Trump team divided on Obamacare replacement
Despite vow of plan at hand, president courts varied ideas.
WASHINGTON — A meeting Friday afternoon between President Donald Trump and Ohio Gov. John Kasich, his former rival in the GOP primaries, had no set agenda. B u t Ka s i c h c a me a r med with one anyway: his hope to blunt drastic changes to the nation’s health care system envisioned by some conservatives in Washington.
Over the next 45 minutes, according to Kasich and others briefed on the session, the governor made his pitch while the president eagerly called in several top aides and then got Health and Human Services Secretary Tom Price on the phone. At one point, senior adviser Jared Kushner reminded his father-inlaw that House Republicans are sketching out a different approach to providing access to coverage. “Well, I like this better,” Trump replied, according to a Kasich adviser.
The freewheeling session, which concluded with the president instructing Price and Chief of Staff Reince Priebus to meet with Kasich the next day, underscores the unorthodox way the White Ho u s e i s p r o c e e d i n g a s Republicans work to dismantle the Affordable Care Act and replace it with something else. The day after Kasich delivered his impromptu tutorial, Trump spent lunch discussing the same topic with t wo other GOP governors with a very different vision — Scott Walker of Wisconsin and Rick Scott of Florida.
Scott said Sunday that he used the lunch to press for principles he has pushed publicly, such as financial c ompensation f or s t a t e s that did not expand Medic aid under the ACA and the importance of providing competition and cutting required benefits to allow people to “buy insurance that fits them.”
While leaving most of the detail work to lawmakers, top White House aides are divided on how dramatic an overhaul effort the party should pursue. And the biggest wild card remains the p r e s i d e n t h i ms e l f , wh o has devoted only a modest amount of time to the grinding task of mastering health care policy but has repeatedly suggested that his sweeping new plan is nearly complete.
This conundrum will be on full display Monday, when Trump meets with some of the nation’s largest health insurers. The session, which will include top executives from Blue Cross and Blue Shield, Cigna and Humana, is not expected to produce a major policy announcement. But it will provide an opportunity for one more important constituency to lobby the nation’s leader on an issue he has said is at the top of his agenda.
Democrats and their allies are already mobilizing supporters to hammer lawmakers about the possible impact of rolling back the ACA, holding more than 100 rallies across the country Saturday. And a new analysis for the National Governors Association that modeled the effect of imposing a cap on Medicaid spending — a key component of House Republicans’ strategy — provided Democrats with fresh ammunition because of its finding that the number of insured Americans could fall significantly.
Trump, for his part, continues to express confidence about his administration’s ostensible plan. He suggested Wednesday that it would be out within a few weeks.
“So we’re doing the health care — again, moving along very well — sometime during the month of March, maybe mid- to early March, we’ll be submitting something that I think people will be very impressed by,” he told reporters during a budget meeting in the Roosevelt Room.
Yet some lawmakers, state leaders and policy experts who have discussed the matter with either Trump or his top aides say the administration is largely delegating the development of an ACA substitute to Capitol Hill. The president, who attended part of a lengthy heath-care policy session his aides held at Mar-a-Lago a week ago, appears more interested in brokering specific questions, such as how to negotiate drug prices, than in steering the plan’s drafting.
“The legislative branch, the House first and foremost, is providing the policy,” said Rep. Tom Cole, R-Okla., who noted that the White House lacks “a big policy shop” and that Price and some key principals just recently got in place. Seema Verma, whom Trump has nominated to head the Centers for Medicare and Medicaid Services, should play a key role in any reform effort if she is confirmed.
In the current process, the White House becomes “the political sounding board” in altering Obamacare, as the 2010 law is known, “and the final voice of reason is what the Senate can accept,” Cole said.