"Repeal and replace Obamacare" has been a rallying cry for the Republican Party since the Affordable Care Act was passed. Now that Republicans have Congress and the presidency, they've got their big chance to scrap the law. Realizing that there are parts of the law that people actually like, though, President-elect Donald Trump has suddenly started talking more about "amending" the law and keeping the parts of it that people liked. Man what a surprise.
Trump told the Wall Street Journal that he likes the provisions keeping insurers from denying coverage based on pre-existing conditions and allowing parents to keep their children on their plans until the age of 26 "very much" and that he would look to keep those in any kind of new healthcare legislation.
“Either Obamacare will be amended, or repealed and replaced,” Trump told the paper, giving us a view into the anything can happen, fly by the seat of your pants legislative process that making America great again entails.
A key piece of understanding Trump? He is often swayed by whoever he last talked to https://t.co/8IuhEnvXUT
— Maggie Haberman (@maggieNYT) November 11, 2016
Trump said his change of heart came after he spoke with President Obama at the White House. It could also come from Congressional Republicans not actually expecting Trump to win, and having to suddenly actually repeal and replace the law that they've made a lot of political hay out of opposing. A "senior G.O.P. aide" told a reporter at LinkedIn that Republicans are currently "in rapid detox of holy crap, we have to actually do this."
"Repeal and replace" has always run up against two realities: there have been parts of the law that are broadly popular, and for all the law's faults, it's expanded coverage. Which means a repeal would have to keep the parts people like and manage to not cost people their insurance. As the Times notes, healthcare experts say that the parts of the law that people like and that Congressional Republicans insist will survive can only be effective if the rest of the law is in place:
Policy experts say that the part of the law that Mr. Trump is rethinking, that prevents insurers from refusing to cover people with costly medical conditions, only works financially for insurers if there are plenty of healthy people also buying insurance. If only sick people enroll, premiums would soar. To get healthy people covered, the existing law includes generous subsidies to help more people to afford a policy and taxes people who don’t buy insurance.
As for what the actual Republican proposals will be outside of somehow keeping things that are broadly popular while removing the unpopular parts, Jacobin has a rundown. A Paul Ryan-backed plan includes things like health savings accounts, weakening the pre-existing conditions coverage protections, putting states in charge of Medicaid and of course, privatizing Medicare. Which Ryan reminded the world he was still very much in favor of during a recent Fox News interview.
Whatever happens, Trump told CBS that there won't be “a two day period or a two year period where there’s nothing. It will be repealed and replaced. I mean, you’ll know. And it’ll be great health care for much less money.” Which is just really, really reassuring.