Trump scrambles GOP’s healthcare plans

President-elect Donald Trump is upending the GOP’s plans on ObamaCare. 

Trump over the weekend said the ObamaCare replacement plan should cover everyone, a pledge that congressional Republicans have repeatedly declined to make. 

The remark came just a few days after Trump said at a press conference that his administration would put forward its own replacement plan for ObamaCare, an announcement that seemed to catch lawmakers by surprise.

At the same press conference, Trump said Congress should repeal and replace ObamaCare simultaneously, shooting down talk that Republicans might delay the replacement plan to a later date. 

Finally, Trump has ripped drug companies and called for Medicare to negotiate prices, embracing a position that has long been taken by Democrats. 

Sen. John Cornyn (Texas), the Senate’s No. 2 Republican, told reporters Tuesday that he did not know that Trump was going to announce his intention to put forward his own ObamaCare replacement last week. And if the new administration follows through on putting forward a plan, Cornyn would not commit that it would be the baseline for work on the Republican replacement. 

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“I don’t know,” Cornyn said. “I want to see it first.”  

Trump created a stir with his remarks to The Washington Post over the weekend about universal coverage.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” 

The promise sounded more like the Democrats’ push for universal coverage than the GOP’s focus on bringing down costs and regulation in healthcare.  

Republican congressional leaders have repeatedly declined to pledge that all of the 20 million people who gained coverage under ObamaCare will stay covered under a replacement.  

“Look, I’m not going to get ahead of our committee process,” Speaker Paul Ryan (R-Wis.) said earlier this month when asked if everyone would keep coverage. “We’re just beginning to put this together.”

House Majority Leader Kevin McCarthy (R-Calif.) said separately this month that “there’s a lot of areas that you want to look at” in a replacement, including cost, not just coverage.  

Trump is also making his voice heard on when an ObamaCare replacement should happen. 

“It will be essentially simultaneously,” Trump said last week of repeal and replacement. “It will be various segments, you understand, but it will most likely be on the same day or the same week, but probably the same day, it could be the same hour.”

After the election, Republicans in Congress had floated the idea of passing repeal first and then focusing on the replacement later. 

“My personal belief, and nothing’s been decided yet, but I would move through and repeal and then go to work on replacing,” McCarthy said in late November.  

Ryan said in December that a replacement would “take time.”

“It’s not going to be replaced come next football season,” Ryan told the Milwaukee Journal Sentinel.  

Last week, Ryan said the process of repeal and replace would occur “concurrently.”

Ryan said there could be elements of a replacement plan in the repeal bill. But including a full replacement could prove difficult, given complex Senate rules that control which provisions can be included in a bill using the fast-track process known as reconciliation.  

“Nobody wants to go out and disagree publicly with their incoming President-elect before he’s in office,” Tom Scully, the former Medicare and Medicaid chief under President George W. Bush, said of Ryan’s new comments moving toward the idea of doing repeal and replace at the same time.

Rep. Chris Collins (R-N.Y.), an early Trump backer, said Wednesday after Trump’s comments, “President-elect Trump’s timeline is a tighter timeline than our leadership was speaking about a month ago.”

Adding another wrinkle, Trump indicated at his press conference for the first time that his administration would put forward its own replacement plan. GOP sources say that announcement caught congressional Republicans off guard, and there has been a round of puzzlement over what is in the plan that Trump says his team is crafting.  

“It’s the first I’ve heard about it,” Collins said after Trump said he would put forward his own plan.  

Ryan said in an interview with Fox6 in Wisconsin, posted Tuesday, that Congress is working with Trump. “We’re working on it all together,” Ryan said. “It’s not his or ours.” 

Healthcare experts say sticking to Trump’s promise of doing a replacement simultaneously with repeal could prove nearly impossible. 

The drafting, negotiations and political maneuvering involved in a replacement plan would take months, if not longer, and could hardly be finished in Trump’s first 100 days.

“A detailed bill in the next few months, it’s very hard to see,” Scully said. He said Republicans could be more likely to put forward an outline of a replacement at the time they repeal the law, which would be faster than working out the details of a full plan.  

Congressional Republicans also say they want the replacement to be a series of smaller bills, not one large bill. Some of those smaller bills could be considered at the same time as repeal.

In the end, Trump’s healthcare plan could be closely in line with what congressional Republicans have been working on. 

One of his top advisers, Kellyanne Conway, went on MSNBC shortly after his comments about “insurance for everybody” and pivoted back to standard Republican ideas like selling insurance across state lines and expanding health savings accounts. 

Trump also promised during the campaign to “take care of everybody,” but the healthcare plan he proposed would have resulted in 21 million people losing coverage, according to an analysis from the Committee for a Responsible Federal Budget.