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President-elect Donald Trump is setting the stage for a potential clash with his fellow Republicans when it comes to the repeal and replacement of the Affordable Care Act. Many of his pronouncements in interviews and on Twitter are at odds with long-held Republican orthodoxy on health care.
Trump's plan will provide “insurance for everybody,” he told The Washington Post in an article that ran Sunday night. He added that he’s going to push for the government to have the ability to negotiate prescription drug prices for Medicare and Medicaid. However, neither of those ideas have been mentioned as possibilities in a Republican replacement plan — and they are both proposals usually opposed by Republicans.
Republicans in Congress have just begun the process of dismantling the Affordable Care Act, also known as Obamacare, a massive health care law that has insured an additional 20 million people and altered the health care industry.
“We’re going to have insurance for everybody,” Trump told the Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
Trump said people who gained coverage under Obamacare will “be beautifully covered.”
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Republicans, in the meantime, have not promised universal coverage and have not even promised that the newly insured from the ACA will continue to have insurance.
Rep. Cathy McMorris Rodgers, R-Wash., a member of Republican leadership promises that no one will “have the rug pulled out from under them,” but Republicans are resistant to the idea of universal coverage, or even widespread coverage. Instead, House Speaker Paul Ryan last week began using the phrase “universal access” when describing the goals of their health care legislation. Republicans say that cost will be lower, giving people the ability to purchase coverage.
Many of the people who gained coverage under Obamacare did so under an expansion of Medicaid — one that Republicans have been fighting.
As for the negotiation of drug prices, Trump said pharmaceutical companies are currently “politically protected” but added: “not anymore.”
Republicans and pharmaceutical companies have long been opposed to the government having the ability to negotiate the cost of prescription drugs. The high cost of drugs for Medicaid and Medicare recipients — although different laws concerning drugs govern each program — are a major expense for the federal government. During the controversial expansion of Medicare to add the Part D program in 2003, Congress instituted a ban on drug price negotiations to garner the support of Republicans who largely opposed the expansion of Medicare.
Trump’s position could be explosive on Capitol Hill. Even one of Trump’s most ardent supporters, Rep. Chris Collins, R-N.Y., told reporters last week that he doesn’t agree with Trump on drug prices.
“We can agree to disagree,” Collins said.
Trump has already significantly changed the tenor of Republican efforts to repeal and replace the ACA. After Republican leaders in Congress said that it could take weeks or months after they repeal Obamacare to pass a replacement, Trump said in his first news conference that a replacement bill would come “essentially simultaneously.” Republicans have since sped up their timeline, saying that parts of the bill could happen “concurrently” with the repeal.
The House and the Senate passed the first of two steps to repeal Obamacare last week. The second step, which will include the details and scope of the repeal, is likely to come in the next one or two months. Republicans must adhere to strict guidelines on what can be repealed because of their use of a budget gimmick called "reconciliation." Reconciliation only needs the support of a simple majority to pass — allowing the GOP to bypass the need to win support of any Democrats — but only tax and spending provisions can be addressed.
Those provisions that could be repealed include a tax on families making more than $250,000 per year, a tax on tanning machines, a tax on the most expensive health care plans, a tax on the insurance industry and a tax penalty on employers who don’t provide health insurance for their employees and a tax penalty on people who don’t purchase it.
Trump said that he would present a plan for health care repeal after his nominee to be Health and Human Services Secretary, Rep. Tom Price of Georgia, is confirmed.