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Trump, Republicans at odds on dealing with provisions in Obamacare

Rep. Tom Price, R-Ga., chairman of the House Budget Committee, left, and House Speaker Paul Ryan, R-Wis., are leading the charge to repeal the Affordable Care Act.
Rep. Tom Price, R-Ga., chairman of the House Budget Committee, left, and House Speaker Paul Ryan, R-Wis., are leading the charge to repeal the Affordable Care Act. Bloomberg

Before Congress passed the federal health reform that became known as Obamacare, President Barack Obama famously told Americans that his proposal would not adversely affect their insurance coverage.

“If you like your plan and you like your doctor, you won’t have to do a thing,” Obama said in 2009. “You keep your plan. You keep your doctor.”

But that turned out not to be true for many people who got their coverage in the individual insurance market instead of through their employer. And opponents of the Affordable Care Act used Obama’s broken promise as a rallying cry for the law’s repeal.

Now, as those repeal efforts take shape under President-elect Donald Trump and the Republican Congress, the question is whether the new president’s promises will be any more reliable than Obama’s.

A number of assurances Trump gave during the campaign and after the election put him on a collision course with Republican leaders in Congress, including the congressman the president-elect has tapped to be his secretary for health and human services.

Trump, in one of his earliest statements on the topic, boasted in a 2015 comment on Twitter that he was the only candidate to promise that there would be “no cuts to Social Security, Medicare & Medicaid.”

Then, on the CBS program “60 Minutes,” Trump committed to preserving or even enhancing the universal coverage that was the goal of Obama’s plan.

“Everybody’s got to be covered,” he said. “I’m going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

He told The Washington Post that he was especially committed to keeping one of the most popular parts of Obamacare, the rule requiring insurance companies to cover everyone who applies, regardless of their health condition.

“I want to keep pre-existing conditions,” he said. “It’s the modern age, and I think we have to have it.”

Those assurances don’t square with the plans put forward by House Speaker Paul Ryan or Rep. Tom Price, who will lead Trump’s repeal efforts.

Most of the millions of people who gained coverage under Obamacare got it through Medicaid, the public insurance program known as Medi-Cal in California. In California alone, 3.5 million people were able to enroll in Medi-Cal under the Obama plan.

But Ryan and Price have both proposed rolling back that expansion and then giving states control over the Medicaid program. Trump has also expressed support for the idea of giving states more freedom to run the program as they see fit. But to keep his promise he would have to insist that the change comes with enough funding to cover all of those who are covered now, or that other changes make private insurance all but free for those people.

And while Trump could continue to require insurance companies to take all applicants, Ryan and Price have suggested a return to state-run “high risk” pools that were unaffordable to most people. To keep his promise without bankrupting the insurance industry, Trump would have to offer generous subsidies similar to those in Obamacare.

Trump promised to guarantee coverage to all, not cut Medicaid and preserve protections for those who have pre-existing conditions. If he does all of that, he will be repealing Obamacare and replacing it with something that changes the name but not the program.

That may be what he has in mind, but it’s not what his closest allies and advisers have said they intend to enact.

Daniel Weintraub is editor of The California Health Report at www.calhealthreport.org. He can be reached at Daniel.weintraub@calhealtheport.org.

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