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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