The honeymoon between Donald Trump and congressional Republicans may be ending. There is widespread disagreement between the president-elect and members of his party on Capitol Hill. At issue is not the viewpoint that Obamacare must go, but how and when to replace it.
The chasm between the two camps is underscored by a weekend interview in which Donald Trump promised that his version of a replacement plan will contain universal health coverage. “We’re going to have insurance for everybody,” Trump told the Washington Post. “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.”
Trump’s promise to expand the healthcare entitlement to cover everyone echoes promises that he made during the campaign to provide coverage for more people. It also puts him at odds with Republicans who oppose the Obamacare mandate and prefer to shrink the government’s role in health insurance. The traditional Republican view is that the government should remove barriers to lowering the cost of health insurance. Economic law dictates that if people want a product, more people will buy it as the price goes down.
Rep. Tom Price (R-Ga.), who Trump named as his nominee to head the Department of Health and Human Services, is one of those who have proposed alternative plans in the past. Price’s plan includes tax credits for those who purchase health insurance, a ban on penalties and denials for pre-existing conditions provided the consumer has had continuous insurance coverage, limiting health care deductions for businesses, allowing insurance policies to be sold across state lines and allowing the sale of basic, cheaper plans that would appeal to younger, healthy consumers. Uninsured people with pre-existing conditions could be covered by assigned risk pools.
A second popular Republican approach is the bill introduced by Rep. Phil Roe (R-Tenn.) and the Republican Study Committee. This bill shares many aspects of Price’s proposal and has broad Republican support. The bill also includes provisions to make the pricing of healthcare more transparent to consumers.
Because of the close balance of power in the Senate, any hardline Republican bill will be dead on arrival. There are enough Senate Democrats to filibuster a replacement bill that does not have at least a minimum of Democrat support.
“I’m willing to listen to Democrats ideas to this bill, to amendments to this bill as opposed to what they did which was to completely shut the other side out,” Rep. Roe told the Daily Caller.
One idea that may bring Democrats on board is Sen. Bill Cassidy’s proposal to allow states to choose to keep Obamacare exchanges. Cassidy’s proposal embodies the conservative ideal that states should be free to choose what works best for their citizens rather than forcing a top-down, one-size-fits-all, federal dictate.
“The bill that I have put forward would actually give states a choice: if they did nothing they would go into the alternative, that we call the state alternative, but a state could actually choose to stay in Obamacare,” Cassidy told CBS News. “Republicans have always said if you like your insurance, you can keep it -- and we mean it, so if the folks in California or New York really love Obamacare they can keep Obamacare.”
The Republican proposals to replace Obamacare all have one thing in common. The authors of the proposals, Tom Price, Phil Roe and Bill Cassidy, are all medical doctors who have had careers in private practice. They understand the real world implications of the laws that they are writing for both doctors and patients.
Some aspects of Price’s old plan may not survive his job change. “My guess is that Tom Price as head of HHS will approach things vastly different than Tom Price who was introducing legislation that was never going to become law, okay?” commented Sen. Bob Corker (R-Tenn.) in Politico.
Nevertheless, many Republicans trust Price’s ability to help shape the debate and influence the new president. “Dr. Price was a leader of our Better Way agenda on health care and helped shape ... much of what the House proposal is,” said House Ways and Means Committee Chairman Kevin Brady (R-Tex.). “So I feel like we’re heading in the same direction.”
The road to an Obamacare replacement may be a long one. Politico reports that Rep. Price’s confirmation as Secretary of Health and Human Services will not take place until sometime in February. Much of the grunt work of crafting a replacement bill can’t take place until Price has stepped into his new role in the Trump Administration.
Originally published
on The
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