Trump can’t easily dump Obamacare

Donald Trump said during his acceptance speech that he found campaigning tough. Wait until he tries governing.

His website has promised: “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” Trump walked back that promise Friday in an interview with the Wall Street Journal, saying he might retain some of the most popular portions of the Affordable Care Act.

The president-elect has figured out — or maybe knew all along — that a total repeal would be exceedingly difficult. Doubly so if he intends to fulfill his promise of a new system to improve the health care of all Americans.

That’s one Trump promise both political parties should hold him to. It’s in the GOP’s best interests. A plan that leaves out many of the people who voted for Trump will quickly turn his fan base sour.

A full repeal would be subject to a filibuster in the U.S. Senate, meaning Republican Senate leaders would need to convince a handful of Democrats to help make up the 60 votes needed to end it.

The only alternative is rewriting the filibuster rules, but Senate Majority Leader Mitch McConnell has been disinclined to do that for good reason. He fears what would happen when Democrats someday regain control of the Senate.

Trump probably will use the budget reconciliation process to shoot down as many Obamacare provisions as he can. Budget reconciliation requires only a majority vote. But it would be limited to the parts of the Affordable Care Act that deal with expenditures and revenue.

He could retain the parts of the law he says he likes, including protecting people with pre-existing conditions and allowing children to stay on their parents’ plans until age 26. Then, he could push the Senate to do away with much of the financing for the rest of Obamacare. But that would come at a heavy political price: Taking away health insurance from as many as 22 million Americans, substantially cutting into insurance company profits and drastically increasing costs for hospitals, which would be forced to provide charity care for the millions of newly uninsured.

Perhaps because of his unexpectedly long conversation with President Obama Thursday, Trump appears to be realizing the challenge of entirely replacing the Affordable Care Act. He’s never been specific about how, and no wonder. Republicans have been trying for eight years to come up with an alternative that doesn’t get laughed out of the room when presented to health care experts.

The three major GOP ideas are giving Americans tax credits for health savings accounts, allowing insurance companies to sell policies across state lines and giving states block grants for Medicaid expenses.

Health savings accounts are great for the wealthy, but do little or nothing for low-income families barely putting food on the table — which is to say, a large majority of the Americans who now benefit from Obamacare.

Selling insurance across state lines is supposed to cut costs by dodging regulations in states such as California, which requires plans to meet certain standards. Consumer groups oppose it because it would lure insurers to states (think Mississippi) with the weakest protections for patients. But here’s something Trump might not have realized: Insurers hate it, too. A race to the bottom is less profitable for them than a broader market for coverage that offers real value.

States dislike block grants because they inevitably shrink over time, regardless of the need. States with large populations of poor people are hurt the most because they have the least resources to make up the difference.

In creating the Affordable Care Act, President Obama learned it was a complex and challenging puzzle, bringing the insurance industry and medical providers together to provide cost-effective care. Let’s face it. It was ugly.

Trump promises his own program is going to be “beautiful, so beautiful.” His best bet for that will likely be improving upon Obamacare, not repealing it. — San Jose Mercury News,

Digital First Media