Donald Trump told the Wall Street Journal that he would be willing to keep at least two of the provisions in the Affordable Care Act: the prohibition against insurance companies denying coverage to people with pre-existing conditions and the provision that allows parents to keep their children on their insurance plans until age 26.
In his first interview since his election earlier this week, Mr. Trump said one priority was moving “quickly” on the president’s signature health initiative, which he argued has become so unworkable and expensive that “you can’t use it.”
Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the health law after the president asked him to reconsider repealing it during their meeting at the White House on Thursday.
Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.
On health care, Mr. Trump said a big reason for his shift from his call for an all-out repeal was that Thursday meeting at the White House with the president, who, he said, suggested areas of the Affordable Care Act, widely known as Obamacare, to preserve. “I told him I will look at his suggestions, and out of respect, I will do that,” Mr. Trump said in his Trump Tower office.
“Either Obamacare will be amended, or repealed and replaced,” Mr. Trump said.
Mr. Trump declined to identify a single top priority upon taking office, saying: “I have a lot of first priorities.”
He did say, though, that he would rely heavily on his vice president-elect, Mike Pence,who had a decade of experience in Congress before becoming Indiana’s governor. “Mike will have a big role. He’s very capable,” Mr. Trump said.
He said he wanted Mr. Pence to handle “different areas of policy” and “be very much involved in health care.” He also said Mr. Pence would serve as his “liaison” with Congress, adding that he and House Speaker Paul Ryan are friends.
Trump has at least two constituencies he must satisfy when dealing with Obamacare. There are the voters who don’t like Obamacare but have become addicted to the subsidies offered by the government to pay for their policies. And the second group is made up of conservative Republicans on the Hill who want to repeal the law entirely.
Trump appears to be falling into a third group: the “repeal and replace” faction. It would be hard to disrupt the health care market more than Obamacare has, but throwing 21 million people off their insurance plans or off of Medicaid would be a catastrophe, both economically and politically.
Some parts of Obamacare are so entangled in the health care system that ripping out the tentacles that have grown over the last five years will do more harm than good. But there is probably close to universal agreement that the individual mandate must go. There is also a consensus that the inability of insurance companies to offer low-cost, minimum coverage to younger, healthy Americans has been a major cause for the law’s failure. This means that coverage mandates will have to be scaled back or eliminated.
This will allow for more than four plans currently offered by Obamacare. And it may entice some insurers to reenter the markets, leading to more competition.
There have been repeal and replace plans floating around Capitol Hill for months, but no GOP consensus has been reached on any of them. What’s needed is a little leadership on the issue. If Trump wants to engage, he will find allies willing to work with him.
For those conservatives who want Obamacare repealed, this was never realistic once the law took hold. Consider that in 2014, five million people had been thrown off their plans because of Obamacare mandates and Republicans won a wave election. If Obamacare is entirely repealed, 21 million people could lose their insurance, leading to a similar electoral debacle.
Hopefully, Republicans are smarter than that.