By MARSHA MERCER
President Donald Trump turned to House Speaker Paul
Ryan the other day and said: “He’s working on Obamacare. It’s going to be very
soon -- right?”
“Yes,” Ryan replied, as cameras rolled in the Oval
Office.
More than a nudge from the president, Ryan could use some
Lyndon Johnson-style arm twisting to make good on the Republicans’ long-term
promise to repeal and replace the Affordable Care Act.
Trump has left details of reforming health insurance
to Ryan and other Republicans in Congress, but they are floundering in a sea of
options.
Trump still sounds like he’s an outsider on the
campaign trail. When Humana became the latest major insurer to say it will stop
selling coverage on Obamacare exchanges in 2018, Trump tweeted: “Obamacare
continues to fail. Will repeal, replace and save health care for ALL
Americans.”
Yet he has presented no plan of his own and the goal
of replacement seems to be slipping farther into the future.
As a House member, Tom Price, the new Health and Human
Services secretary, offered a plan, one of many. None of the other plans has galvanized
widespread support even within the GOP, let alone with Democrats. It’s unclear
what Senate Republicans will accept.
Ryan went door-to-door, trying to build a consensus
around his “Better Way” plan, but Republicans even disagree on timing -- repeal
and replace at the same time or repeal first and take time on a replacement.
Trump has said repeal and replace will be “essentially
simultaneous.”
But Ryan told reporters this week that reform “affects
every person and every family in America,” and a deliberate, “step-by-step
approach” is needed for stability.
House Republicans received plan options at a party
caucus before they headed home for the week-long Presidents Day break.
Meanwhile, the House Freedom Caucus, a group of about
35 to 40 of the most conservative Republicans, wants to repeal the law now and is
backing a plan by Sen. Rand Paul of Kentucky.
Paul’s plan would undo most of the Obamacare rules,
rely on expanded health savings accounts, allow people to buy insurance across
state lines and join associations to increase purchasing power.
Paul would also jettison the Medicaid expansion that
was a state option under the Affordable Care Act. That’s a sticking point. It’s
always easier to give people a benefit than take one away.
Before he left office, President Barack Obama urged
Democrats not to “rescue” Republicans in their efforts to replace Obamacare. House Republicans voted scores of times to repeal Obamacare
since the law was enacted in 2010 without a single Republican vote.
Despite the years of controversy over Obama’s
signature law, it appears many Americans remain surprisingly uninformed. More
than one in three either thought the Affordable Care Act and Obamacare are
different programs or didn’t know whether they are the same or different, a
poll by Morning Consult reported last month.
The Trump administration is taking actions that
actually could make the law more palatable to critics.
The Internal Revenue
Service is relaxing a key enforcement mechanism scheduled to take effect this
year. The IRS was to withhold tax refunds from people who failed to comply with
the mandate to purchase health insurance or pay a tax penalty. Instead, IRS will
process returns and refunds as usual.
In addition, HHS just proposed new rules aimed at
stabilizing the exchanges to encourage insurers to keep offering coverage and customers
more plan choices.
Obama promised Americans if they liked their doctors
or their health insurance plans, they could keep them. The claim turned out to
be false and was a source of anger that motivated many voters.
Trump promised to get rid of Obamacare and put
something better in its place while retaining the law’s popular provisions.
People
hate paying higher insurance premiums – which they blame on Obamacare even
though premiums were rising before the law. But they like keeping children under
26 on their insurance plans and not being denied, or priced out of, coverage
because of pre-existing medical conditions.
It’s a curious turn that, for the time being anyway, Republican
dithering on Capitol Hill means Trump is keeping Obamacare alive.
©2017 Marsha Mercer. All rights reserved.
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