases are reasonable, though.

Idaho is far from the only state facing double-digit premium increases. Florida's insurance regulator expects rates to increase by nearly 45 percent, and Utah 39 percent, according to the Salt Lake Tribune.

Major contributors to the rate increases have been risk pools without enough healthy people to offset high claims from sicker customers, uncertainty around whether insurer subsidies will be paid by the federal government and the looming health insurance tax being reinstated next year.

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President Donald Trump is reaching out to Democrats to see if they "want to do a great HealthCare Bill" after Republicans have failed so far to fulfill their yearslong promise to repeal and replace the Obama health law.

Trump tweeted that he called Senate Democratic leader Chuck Schumer on Friday. The president says the Obama health law "is badly broken, big premiums. Who knows!"

The president has suggested earlier that he'd be open to negotiating with Democrats on health care.

But there have been no clear signs of a compromise between Republicans who've wanted to scrap the Affordable Care Act since it became law in 2010, and Democrats who want to protect it.

The day after the Republicans decided against bringing the Graham-Cassidy healthcare bill to the floor for a vote in late September, Trump outlined several potential paths forward on healthcare. One suggestion was to work with Democrats to pass a bill by early 2018.

"I'm also going to meet with Democrats and see if we can get a health care plan that's even better," said the president at the time. "So I will negotiate with Democrats."

It's unclear what sort of plan Trump would pursue with Democrats, Business Insider's Bob Bryan reported earlier. 

It could be a stabilization package for the Obamacare exchanges, similar to one that was being developed by GOP Sen. Lamar Alexander and Democratic Sen. Patty Murray — before Republican leaders scrapped the plan. It could also be a broader package to help correct some of the issues with Obamacare. 

Reporting for the Associated Press by Ken Thomas.

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WASHINGTON (Reuters) - US President Donald Trump said on Saturday he would be open to a one- or two-year deal as a way to reform the nation's healthcare system, as his administration and the Republican Party have vowed to do.

"So if we could do a one-year deal or two-year deal as a temporary measure, you’ll have block granting ultimately to the states, which is what Republicans want," Trump told reporters at the White House.

Republicans fell short several times this year in their drive to repeal Obamacare, formally known as the Affordable Care Act, a promise they had campaigned on for seven years.

Trump has been frustrated by the failure, openly taunting Republicans as “total quitters” and “fools” this summer over their inability in the Senate to replace former President Barack Obama's signature legislation.

(Reporting by Valerie Volcovici; Writing by Yara Bayoumy; Editing by Bill Rigby)

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• The Trump administration is taking unilateral steps that could lead to the demise of the Affordable Care Act's individual insurance markets.
• It comes as repeal efforts have failed at the legislative level repeatedly this year.
• Most studies show these exchanges have stabilized, but Trump's actions 

It will be months before the Republican Party can take another legislative whack at repealing and replacing the Affordable Care Act. But the Trump administration has continued to take steps to undermine the law.

President Donald Trump repeatedly asserted in the months before and after his election that Obamacare markets were collapsing on their own.

Most studies, however, have showed that the Obamacare exchanges were stabilizing — and that insurers participating in the market were seeing a turnaround. But the Trump administration's recent moves, in the face of the failed repeal effort, could undermine these markets and make Trump's prediction about their demise come to fruition.

Open enrollment

The Department of Health and Human Services recently moved to significantly reduce the length of the Obamacare open enrollment period later this year. Instead of the typical three months for people to get insurance through the exchanges, there will only be a six-week open enrollment session in 2017 — cutting the time in half.

HHS also dramatically reduced the budget for Obamacare outreach programs that helped to drive enrollment for exchange plans. The department will spend $10 million on advertising for open enrollment, compared with $100 million last year. Additionally, the budget for navigators — groups that assist people in enrolling or reenrolling for exchange plans — plunged to $36 million from $62.5 million last year.

Vox's Sarah Kliff also found that many of the navigator groups did not receive funding when the prior year's money expired on September 1. Many groups went over a week with no funding and were forced to lay off employees as a result. Even when money did arrive, Kliff reported, some groups saw their grant amounts sliced by as much as 98%.

Even before the latest developments, the Trump administration yanked a significant portion of a $5 million ad buy for the end of open enrollment in January 2017. According to enrollment figures, a significant slowdown in enrollment ensued in the two weeks after the administration pulled the ads, though it is difficult to make a causal connection.

Even smaller moves, like scheduling significant maintenance for the Healthcare.gov platform during the shortened open enrollment period, suggests the Trump administration is trying to destabilize the marketplaces, experts say.

Together, the moves are likely to lead to lower enrollment, especially among younger and healthier people that are necessary to keep down costs in the marketplace, said Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation.

"There's little question that cutting back on outreach and advertising will result in more people uninsured," Levitt told Business Insider. "Those who fail to sign up will be healthier than average, which will cause the risk pool to deteriorate and premiums to rise. This is not a signal that the administration is trying to make the law succeed."

Cost-sharing reduction payments

The Trump administration has also continued to toy with the critical so-called cost-sharing reduction (CSR) payments, which help offset costs to insurers that offer plans with low out-of-pocket costs to poorer Americans.

The Trump administration has been doling out the payments on a month-to-month basis without providing a long-term plan. If Trump were to end the payments, insurers have said they would be forced to significantly increase their costs, though the degree to which this would destabilize the individual marketplace is a source of debate.

The payments are also the subject of a lawsuit between the House of Representatives and the executive branch. The Republican-controlled House sued the Obama administration, arguing that the CSRs bring funded by the executive branch was illegal.

A judge sided with the House in 2016, and the Obama administration appealed the ruling. Trump could drop the appeal or decide to end payments due to the lawsuit (though some states could step in to defend the case), adding another layer of uncertainty for insurers.

The combined concern over the future of CSR payments has already been cited by insurers as a reason for increased 2018 exchange premiums.

New rules

In the wake of the failed push on the Graham-Cassidy healthcare legislation in the Senate, Trump floated ideas for two new executive orders designed to go around Congress and allow him to act unilaterally.

One of the two orders Trump referenced would allow people in the individual market to group together and purchase group insurance. As BuzzFeed's Paul McLeod laid out Friday, that process could cherry-pick healthy people out of the exchange market into these association plans, leaving a sicker pool of people on the exchanges.

Much like the impact of the open enrollment tweaks, more sick people would lead to higher costs and larger premium increases.

State interference

The administration has also made moves to try to prevent some states from attempting to stabilize the health law.

In Minnesota, the Republican-controlled legislature and Democratic governor both agreed to institute a new reinsurance program to help shore up their Obamacare markets. To do so, the state submitted a 1332 waiver, a request that if approved allows states to modify their exchanges to help reduce costs as long as it remains inside the law's rules.

It was stymied by the Department of Health and Human Services and the Trump administration, Dayton charged in a heated letter late last month.

"Unfortunately, Minnesota's experience with its 1332 Waiver application has been the opposite; it has been nightmarish," Dayton wrote in the letter on September 20. "Despite repeated verbal assurances that our waiver application would be approved in August, and even though the deadline for 2018 rate-setting is fast approaching, we have still not received the formal approval upon which our entire state reinsurance program, at the insistence of CMS, depends."

Oklahoma went as far as to pull their waiver request due to what they said was interference from the administration. A letter from Oklahoma Secretary of Health and Human Services Terry Cline cited a "federal department promise" that the waiver was going to be approved on September 25 — but ultimately was not.

"While we appreciate the work of your staff, the lack of timely waiver approval will prevent thousands of Oklahomans from realizing the benefits of significantly lower insurance premiums in 2018," wrote Terry Cline, the Oklahoma health secretary.

And a similar issue popped up in Iowa, where the Republican-led government's waiver request was denied, according to The Washington Post, even though it contained many reforms the GOP favored in its legislative push. The Post reported that Trump himself told HHS to deny the waiver. 

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President Donald Trump on Tuesday tweeted he that he would "use the power of the pen" to make unilateral changes to the Affordable Care Act.

According to The Wall Street Journal's Louise Radnofsky, Stephanie Armour, and Anna Wilde Mathews, Trump is expected to sign an order allowing the use of association health plans and short-term insurance plans. The order is expected to include broad language instructing various departments to look at ways to reduce insurance costs.

Association health plans allow people in the individual or small group markets to pool together to purchase insurance at a more favorable rate. According the the report, these plans will also not be subject to certain Obamacare regulations, helping make them even cheaper for people participating.

In addition, the order is expected to instruct the Labor Department to look into allowing the sale of these insurance plans across state lines. Trump has long espoused the idea of selling insurance across state lines, but there are doubts about how effective it would be in actually bringing down costs.

Short-term insurance plans are cheap but cover little. The Affordable Care Act prevents people from buying these plans for more than 90 days, but the new order could allow people to purchase them for up to a year.

Both executive orders appear to be targeted at allowing healthier, younger people to obtain lower-cost options than what is currently available in the Obamacare exchanges.

But experts say the order could leave behind older and sicker people currently are getting insurance through the Obamacare markets.

"Loosely regulated association plans could charge lower premiums to healthy people, effectively leaving ACA marketplaces as high-risk pools," tweeted Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan health policy think tank.

Levitt continued: "With this executive order healthy people could pay less for insurance, but middle-income people with pre-existing conditions pay more."

That means healthier people would rely on the cheaper, deregulated plans allowed under the new rules. Since sicker people would need more generous plans, they would likely remain in the more regulated Obamacare exchanges.

As the percentage of sick people in the exchanges increases, it would be more costly for insurers in that market. And as costs increase, so too would the prices insurers charge in the exchanges.

With the collapse of the Republican attempts to repeal and replace Obamacare, Trump signaled over the last few weeks that he would consider executive actions to reshape the insurance market as well as potential bipartisan deals.

The president held a call with Senate Minority Leader Chuck Schumer last week, tweeted about the call and a possible healthcare deal on Saturday morning, and then reiterated the possibility of a deal to reporters as he departed the White House for an event in North Carolina on Sunday.

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President Donald Trump thinks there is only one person to blame for any problems with the law known as Obamacare: the man after whom the law is informally named.

In an interview with Forbes, Trump pinned any problems with the Affordable Care Act squarely on President Barack Obama's shoulders. That's despite the current administration's actions that analysts say have helped destabilize the law.

When asked by Forbes' Randall Lane if he should be trying to fix Obamacare to make it better, Trump said he was trying to "keep it afloat, because it's failing."

"I mean the insurance companies are fleeing and have fled. They fled before I got here. But with that being said, no, Obamacare is Obama's fault. It's nobody else's fault," he said.

In the nearly nine months since Trump took office, however, his administration has taken numerous steps that analysts say have undermined any sense of stability for the law's individual insurance exchanges.

The administration has taken moves like threatening to end cost-sharing reductions payments, denying states waivers to adopt their own measures to fix problems, and cutting funding for Obamacare sign-up programs by tens of millions of dollars.

Insurance companies have repeatedly cited uncertainty in Washington as a reason to pull out from Obamacare markets or raise premiums in 2018.

It's unclear whether Trump's pinning of blame on Obama will resonate. According to an August poll from the Kaiser Family Foundation, a nonpartisan health policy think tank, 60% of Americans said they believe Trump and Republicans are responsible for any problems with Obamacare going forward. Just 28% say the responsibility lies with Obama and Democrats.

"Yes. But I've always said Obamacare is Obama's fault," Trump said. "It's never going to be our fault."

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President Donald Trump on Tuesday used former Secretary of State Henry Kissinger as a misleading example of rising healthcare premiums.

"We're going to have to do something on Obamacare because it is failing," Trump told reporters in the Oval Office. "Henry Kissinger does not want to pay 116% increase in his premiums, but that's what's happening and it's actually getting worse."

Trump appeared to be citing the statistic for the average increase between 2016 and 2017 in premium costs for a plan purchased on the Obamacare individual insurance exchange in Arizona, which was 116% before subsidies were included.

Kissinger, however, likely has not experienced financial stress from the healthcare law. For one, Kissinger lives in New York, where Obamacare premiums increased 16.6% on the individual exchange last year.

Kissinger, 94, is also on Medicare — the government sponsored insurance program for older Americans. While there were some changes to Medicare under Obamacare, Trump's concerns about the exchanges have nothing to do with the program.

In addition to the statement about Kissinger, Trump reiterated that he plans to roll out a series of healthcare-related executive orders in the coming days that would allow for association health plans and other modified types of insurance.

"I'll also be signing something probably this week which is going to go a long way to take care of so many of the people that have been so badly hurt on healthcare," Trump said.

Incidentally, most health policy experts predict that older Americans and those with health conditions, like Kissinger, could face higher costs under Trump's planned executive orders.

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The White House announced Thursday night that President Donald Trump would end cost-sharing-reduction payments, a move that could wreck the Affordable Care Act's individual insurance exchanges and send healthcare costs soaring for many Americans.

"Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare," the White House said in a statement. "In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments."

The payments were introduced by the ACA to help offset the cost to insurers of offering affordable plans to poor Americans. Insurers have repeatedly warned that if the payments were cut off, they would be forced to raise premiums to make up the financial loss.

After multiple failures by Republicans to pass legislation to overhaul the US healthcare system, Trump has pursued measures to undermine the stability of the ACA, the landmark healthcare law also known as Obamacare.

The CSR payments have long been disputed. The Republican-controlled House of Representatives sued the Obama administration in 2014, arguing the payments were illegal since they were being appropriated by the executive branch instead of Congress, which never authorized them.

A federal court ruled in favor of the House, but the Obama administration appealed the ruling, allowing the payments to continue. The Trump administration has kicked the can down the road on the appeal and appropriated the payments on a monthly basis, attempting to use them as leverage in multiple negotiations with Democrats.

In August, a federal judge ruled that 17 states and the District of Columbia could continue the lawsuit even if the Trump administration pulled out of the appeal since the end of the payments would directly affect residents. This could allow the payments to continue despite the announced decision to end them.

Democrats have repeatedly sought to appropriate the payments through congressional action, most recently in bipartisan talks between Republican Sen. Lamar Alexander, the chairman of the Senate Committee on Health, Education, Labor, and Pensions, and the ranking member of that committee, Democratic Sen. Patty Murray.

House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer decried Trump's actions in a statement released minutes after the decision was announced.

"Sadly, instead of working to lower health costs for Americans, it seems President Trump will single-handedly hike Americans' health premiums," they said. "It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America. Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it."

Many Republicans have resisted the idea of Congress appropriating the payments, but some moderate GOP members think it is necessary to maintain stability in the insurance exchanges.

"Cutting health care subsidies will mean more uninsured in my district," Republican Rep. Ileana Ros-Lehtinen tweeted, adding that the president "promised more access, affordable coverage," but that this would do the opposite.

House Speaker Paul Ryan applauded the decision on procedural grounds, saying the method of appropriating the payments through the executive branch was illegal.

"Today's decision by the Trump administration to end the appeal of that ruling preserves a monumental affirmation of Congress's authority and the separation of powers," Paul said in a statement. "Obamacare has proven itself to be a fatally flawed law, and the House will continue to work with Trump administration to provide the American people a better system."

How much ending the payments could destabilize the exchanges is a subject of debate. Some health-policy experts have said that without the payments, the individual insurance exchanges could be devastated as insurers leave and premiums skyrocket. The nonpartisan Congressional Budget Office, however, has found that while the move would cause some pain in the short term for the exchanges, they would eventually find their footing.

Earlier Thursday, Trump signed an executive order to allow two types of healthcare plans that would let people skirt some Obamacare regulations — a move he said was designed to undermine the healthcare law. Experts have said that the introduction of these plans could increase costs for sicker Americans.

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Top Democrats scolded President Donald Trump on Thursday night after the White House announced the president would end cost-sharing reduction payments, a crucial subsidy designed to help low-income people afford health insurance.

The CSR payments were introduced by the Affordable Care Act to offset the cost to insurers that offer affordable plans to poor Americans. Without the subsidy, which Congress never authorized and which Republicans have called illegal, insurers would most likely raise premiums.

House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer decried the move in a joint statement Thursday night. "Sadly, instead of working to lower health costs for Americans, it seems President Trump will single-handedly hike Americans' health premiums," they said.

Pelosi and Schumer called the move a "spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America."

"Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it," they said.

It is Trump's latest attempt to dismantle the ACA, the healthcare law better known as Obamacare. Trump earlier Thursday signed an executive order calling for the introduction of lower-cost, loosely regulated health plans, a move designed to unravel Obamacare. The president's moves follow months of failed attempts by the Republican-controlled Congress to agree on a replacement for Obamacare, a key campaign promise of Trump's.

Trump has publicly bristled over his party's repeated failure to get a healthcare bill to his desk and has previously threatened to take unilateral steps to undermine President Barack Obama's signature legislative achievement.

Read the Schumer-Pelosi statement in full below:

"Sadly, instead of working to lower health costs for Americans, it seems President Trump will single-handedly hike Americans' health premiums. It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America. Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.

"President Trump has apparently decided to punish the American people for his inability to improve our health care system. Trumpcare collapsed because Americans overwhelmingly recognized the cruelty and higher costs it meant for them and their loved ones. Now, millions of hard-working American families will suffer just because President Trump wants them to.

"If these reports are true, the President is walking away from the good faith, bipartisan Alexander-Murray negotiations and risking the health care of millions of Americans."

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President Donald Trump is inviting congressional Democrats to "call me to fix" America's healthcare system, as he prepares an order ceasing federal subsidy payments to health insurers.

In a predawn post on his Twitter account Friday, the president reiterated his oft-stated argument that "Obamacare is imploding."

Addressing Democrats, he tweeted that "massive subsidy payments to their pet insurance companies has stopped," adding: "Dems should call me to fix!"

Since his presidential campaign and nearly nine months in office, Trump has persistently called for getting rid of the Affordable Care Act, the 2010 Obama-era healthcare law. His fellow Republicans joined him in that cause, but neither Trump nor the GOP has been able to muster sufficient strength to get a repeal bill through the Senate.

In a brash move likely to roil insurance markets, Trump says he will "immediately" halt payments to insurers under the ACA, which he has been trying to unravel for months.

The Department of Health and Human Services made the announcement in a statement late Thursday. "We will discontinue these payments immediately," said the acting health and human services secretary, Eric Hargan, and the Medicare administrator, Seema Verma. Sign-up season for subsidized private insurance starts November 1, in less than three weeks, with about 9 million people currently covered.

In a separate statement, the White House said the government could not legally continue to pay the so-called cost-sharing reduction subsidies because they lack a formal authorization by Congress.

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• The Trump administration is ending so-called cost-sharing reduction payments under the Affordable Care Act.
• The payments were critical for insurers to help offset the cost of providing insurance to low-income Americans.
• Their end brings with it a cascade of effects on the federal budget deficit, individuals' health insurance, and more.

Late Thursday evening in Washington DC, the Trump administration announced it would end so-called cost sharing reduction (CSR) payments under the Affordable Care Act.

The payments helped to offset costs for insurers to provide low income Americans plans with a lesser burden of out of pocket payments. The CSR payments also were the subject of a lawsuit between the Republican-controlled House and the Obama administration.

The House argued that the executive branch was illegally appropriating the funds, and a lower court agreed in 2016. The Obama administration, however, appealed the ruling which allowed the CSR payments to be made.

The Trump administration maintained the payments for months but said Thursday it can't lawfully continue to make the payments since they are not appropriated by Congress.

The move adds another layer of uncertainty to Obamacare's individual insurance markets. It also could have major effects on the federal deficit, insurers' decisions to stay in the Obamacare market, and the political landscape of healthcare.

Costs to consumers, insurers and the government

Insurers are still mandated buy law to provide lower out-of-pocket costs. So they will almost certainly increase premiums to offset the loss of the cost sharing payments.

According to a study from the Kaiser Family Foundation, a nonpartisan health policy think tank, premiums would likely rise 19% to compensate for the loss of funding. A report from the Congressional Budget Office projected an increase of 20% next year.

The increase would likely not be passed directly to consumers, however, since most of the more than 10 million people on the exchanges already receive subsidies from the government to offset the costs of premiums. According to the Department of Health and Human Services, around 70% of people on the exchanges pay less than $75 per month for insurance.

That means the higher premiums could force the federal government to adjust the amount of subsidies people receive, increasing the financial burden on the government. The CBO predicted that the federal deficit would increase by $194 billion over the next 10 years if the CSR payments ended.

"Because the tax credits would increase when premiums for silver plans rose, the agencies estimate that the average subsidy per person receiving premium tax credits to purchase non-group health insurance would increase," the report said.

People who do not receive subsidies, however, could see their premiums increase drastically.

Market stability

Perhaps the most immediate effect of the end of CSR payments could be on the stability of the Obamacare markets for 2018.

While insurers and states have already locked down contracts on next year's exchanges, there could now be further fallout. Some insurers' contracts with states include clauses allowing them to pull out of the exchanges if certain events occur — including the end of CSR payments. So far, no states have given any indication they plan to do so.

Additionally, the CBO report found that 1 million more Americans could go without insurance in 2018 if the CSR payments ended. That would come mostly from people who would see their costs increase but do not receive subsidies.

Legal challenges

Trump's decision on CSR payments does not bring with it the end of debate on the issue. Ongoing litigation and lawsuits that could stem from the administration's decision to end the payments could leave their future in doubt for the foreseeable future.

Earlier this year, 17 states and the District of Columbia were granted the ability to step in themselves if the payments were ended. They argued people living in their states would be harmed if the payments ceased.

Additionally, several state attorneys general have already said they plan to sue the Trump administration if they do not continue to pay the CSRs.

Some health policy and legal academics have suggested that states could have a variety of options to keeping the money flowing, including paying the CSRs themselves and charging the federal government for the bill. The degree to which these measures would be effective, however, is uncertain.

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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 closed down 3.3 percent and Molina Healthcare closed down 3.4 percent. Among hospital shares, Tenet Healthcare finished 5.1 percent lower and Community Health Systems 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)

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• Trump announced Thursday an end to Obamacare's payments to insurance companies, which helped lower insurance costs for poor Americans.
• Many healthcare industry stocks took a dive in trading Friday.
• Trump celebrated the plunge in a tweet Saturday morning.

President Donald Trump celebrated his most recent executive order on Twitter Saturday, saying that he is "very proud" of his decision to end the Affordable Care Act's cost-sharing-reduction payments, a move send healthcare costs soaring for many Americans.

Trump, who announced ending the payments Thursday night, celebrated that stocks related to the healthcare industry took a sharp dive on Friday after the news. 

"Health Insurance stocks, which have gone through the roof during the ObamaCare years, plunged yesterday after I ended their Dems windfall!" Trump tweeted early Saturday morning.

UnitedHealth and Cigna tanked early Friday morning, but had mostly recovered by the close of trading. Anthem and Humana, meanwhile, fell 3.11% and 1.54% by the end of Friday. Centene and Molina Healthcare, which both have significant Medicaid business and offer some individual insurance plans, dropped 3.33% and 3.37% respectively.

Trump further said on Twitter that he is "very proud" of his executive order, adding that it would "allow greatly expanded access and far lower costs for HealthCare."

The payments ended by Trump's executive order were introduced by the ACA, the law better known as Obamacare, to help offset the cost to insurers of offering affordable plans to poor Americans. Insurers have repeatedly warned that if the payments were cut off, they would be forced to raise premiums to make up the financial loss.

After multiple failures by Republicans to pass legislation to overhaul the US healthcare system, Trump has pursued measures to undermine the stability of the ACA, the landmark healthcare law also known as Obamacare.

Announcing the executive order Thursday, the White House said it could not "lawfully" make the payments because "there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare." 

The CSR payments have long been disputed. The Republican-controlled House of Representatives sued the Obama administration in 2014, arguing the payments were illegal since they were being appropriated by the executive branch instead of Congress, which never authorized them.

A federal court ruled in favor of the House, but the Obama administration appealed the ruling, allowing the payments to continue. The Trump administration has kicked the can down the road on the appeal and appropriated the payments on a monthly basis, attempting to use them as leverage in multiple negotiations with Democrats.

In August, a federal judge ruled that 17 states and the District of Columbia could continue the lawsuit even if the Trump administration pulled out of the appeal since the end of the payments would directly affect residents. This could allow the payments to continue despite the announced decision to end them.

Democrats have repeatedly sought to appropriate the payments through congressional action, most recently in bipartisan talks between Republican Sen. Lamar Alexander, the chairman of the Senate Committee on Health, Education, Labor, and Pensions, and the ranking member of that committee, Democratic Sen. Patty Murray.

House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer decried Trump's actions in a statement released minutes after the decision was announced.

"Sadly, instead of working to lower health costs for Americans, it seems President Trump will single-handedly hike Americans' health premiums," they said. "It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America. Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it."

Many Republicans have resisted the idea of Congress appropriating the payments, but some moderate GOP members think it is necessary to maintain stability in the insurance exchanges.

"Cutting health care subsidies will mean more uninsured in my district," Republican Rep. Ileana Ros-Lehtinen tweeted, adding that the president "promised more access, affordable coverage," but that this would do the opposite.

House Speaker Paul Ryan applauded the decision on procedural grounds, saying the method of appropriating the payments through the executive branch was illegal.

"Today's decision by the Trump administration to end the appeal of that ruling preserves a monumental affirmation of Congress's authority and the separation of powers," Paul said in a statement. "Obamacare has proven itself to be a fatally flawed law, and the House will continue to work with Trump administration to provide the American people a better system."

How much ending the payments could destabilize the exchanges is a subject of debate. Some health-policy experts have said that without the payments, the individual insurance exchanges could be devastated as insurers leave and premiums skyrocket. The nonpartisan Congressional Budget Office, however, has found that while the move would cause some pain in the short term for the exchanges, they would eventually find their footing.

Earlier Thursday, Trump signed an executive order to allow two types of healthcare plans that would let people skirt some Obamacare regulations — a move he said was designed to undermine the healthcare law. Experts have said that the introduction of these plans could increase costs for sicker Americans.

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• President Donald Trump ended Obamacare's cost sharing reduction (CSR) payments on Thursday.
• Some Republicans applauded the decision and don't want to pass a bill to make the payments.
• Other Republicans say the CSR payments are critical to keeping healthcare costs down, and say Congress should pass a bill to fund them.

President Donald Trump continued a battle to undermine Obamacare on Thursday, when his administration announced it would cease paying the cost sharing reduction (CSR) payments under the Affordable Care Act. And in doing so, he created another battle that is set to play out among congressional Republicans in coming weeks.

The administration's decision will halt payments to insurers that offset the cost of offering low-income Americans plans with cheaper out-of-pocket costs. Analyses say it could lead to higher premiums for some, an increased number of people without coverage, insurer uncertainty, and destabilization of the Obamacare individual insurance markets in the short-term.

(Here's a complete explanation of the healthcare ramifications of the decision »)

But the move also shifts the onus onto Congress, where Republicans are set to battle over whether to appropriate the payments and help stabilize a law they have tried for the better part of a decade to repeal. Alternatively, they could let the law crumble and try to replace it again.

"While some lawmakers will use this as an excuse to pursue 'bipartisan market stabilization' measures, Obamacare is a fundamentally flawed law that cannot be saved, repaired or bailed out," said Michael Needham, the CEO of the conservative group Heritage Action.

To mitigate any short-term fallout, Congress could pass a bill to appropriate the funds. But that would require a push from influential congressional Republicans.

Some moderate members are calling on Congress to take up a bill to appropriate funding for the payments, while conservatives have come out against the idea.

Mick Mulvaney, the director of the Office of Management and Budget in the White House, said Trump does not support any bill to appropriate CSRs unless it includes something to further the president's agenda, such as funding for a wall along the US-Mexico border.

House Speaker Paul Ryan applauded the choice by Trump, arguing the payments were on shaky legal ground when they were paid by the executive branch, something the administration said in justifying its decision.

Rep. Jim Jordan of Ohio, a leader of the conservative House Freedom Caucus, also agreed with the decision.

"He’s stopping unconstitutional payments to insurance companies who’ve made record profits the last few quarters," Jordan told CNN.

While much of the conservative response applauded the legal grounds for the decision, Ryan and other Republican leaders have come out against a bill to stabilize the markets, one piece of which would include funding the CSRs.

But other Republicans are grappling with the potential consequences: namely, that the move could hurt some of the poorest of the more than 10 million people on the Obamacare exchanges. Rep. Charlie Dent, chair of the moderate Tuesday Group caucus, told CNN that he was concerned by the administration's decision.

"I am fearful now that the president made this announcement that will destabilize the insurance markets, it will raise premiums for a lot of folks," Dent said, saying that Republicans will likely "own this" going forward.

Republican Rep. Ileana Ros-Lehtinen of Florida also tweeted her opposition to the decision.

"Cutting health care subsidies will mean more uninsured in my district,"she tweeted. "@potus promised more access, affordable coverage. This does opposite."

Many Republicans wanted Trump to continue the payments to avoid potential downsides. Sen. John Thune, the third-highest ranking GOP Senate member, said in July that he was hopeful"the president will keep making them, and if he doesn't then I guess we'll have to figure out from a congressional standpoint what we do."

On the state level, Republican Gov. Brian Sandoval of Nevada said ending the CSR payments would hurt people in his state and that he is looking at options to preserve the payments. Sandoval was a critic of multiple GOP Obamacare repeal efforts this year.

Charlie Baker, the Republican governor of Massachusetts, echoed similar sentiments.

"The governor believes that the Trump Administration is making the wrong decision to eliminate cost sharing reductions for all fifty states, as it will destabilize insurance markets and jeopardize coverage for thousands of Massachusetts residents relying on CSRs for affordable health care coverage," a spokesperson said in a statement Friday.

Democrats are all but guaranteed to support a standalone measure that would appropriate funding for CSRs, but complications could arise if the appropriation is part of larger package. 

"He should do the right thing," House Minority Leader Nancy Pelosi said Friday. "And the right thing is to respect what we’re trying to do to bring healthcare to all Americans as well as those with preexisting medical conditions. I don’t know what he wants. Do you know what he wants? Do you know what the president wants? Do you have any idea from his vision, his presentation what he might want?"

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Sen. Lindsey Graham had a frank assessment of the GOP's electoral hopes if the party doesn't get tax reform passed.

"Yeah, if we don't, we're dead," said the South Carolina senator on CBS' "Face The Nation" when he was asked if Congress would pass tax reform this year.

Graham then preemptively brought up the supposed primary challenges being organized by Steve Bannon, the former White House chief strategist and leader of the alt-right website Breitbart News.

Bannon pledged to field primary challengers for six of the seven incumbent GOP senators in 2018 because, in his opinion, they are not doing enough to support President Donald Trump's agenda.

Graham said that the threat to the GOP isn't necessarily Bannon, but that his push is the "symptom of a greater problem" for the party that they haven't delivered on the headline legislative promises from the 2016 election.

"If we don't cut taxes and we don't eventually repeal and replace Obamacare, then we're going to lose across the board in the House in 2018," Graham said. "And all of my colleagues running in primaries in 2018 will probably get beat."

Graham was then asked about Bannon's attacks on Senate Majority Leader Mitch McConnell, whom Bannon has targeted heavily. While Graham said that the failure to pass tax reform would be "the end of Mitch McConnell as we know it," that is not because of McConnell in particular.

"Mitch McConnell's not our problem," Graham said. "Our problem is that we promised to repeal and replace Obamacare, and we failed. We promised to cut taxes and we have yet to do it. If we're successful, Mitch McConnell's fine. If we're not, we're all in trouble."

As it stands now, tax reform is already on a very tight deadline, with the House in session for just 28 more days this calendar year. Additionally, come December, Congress must deal with a bill to fund the government and other year-end deadlines.

Despite this, Graham said the electoral fallout from not getting any major legislative wins in the first year of the Trump presidency would be disastrous.

"Bannon can't beat us if we're successful," he concluded. "And if we're not successful, it doesn't matter who tries to beat us, they'll be successful."

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President Donald Trump on Monday claimed that the Affordable Care Act, the law also known as Obamacare, is "dead."

"Obamacare is finished, it's dead, it's gone, you shouldn't even mention it, it's gone," Trump said at a meeting of his Cabinet. "There's no such thing as Obamacare anymore."

Trump's statement came the week after he made a series of moves to change parts of the law, including an executive order designed to allow people to sign up for health plans outside of the Obamacare exchanges and end the cost sharing reduction (CSR) payments under the law.

On the latter move, Trump once again claimed that the CSR payments were a "bailout" for insurers designed by Democrats.

"Knocked out CSRs, as you know, that was a subsidy to the insurance companies, that was frankly a gift," Trump said Monday.

The payments were designed to help defray costs to insurers for providing insurance plans with lower out-of-pocket costs, which is mandated by the Affordable Care Act. The Congressional Budget Office (CBO) has projected, however, that the end of CSRs will actually lead to higher federal government spending, since insurance companies would increase premiums to compensate for the loss of CSRs. In turn, higher premiums would be offset by increased subsidies for marketplace enrollees funded by the federal government.

Trump told the assembled group of Cabinet members and reporters that Republicans and Democrats are meeting on a short-term fix for the CSR payments and the exchanges because he stopped the payments. However, talks between senators on both sides of the aisle have been ongoing for nearly two months.

"In my opinion what's happening is that as we meet, Republicans are meeting with Democrats because of what I did with the CSRs because I cut off the gravy train," Trump said. "If I didn't cut off the CSRs, they wouldn't be meeting. They'd be enjoying lunch by themselves."

Health policy experts say Trump's recent actions could threaten the law's future.

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Following the decision to cut off key payments for Obamacare on Thursday, President Donald Trump rolled out a simple explanation for the move — that insurers were raking in cash from the payments to pad their massive bottom-line expansion.

"So the insurance companies have made a fortune with Obamacare — an absolute fortune," Trump said Monday. "As you know, what I did with the cuts at the end, which were all going — you know, you're talking about hundreds of millions of dollars a month going right into the pockets of the insurance companies. And I'm very happy with what I did."

But analysts say the cost-sharing reduction (CSR) payments were not a "bail out" for insurers and that insurance companies weren't really making a "fortune" off of Obamacare due to the payments.

One of the biggest reasons that insurers were withdrawing from the Obamacare individual insurance exchanges was due to financial losses on the exchanges because the pool of people being insured was sicker and older than expected.

While analysis shows this issue was stabilizing, it's clear that no insurer was raking in money from the exchange business where CSR payments applied.

As for the claim that CSR payments were a "bail out," much of that is in the eye of the beholder. If one, however, defines a bail out as the federal government providing monetary relief for an industry due to a business model failure — think federal funding for the banking industry in the financial crisis — then CSR payments don't really.

CSR payments were provided to insurers not because their business model failed in the Obamacare market, but to defray the costs associated with providing Americans cheaper plans mandated by the law itself.

Insurance companies have to provide lower out-of-pocket costs to people making less than 250% of the federal poverty limit— about $30,150 annually for an individual. In order to make this financially feasible and incentivize insurers to maintain a presence in the market, the CSRs were included in the plan.

Ending the payments will almost certainty cause insurers to increase premiums to compensate since they will still have to abide by the low out-of-pocket cost regulations. Since most people in the Obamacare market receive subsidies to purchase insurance, the increased costs will eventually work their way back to the federal government.

In the end, the Congressional Budget Office estimated that the federal government will end up paying $194 billion more in subsidies to offset the rising premiums over the next 10 years than if CSRs were continued.

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Republican Sen. Lamar Alexander told reporters Tuesday that he and Democratic Sen. Patty Murray have reached a deal that would formally appropriate Obamacare's cost sharing reduction (CSR) payments.

The deal, which has been in the works since August, comes less than a week after President Donald Trump said his administration would stop the payments, saying it could not legally continue to do so.

CSR payments help to defray costs to insurers that are mandated to provide plans with low out-of-pocket costs to poorer Americans. 

The deal would continue the CSR payments for through 2019 and restore $106 million in outreach to encourage people to sign up for Obamacare plans during the upcoming open-enrollment period.

It would also allow states to implement on reinsurance programs, which helps to mitigate losses for insurers with assistance from the government ad is designed to lower costs for consumers. Additionally, the plan would expedite approvals for what are known as "1332 waivers," which allow states to make changes to their Obamacare exchanges as long as they lower costs.

The Alexander-Murray talks were quashed by Republican leadership in September in favor of an attempt to pass the Graham-Cassidy legislation that would have repealed and replaced the Affordable Care Act. The two senators are the chair and ranking member on the Senate Health, Education, Labor, Pensions Committee, respectively.

At a press conference with Greek Prime Minister Alexis Tsipras on Tuesday, Trump endorsed the deal and said the White House was "involved" with the talks.

It is unclear whether the deal can succeed in Congress, given that House Speaker Paul Ryan previously said he would not bring a stabilization bill to the floor.

Democratic leadership supports the plan. With the bipartisan support, Eric Assaraf, an analyst at Cowen Washington Research Group, said that the plan would likely pass, though he said it could take some time.

"We believe the market stabilization bill would likely garner enough votes for passage and would be signed into law as President Trump has expressed his desire for a short-term fix to Sen. Alexander after moving to end CSR payments last week," Assaraf wrote in a note to clients.

But conservatives have strongly hinted at opposition. Rep. Mark Walker, chair of the conservative Republican Study Committee, said that he would not support the package.

"The GOP should focus on repealing & replacing Obamacare, not trying to save it," Walker said, via the committee's Twitter account. "This bailout is unacceptable."

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President Donald Trump laid the blame at Democrats' feet for an increase in the cost of health insurance premiums on the Obamacare markets on Tuesday.

Trump's comments come less than a week after he made a move that insurance companies already attributed to rising premiums.

"Any increase in ObamaCare premiums is the fault of the Democrats for giving us a 'product' that never had a chance of working,"Trump tweeted.

The tweets follow Trump's move on Friday to stop the cost sharing reduction (CSR) payments, which help defray the cost to insurers for providing low-income Americans plans with cheaper out-of-pocket costs.

Various insurers have said that without the CSR payments, they are forced to increase premiums on the Obamacare exchanges to make up for the funding drop. According to the Congressional Budget Office, premiums will likely increase around 20% for 2018 due to the end of CSRs.

In fact, the Pennsylvania Department of Insurance said Monday insurers would have to increase Obamacare premiums more than four times the amount they originally proposed due to Trump's discontinuation of the CSR payments.

Most of this cost will not fall on consumers, however, as a large majority of Obamacare marketplace enrollees receive subsidies to help with premiums. Instead, most of the burden will fall on the federal government. The CBO estimated the federal deficit will increase by $194 billion over 10 years without CSR payments due to the increase subsides.

The tweet also comes just hours after Sens. Lamar Alexander and Patty Murray, a Republican and Democrat respectively, came to an agreement on an Obamacare stabilization package that included funding the CSR payments through 2019.

At a press conference Tuesday, Trump indicated his support for the plan.

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• President Donald Trump on Wednesday tweeted that he supported GOP Sen. Lamar Alexander "as a person" but couldn't support a key part of the bipartisan Obamacare package Trump helped craft.
• Trump has called the component in question, cost-sharing reduction payments, a bailout for health insurers.
• Trump seemed to support the package at first but has been backing down from that support since Tuesday evening.

President Donald Trump added to confusion over the new Obamacare-stabilization package in a tweet on Wednesday, saying he "could not support" a key part of the plan.

"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,"the president tweeted.

Sen. Lamar Alexander, the Republican who serves as chair of the Senate Health, Education, Labor, and Pensions Committee, announced that he and Sen. Patty Murray, the committee's ranking Democrat, reached a deal on a bill Tuesday after roughly two months of negotiating.

As part of that deal, the cost-sharing reduction payments in Obamacare, the healthcare law formally known as the Affordable Care Act, would be funded through 2019. The payments help defray costs to insurers, which are mandated to provide plans with low out-of-pocket costs to poorer Americans.

For the past few years, the payments have been paid through the executive branch, a practice that was challenged by the Republican-controlled House. A judge ruled in 2016 that the payments were made illegally, but the ruling was challenged by the Obama administration. Trump decided to drop that challenge and discontinue the payments Thursday.

To solve the legal issue, the Alexander-Murray plan would add the payments to the law, but Trump has recently resisted them as a bailout for insurers.

Trump nevertheless appeared supportive of the bipartisan plan when asked about it at a press conference with Greek Prime Minister Alexis Tsipras on Tuesday.

"So they are indeed working, but it is a short-term solution so that we don't have this very dangerous little period — including dangerous periods for insurance companies, by the way," Trump said. "For a period of one year, two years, we will have a very good solution."

But later, in a speech at the conservative Heritage Foundation, Trump appeared to walk back his support for the package somewhat.

"While I commend the bipartisan work done by Senators Alexander and Murray — and I do commend it — I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies," Trump said Tuesday night.

A White House representative told Business Insider that the tweet Wednesday represented the president's position.

At the same time, however, Alexander said Trump was supportive of the plan and helped craft it.

"Trump completely engineered the plan that we announced yesterday," Alexander said at an event held by the news website Axios on Wednesday morning.

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