Trump: Kill health bill now, replace at later date
Conservatives get behind idea abandoned in January
WASHINGTON — With Senate Republicans bogged down over how to dismantle the Affordable Care Act, President Donald Trump on Friday tossed in a new complication with an old idea: The Senate could repeal the health law now, then replace it later.
Trump gave his blessing in a Twitter post after a Republican dissatisfied with the current repeal bill, Sen. Ben Sasse of Nebraska, floated the two-stage approach as a backup plan. Sasse sent a letter to the president and made a pitch Friday on Fox News as an agreement on a new version of the Senate’s repeal bill remained elusive.
Other conservatives quickly picked up the idea — including Sen. Rand Paul of Kentucky and the advocacy group Americans for Prosperity, backed by Charles and David Koch — presenting a new headache to Senate leaders who are trying to focus their conservative and moderate troops on finding a compromise.
Days ago, Senate Republican leaders spoke optimistically of finishing their revisions to the repeal bill by Friday, clearing the way for the Congressional Budget Office to prepare a new analysis of the bill. That way, after lawmakers return from their Fourth of July recess, the majority leader, Sen. Mitch McConnell of Kentucky, could try to move ahead with a vote.
But Friday came and went without any agreement or public show of progress — and with no vote in sight. Instead, McConnell was dealing with a new dose of uncertainty about whether Republicans should continue on their current course, or scrap their bill for a repeal-only measure that would probably have at least as much difficulty garnering enough votes to pass.
The health care debate almost certainly will continue deep into July, when Congress will also face other pressing
issues, including raising the government’s statutory borrowing limit.
“We need repeal; we need replace,” Sasse said on Fox News. “Trying to do them together hasn’t seemed to work.”
Republican leaders in Congress had embraced the repeal-now-replace-later mantra after Trump’s election, envisioning legislation that would end the Affordable Care Act in a few years as they work on a replacement. But that plan was blown up quickly in January when Trump publicly demanded a replacement be adopted simultaneously. Since then, McConnell and Speaker Paul Ryan have choreographed a complicated legislative dance that would fulfill Trump’s repeal-and-replace wishes. Now, those wishes could be changing. In his letter to the president, Sasse said that if a deal on a revised health care bill had not been struck by the time the Senate returns from its recess on July 10, Trump should call on Congress to “immediately repeal as much of Obamacare as is possible” under the rules that must be followed to avoid a filibuster, with a one-year delay on the repeal bill’s implementation.
Then, he said, lawmakers should get to work on replacing the health law, and should cancel their planned August recess.
“On the current path, it looks like Republicans will either fail to pass any meaningful bill at all, or will instead pass a bill that attempts to prop up much of the crumbling Obamacare structures,” Sasse wrote. “We can and must do better than either of these — both because the American people deserve better, and because we promised better.”
Soon after Sasse’s appearance on Fox News, Trump wrote on Twitter, “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!”
Asked about the tweet, a White House spokeswoman, Sarah Huckabee Sanders, said, “The president hasn’t changed his thinking at all.”
“We’re still fully committed to pushing through with the Senate at this point,” she said. “But we’re looking at every possible option of repealing and replacing Obamacare.”
McConnell was hoping the Senate would pass his bill this week. But he dropped that idea Tuesday after it became clear that he did not have the votes and would have to revise his bill for it to have any chance of passing. A spokeswoman for McConnell declined to comment on the president’s tweet.
Trump weighed in as Senate Republicans are struggling to decide how much of the Affordable Care Act should be eradicated and how much should be retained. In the Senate this week, Republicans veered from their original approach and said they were discussing whether to keep a tax imposed by the Affordable Care Act on the investment income of the most affluent Americans. The revenue could be used to increase insurance subsidies for lower-income people.
Subsidies in the Senate bill were already beginning to look like those in the Affordable Care Act, which are tied to a person’s income and local insurance costs. However, the Senate subsidies are less generous than those under current law.
The repeal bills written by House and Senate Republicans would provide tens of billions of dollars in assistance to health insurance companies to help stabilize insurance markets and hold down premiums. Many of the same Republicans attacked such payments, when made by the Obama administration, as a bailout for the insurance industry.
But as senators tried to come to agreement, Trump effectively added a distraction. A clean repeal of the Affordable Care Act would face huge political obstacles in the Senate if it was not accompanied by legislation to provide health coverage in some other manner. Republican senators are faced with pleas from constituents who want the health law to remain in place. If they approve a repeal-only measure, they would face enormous pressure to explain what comes next.
“It’s distressing to see so many Republicans who’ve lied about their commitment to repeal,” said Ken Cuccinelli, a former Republican attorney general of Virginia who is now president of the Senate Conservatives Fund, which supports conservative candidates.
Conservatives are pressing McConnell to accept a proposal by Sen. Ted Cruz, R-Texas, that would allow insurers to sell cheaper, less comprehensive health plans if they also offered at least one plan that met federal insurance standards, including a requirement to provide certain benefits like maternity care and mental health coverage.
Cruz has said the proposal would increase the number of health insurance options available to consumers, allowing them to choose plans that would cost less because they did not have to comply with federal mandates.
But critics said the proposal was unworkable because less healthy people would gravitate to insurance plans that provide a full set of benefits, and they could face higher premiums, while healthy people would tend to choose lower-cost plans.