Northwest Arkansas Democrat-Gazette
Trump tweets for health law repeal
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.