Trump tweets for health law re­peal

Northwest Arkansas Democrat-Gazette - - FRONT PAGE -

WASH­ING­TON — The dis­pute within the Repub­li­can Party over health care widened fur­ther Fri­day as Pres­i­dent Don­ald Trump joined with two con­ser­va­tive sen­a­tors in call­ing for an out­right re­peal of the Af­ford­able Care Act if the party fails to agree on an al­ter­na­tive plan by the end of the July re­cess.

Se­nate Ma­jor­ity Leader Mitch McCon­nell, R-Ky., con­tin­ued to work on forg­ing a com­pro­mise that could gar­ner suf­fi­cient sup­port once his col­leagues re­turn to Wash­ing­ton on July 10. But Trump’s sug­ges­tion that Repub­li­can sen­a­tors should switch gears and im­me­di­ately try to re­peal the 2010 Pa­tient Pro­tec­tion and Af­ford­able Care Act if com­pro­mise is elu­sive could em­bolden con­ser­va­tives, mak­ing it harder for McCon­nell to bro­ker a deal.

The early-morn­ing tweet was Trump’s first pub­lic state­ment since tak­ing of­fice in fa­vor of bring­ing down the health care law with no re­place­ment sys­tem in place.

“If Repub­li­can Sen­a­tors are un­able to pass what they are work­ing on now, they should im­me­di­ately RE­PEAL, and then RE­PLACE at a later date!” Trump tweeted.

Health in­dus­try of­fi­cials have warned that over­turn­ing the ex­ist­ing law, which has ex­tended in­sur­ance to roughly 20 mil­lion Amer­i­cans and changed the rules un­der which in­sur­ance is of­fered across the coun­try, would cre­ate chaos in a sec­tor that ac­counts for one-sixth of the U.S. econ­omy.

Robert Laszewski, pres­i­dent of Health Pol­icy and Strat­egy As­so­ciates, said re­peal­ing the 2010 law without a re­place­ment would be

“a trauma” for an in­sur­ance mar­ket that needs reg­u­la­tory clar­ity to set pre­mium rates.

“There would be ab­so­lutely no cer­tainty, what­so­ever, about any­thing,” Laszewski said.

In June 2015, the Con­gres­sional Bud­get Of­fice pro­jected that such an out­right re­peal would add $137 bil­lion to the fed­eral deficit be­tween 2016 and 2025 and leave 24 mil­lion nonelderly adults without health cov­er­age be­tween 2021 and 2025.

Two GOP sen­a­tors who es­pouse this ap­proach, Rand Paul of Ken­tucky and Ben Sasse of Ne­braska, wel­comed Trump’s sug­ges­tion. But some of the high-rank­ing Repub­li­cans who have been work­ing on the leg­is­la­tion re­jected it as im­prac­ti­cal, not­ing that it might force them to fash­ion a sub­sti­tute with Democrats.

While it is un­clear what specif­i­cally prompted Trump’s tweet, an aide to Sasse said that the sen­a­tor had dis­cussed the idea of a straight re­peal pri­vately with White House of­fi­cials in re­cent days. On Fri­day, Sasse re­leased a let­ter to the pres­i­dent sug­gest­ing that if an agree­ment is not reached by the day that mem­bers re­turn from their week-long re­cess, the pres­i­dent should call on Congress to re­peal the Af­ford­able Care Act and work through Au­gust to craft a re­place­ment by La­bor Day.

Latch­ing onto Sasse’s sug­ges­tion, a group of Se­nate Repub­li­cans sug­gested Fri­day that McCon­nell should scale back or can­cel the cham­ber’s month-long Au­gust re­cess, given the lack of progress they have made on not just health care but tax re­form, spend­ing bills, the debt ceil­ing and a bud­get res­o­lu­tion.

GOP Sens. David Per­due of Ge­or­gia, Steve Daines of Mon­tana, Joni Ernst of Iowa, John Kennedy of Louisiana, James Lank­ford of Ok­la­homa, Mike Lee of Utah, Mike Rounds of South Dakota, Luther Strange of Alabama, Dan Sul­li­van of Alaska and Thom Til­lis of North Carolina sent McCon­nell a let­ter Fri­day ask­ing him to ei­ther shorten or can­cel the month-long Au­gust re­cess so they can get more done.

“De­liv­er­ing mean­ing­ful re­sults was never as­sumed to be easy, but the mil­lions of Amer­i­cans who placed their con­fi­dence in our lead­er­ship ex­pect our full and best ef­fort,” the 10 sen­a­tors wrote.

Paul, who retweeted Trump on Fri­day morn­ing, later fired off a sec­ond tweet say­ing he had spo­ken to Trump and Se­nate GOP lead­er­ship “about this and agree. Let’s keep our word to re­peal then work on re­plac­ing right away.”

White House spokesman Sarah Huck­abee San­ders said Trump did not see July 10 as a dead­line to pass leg­is­la­tion. She added, “We’re still fully com­mit­ted to push­ing through with the Se­nate, at this point, but we’re, you know, look­ing at ev­ery pos­si­ble op­tion of re­peal­ing and re­plac­ing Oba­macare. We are fo­cused on do­ing that.”

Asked for the ma­jor­ity leader’s re­sponse to Trump’s Fri­day tweet, a McCon­nell spokesman said she didn’t have any new an­nounce­ments.

House Ways and Means Com­mit­tee Chair­man Kevin Brady, R-Texas, dis­missed Trump’s sug­ges­tion that Congress could sim­ply re­peal parts of the ACA, then go back and re­place them later.

“That doesn’t achieve what Pres­i­dent Trump set out to do,” he said. “I re­ally think the Se­nate’s ap­proach - cer­tainly in the House — of not sim­ply re­peal­ing but start­ing to put into place the el­e­ments that can make health care af­ford­able … that should con­tinue to be our goal.”

Be­fore Trump was in­au­gu­rated in Jan­uary, Repub­li­cans had de­bated and ul­ti­mately dis­carded the idea of re­peal­ing the Af­ford­able Care Act be­fore re­plac­ing it, con­clud­ing that both must hap­pen si­mul­ta­ne­ously. Do­ing oth­er­wise would in­vite ac­cu­sa­tions that Repub­li­cans were sim­ply toss­ing peo­ple off cov­er­age and would roil in­sur­ance mar­kets by rais­ing the ques­tion of whether, when and how Congress might re­place the 2010 law once it was gone.

PRE­PAR­ING TO FACE PUB­LIC

Repub­li­cans are steel­ing them­selves for at­tacks on their health care ne­go­ti­a­tions over the Fourth of July re­cess, where ac­tivists are plan­ning to pres­sure any mem­bers of Congress they see at pub­lic events.

Most GOP sen­a­tors were keep­ing their plans close to their vests, though a hand­ful, in­clud­ing Bill Cas­sidy of Louisiana, Ted Cruz of Texas, Su­san Collins of Maine, Jerry Moran of Kansas and Lisa Murkowski of Alaska have an­nounced ei­ther town halls or pa­rade vis­its.

Cas­sidy, who has said he can­not yet sup­port the cur­rent draft of the Se­nate bill be­cause of the im­pact its cuts in Med­i­caid fund­ing would have on his state, re­ceived a blis­ter­ing re­cep­tion at a Ba­ton Rouge town hall Fri­day. Even as he sought to dis­cuss flood­ing is­sues, an at­tendee in­ter­rupted to men­tion Med­i­caid, prompt­ing oth­ers to chant, “Health care! Health care!”

“If you wish to chant and stop oth­ers from be­ing able to speak or be heard, that is not civil,” Cas­sidy re­torted.

Se­nate Democrats are stag­ing events aimed at high­light­ing how the Se­nate’s draft bill could hurt health-care de­liv­ery in their home states. Heidi Heitkamp, D-N.D., is vis­it­ing at least two ru­ral hospi­tals over the break to un­der­score the im­pact of its pro­posed fund­ing cuts.

McCon­nell is try­ing to tweak his pro­posal to make deep cuts in Med­i­caid while pro­vid­ing tax cuts to com­pa­nies and wealthy Amer­i­cans — part of an ef­fort to bring on a hand­ful of con­ser­va­tive and cen­trist sen­a­tors who have ques­tioned parts of the bill.

But the calls for re­peal re­flect the anger that Trump and many con­ser­va­tives feel about the mea­sure McCon­nell crafted be­hind closed doors, which would cut $772 bil­lion over 10 years from Med­i­caid, the pub­lic in­sur­ance pro­gram that cov­ers nearly 70 mil­lion Amer­i­cans, while pro­vid­ing $541 bil­lion in tax cuts.

Se­nate lead­ers also are rewrit­ing their bill to pro­vide $45 bil­lion to com­bat opi­oid ad­dic­tion and pro­vide more fi­nan­cial as­sis­tance to lowand mod­er­ate-in­come Amer­i­cans. They hope to win over con­ser­va­tives by elim­i­nat­ing many of the ACA’s in­sur­ance man­dates and al­low­ing higher tax de­duc­tions through ex­panded health-sav­ings ac­counts.

But they have not set­tled on how they would fi­nance all th­ese changes, since con­ser­va­tives op­pose the cen­trists’ push to pre­serve one of the bill’s cur­rent taxes as a way of fun­nel­ing more money to those who can­not af­ford health cov­er­age on their own.

On Fri­day, Brady joined the cho­rus of con­ser­va­tives who ob­ject to main­tain­ing a 3.2 per­cent tax on in­vest­ment in­come for high earn­ers as a way of pro­vid­ing more money to low-in­come Amer­i­cans in the health bill. The cur­rent draft re­peals or de­lays all the taxes im­posed by the ACA.

Keep­ing the tax, he said, would be a “tough red flag” if the bill comes back to the House.

Given the cur­rent im­passe, the bill con­tin­ues to come un­der at­tack from both the right and left flanks of the GOP.

On a Fri­day con­fer­ence call with re­porters, of­fi­cials at sev­eral con­ser­va­tive ad­vo­cacy groups said it does not re­peal the ACA force­fully enough.

“We be­lieve that real re­peal means full re­peal. Root and branch doesn’t mean trim­ming the hedges, as is cur­rently the case,” said Andy Roth, vice pres­i­dent for gov­ern­ment af­fairs at the Club for Growth.

In­for­ma­tion for this ar­ti­cle was con­trib­uted by Juliet Eilperin, Sean Sul­li­van, Kelsey Snell, Ash­ley Cu­sick, Mike DeBo­nis, David Weigel and Ed O’Keefe of The Wash­ing­ton Post; by Erica Werner and Alan Fram of The As­so­ci­ated Press; by Thomas Ka­plan and Robert Pear of The New York Times.

AP/J. SCOTT AP­PLE­WHITE

The U.S. Se­nate cor­ri­dors were quiet Fri­day after law­mak­ers de­parted Capi­tol Hill for the In­de­pen­dence Day re­cess. Repub­li­can lead­ers in the Se­nate de­cided this week to de­lay a vote on their health care bill after op­po­si­tion sur­faced in the GOP ranks.

AP/MANUEL BALCE CENETA

White House spokesman Sarah Huck­abee San­ders said Fri­day that Pres­i­dent Don­ald Trump does not con­sider July 10, when Congress re­turns, as a dead­line to pass health care leg­is­la­tion.

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