The new House Republican legislation to repeal and replace -ObamaCare gives President Trump a chance to fulfill one of his most touted campaign promises.
“My first day in office, I am going to ask Congress to put a bill on my desk getting rid of this disastrous law and replacing it with reforms that expand choice, freedom, affordability,” Trump told supporters during an October rally in Florida.
As the GOP nominee, Trump made opposition to the healthcare law a major portion of his presidential campaign, at times making lofty claims about what the future of care would look like in his administration.
While the party couldn’t agree on a plan by Trump’s first day in office, the president embraced the new GOP plan after it was unveiled Tuesday, calling it “our wonderful new healthcare bill” on Twitter.
But, perhaps in a nod to the mounting concerns from within his own party, Trump added that the legislation is “out for review and negotiation,” leaving the door open for changes now and subsequent bills to finalize the full repeal-and-replace.
Here are five of Trump’s most important campaign promises on healthcare and how they are being addressed — or aren’t — in the new legislative framework.
One of Trump’s most surprising claims came back in September of 2015 when he effectively called for universal healthcare coverage through an undefined shift away from -ObamaCare.
“Everybody’s got to be covered. This is an un-Republican thing for me to say, because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private,’” Trump said on CBS’s “60 Minutes.”
“I am 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. … The government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan, and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies, and they can have their doctors, they can have plans, they can have everything.”
Trump presidential rival Sen. Ted CruzRafael (Ted) Edward CruzSenate confirms four Biden ambassadors after delay Overnight Health Care — Presented by Carequest — Colin Powell's death highlights risks for immunocompromised The Senate confirmation process is broken — Senate Democrats can fix it MORE (R-Texas) used that interview to accuse Trump of embracing single-payer healthcare, even though Trump seemed to be alluding to a private-sector arrangement.
The new Republican plan would repeal -ObamaCare subsidies to help with insurance purchases, replacing them instead with tax credits.
The Congressional Budget Office hasn’t considered the legislation yet, but most experts agree it would likely reduce the number of insured people.
Health savings accounts
Trump has long touted health savings accounts (HSAs), dedicated accounts that provide tax breaks for money spent on healthcare.
He called the accounts “phenomenal” during an October appearance on Fox News in October. During a pivotal speech in Gettysburg, Pa. a few days earlier, Trump said he planned to “fully repeal -ObamaCare and replace it with health savings accounts.”
The new GOP legislation doesn’t rely on HSAs as the primary vehicle for the replacement, instead using tax credits to help people buy insurance. But the new plan would revamp HSAs by lowering taxes on the funds, allowing spouses to contribute to one account and raising contribution limits.
Buying insurance across state lines
The push to allow healthcare sales across state lines is supported by both Trump and many Republican lawmakers, a free-market argument that blames restricted competition in part for high healthcare costs.
“We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing,” Trump said during the second general election debate in October.
“President Obama and whoever was working on it, they want to leave those lines, because that gives the insurance companies essentially monopolies. We want competition.”
Laws currently restrict insurers from selling nationwide or multistate plans as part of deference to state insurance laws. Republicans have long argued that this is an example of unnecessary government regulation that keeps prices high. But many healthcare experts say that sales across state lines would fail to significantly reduce the cost of healthcare.
The new legislation does not address this issue, since it can’t be achieved using the filibuster-proof budget reconciliation process that Republicans plan to use for the first repeal bill. But Trump tweeted Tuesday morning that the policy will be addressed in a later “phase” of the “healthcare rollout.”
Republicans have long targeted entitlement reform as a way to cut deficits and reduce debt, but Trump drew a line in the sand on Medicaid during the campaign.
“I’m not going to cut Social Security like every other Republican. And I’m not going to cut Medicare or Medicaid,” he told The Daily Signal in 2015 before he officially announced his bid.
“And even if they wouldn’t, they don’t know what to do because they don’t know where the money is. I do.”
Trump repeated the promise throughout the campaign, distancing himself from Republican orthodoxy.
Some Republican governors accepted -ObamaCare’s Medicaid expansion, which will ultimately be rolled back under the new framework. Along with capping federal Medicaid payments, the new legislation would eventually amount to a cut in the program altogether, which could potentially cost support from key lawmakers.
While he’s no fan of -ObamaCare, Trump agrees with politicians who want to keep the -ObamaCare rule that prevents insurance companies from denying coverage to or raising rates on patients with pre-existing conditions.
“Except pre-existing conditions, I would absolutely get rid of -ObamaCare. We’re going to have something much better, but pre-existing conditions ... I want to keep pre-existing conditions. I think we need it, I think it’s a modern age, and I think we have to have it,” Trump said during the CNN-Telemundo debate in February of 2016.
It’s a politically smart position, as a new CNN poll found that 87 percent of Americans back keeping the policy in place.
-ObamaCare’s individual mandate was meant to force enough young people into insurance plans to subsidize more expensive insurance customers, including those with pre-existing conditions.
It’s not clear whether the GOP plan will have the same level of incentives for insurers. Instead of an individual mandate, the new GOP plan promises monthslong surcharges for customers who allow their coverage to lapse.
The plan also allots $100 billion for states to fund “high-risk pools” for residents with pre-existing conditions who couldn’t afford coverage, but many experts say that isn’t nearly enough funding to cover the pools’ costs.