We don’t know what will emerge as President Trump’s plan to replace Obamacare, which he has promised to unveil immediately after the 2020 elections. But he has recently endorsed several proposals, and they could provide clues.
Over the last two weeks, he has sought to re-emphasize health care as an issue, after a set of bruising legislative defeats in 2017. He directed the Justice Department not to defend the Affordable Care Act against a legal challenge. And he issued statements and tweets calling for Republicans to become “the party of health care,” at a moment when many of his party’s leaders had hoped to focus on different issues.
He also began reprising various promises about what a future plan to repeal and replace parts of the Affordable Care Act might achieve. The plan, short on specifics, will come with “far lower premiums (costs) & deductibles,” he said this week in a series of tweets. He promised that any Republican health plan would protect Americans with pre-existing health conditions, a major concern of voters that Democrats effectively exploited in the 2018 midterm elections.
After his election, President Trump made similar promises, saying that the Republican proposal would be “far less expensive and far better” than Obamacare. The legislation that came later, and earned his endorsement, would have made insurance less expensive, but only for certain groups of young, high-income, healthy Americans. The bills would have also eliminated coverage for millions of people by scaling back Medicaid, and would have made it harder for those with pre-existing illnesses — and those who are older with low incomes — to find meaningful affordable options if they didn’t get insurance from work.
The three senators he has chosen to lead the effort — Bill Cassidy of Louisiana, John Barrasso of Wyoming and Rick Scott of Florida — have so far also declined to point to many specifics. When asked about an Obamacare replacement this week, they mentioned their more modest bills to reduce health care costs in the emergency room and at the drugstore. (A fourth senator the president has mentioned, the majority leader, Mitch McConnell of Kentucky, has been even more clear that he has little interest in pursuing comprehensive health care legislation.)
One clue to Mr. Trump’s thinking is the choice of Mr. Cassidy. Along with Senator Lindsey Graham of South Carolina, he was the author of a legislative plan that received some scrutiny in 2017 but never came up for a vote. Another hint can be found in the president’s own budget, released just before his reinvigorated health care push. A third is a draft proposal developed by a group of conservative Washington policy groups.
The Graham-Cassidy bill
The president has spoken fondly several times about this proposal, which did not have enough support in Congress to advance to a vote. It would eliminate current programs funding Obamacare’s Medicaid expansion, which covers the working poor, and insurance subsidies helping low- and middle-income Americans buy their insurance. Instead, that money would be grouped together, then parceled out to states to use in the service of health care programs they favor.
The legislation attaches some rules to how the money can be used — it must go toward health care, for example — but its main goal is to provide states with maximum flexibility to develop local and innovative solutions. (Some experts worry that states could struggleto develop such plans on the bill’s abbreviated timetable.)
That flexibility would allow states, if they so chose, to waive Obamacare’s rules that plans must cover a standard set of medical benefits, and that insurers must charge the same prices to customers with different health histories. It would be easy for states to circumvent current protections for Americans with pre-existing conditions. That ability would be at odds with the president’s recent promises to protect such rules.
Courtesy of New York Times