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Trump Tells G.O.P. to Replace Health Care Law ‘Quickly’ Trump Tells Congress to Repeal Health Care Law ‘Very Quickly’
(about 2 hours later)
President-elect Donald J. Trump pressed Republicans on Tuesday to move forward with the immediate repeal of the Affordable Care Act and to replace it very quickly thereafter, saying, “We have to get to business. Obamacare has been a catastrophic event.” President-elect Donald J. Trump demanded on Tuesday that Congress immediately repeal the Affordable Care Act and pass another health law quickly thereafter, issuing a nearly impossible request: replace a health law that took nearly two years to pass with one Republicans would have only weeks to shape.
Mr. Trump’s position undercuts Republican leaders who want a quick vote to repeal President Obama’s signature domestic achievement but who also want to wait as long as two to three years to come up with an alternative. But he was also challenging the resolve of nervous Republicans in Congress who do not want any vote on a repeal until that replacement exists. “We have to get to business,” Mr. Trump told The New York Times in a telephone interview. “Obamacare has been a catastrophic event.”
Mr. Trump, who seemed unclear about the timing of already scheduled votes in Congress this week, demanded a repeal vote “probably some time next week,” and said “the replace will be very quickly or simultaneously, very shortly thereafter.” Mr. Trump appeared to be unclear both about the timing of already scheduled votes in Congress and about the difficulty of his demand — a repeal vote “probably some time next week” and a replacement “very quickly or simultaneously, very shortly thereafter.”
That demand is very likely impossible. Republicans in Congress are nowhere close to agreement on a major health bill that would replace President Obama’s signature domestic achievement. A number of Republicans in the House and Senate have said publicly that they wanted to hold off on voting to eviscerate the health law until a replacement measure could be negotiated. Republican leaders have made the repeal of President Obama’s signature domestic achievement a top priority, and votes on Thursday in the Senate and Friday in the House would approve parliamentary language crafted to protect legislation to appeal the Affordable Care Act from a filibuster in the Senate.
For now, the Senate is planning to vote Thursday morning on a budget resolution that would set up parliamentary protections for a health care repeal bill that would have to emerge from House and Senate committees by Jan. 27. The House would vote on Friday if that budget measure clears the Senate. The House speaker, Paul D. Ryan of Wisconsin, who consults often with Mr. Trump, set forth a similar timetable on Tuesday, saying that a bill to repeal the health care law would include some legislation to replace aspects of it, though Republicans have yet to agree on the details of their alternative.
That plan is under pressure from Republicans who want to slow the process as they struggle for an agreement on what would follow repeal. “It is our goal to bring it all together concurrently,” Mr. Ryan said.
But Mr. Trump said there was no cause for delay. And he said he would not accept a delay of more than a few weeks before a replacement plan was voted on. “Long to me would be weeks,” he said. “It won’t be repeal and then two years later go in with another plan.” That directly contradicts House Speaker Paul D. Ryan’s plans. But those ambitions will be difficult to achieve and will almost certainly require Democratic cooperation. Until now, Republicans could vote to repeal Mr. Obama’s health law with no fear that they would have to live with the political consequences of scuttling a law that provides health care for 20 million Americans and protects millions more from discrimination for pre-existing medical conditions, ends lifetime caps on insurance coverage and allows children to remain on their parents’ insurance policies until age 26.
Mr. Ryan, who met privately on Monday with top transition officials, agreed with Mr. Trump on the state of the Affordable Care Act, saying Tuesday that its marketplaces were in a “death spiral.” But he has argued that lawmakers need time to write a bipartisan health bill that would replace it. With complete control of Washington, what comes next in health policy will belong to the Republican Party. For several days, congressional Republicans of diverse political views — moderates and conservatives alike — have been saying they are nervous about repealing the law without any clear idea of what comes next. Five Senate Republicans have pressed to delay the deadline for a repeal vote until March and several House Republicans are also demanding that the pace slow down.
In fact, new enrollment numbers from the Obama administration undercut that claim. Despite increasing premiums and a torrent of negative news about the future of the health law, enrollment under the act’s health care plans has continued to grow. There are now 11.5 million people who have chosen the marketplace plans for this year, nearly 300,000 more than at this time last year. “In an ideal situation, we would repeal and replace Obamacare simultaneously, but we need to make sure that we have at least a detailed framework that tells the American people what direction we’re headed,” said one of those five Republicans, Senator Susan Collins of Maine.
Those numbers do not represent surprising enrollment growth — they are roughly in line with projections put out by the administration a few months ago — but they do suggest that higher prices have not scared away consumers. The proportion of young adults signing up has held steady, a sign that the mix of people buying insurance this year is unlikely to be substantially sicker and more expensive than the people enrolled in plans last year. As it stands, the budget resolution that will fast-track that vote gives Senate and House committees until Jan. 27 to write legislation that would repeal major provisions of the health care law. But the schedule for action on that legislation, its effective date and the timetable for phasing in a new system of health insurance coverage are all unresolved questions.
“Today’s data show that this market is not merely stable, it is actually on track for growth,” Aviva Aron-Dine, a senior counselor to Sylvia Mathews Burwell, the secretary of Health and Human Services, said in a conference call with reporters. “Today we can officially proclaim these death spiral claims dead.” Even the Jan. 27 deadline is not enforceable or particularly meaningful, Senate aides said, indicating that Congress could follow any timetable its leaders might prescribe.
The data released Tuesday did not capture all Americans who buy their own insurance plans. While enrollment in health care plans under the act is growing, it will take time to know whether people are continuing to purchase similar plans sold directly by health insurance companies. Those plans have also been subject to large price increases, and the people buying them do not have access to federal subsidies to bring down their premiums and deductibles. That uncertainty apparently convinced Mr. Trump to leap into the fray. Not only did he try to steel Republican spines, but he threatened Democrats who might stand in his way, saying he would campaign against them, especially in states that he won in November.
But Mr. Trump showed no sign of willingness to accept the health law any longer. “It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, he said, warning that “they have 10 people coming up” for re-election in 2018. That alluded to Democratic senators in states he won.
“It’s a catastrophic event,” he said. “I feel that repeal and replace have to be together, for very simply, I think that the Democrats should want to fix Obamacare. They cannot live with it, and they have to go together.”
Mr. Trump issued a political warning to Democrats who might stand in his way, saying he would campaign against lawmakers, especially in states that he won in November.
“It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, warning that “they have 10 people coming up” for re-election in 2018. That alluded to Democratic senators in states he won.
“I won some of those states by numbers that nobody has seen. I will be out there campaigning,” he said.“I won some of those states by numbers that nobody has seen. I will be out there campaigning,” he said.
He described the health law as a catastrophe. “I feel that repeal and replace have to be together, for very simply, I think that the Democrats should want to fix Obamacare,” he said. “They cannot live with it, and they have to go together.”
After meeting with House Republicans on Tuesday, Mr. Ryan took a similar tone, calling the campaign to repeal the health law “a rescue mission to save families who are getting caught up in the death spiral that has become Obamacare.”
Aides to Mr. Ryan said the effort to dismantle the Affordable Care Act would include not only the main bill that would be protected from a filibuster in the Senate, but also legislation that would not enjoy such protections. That legislation would take Democratic cooperation to be passed, because Senate Republicans are eight votes short of a filibuster-proof majority.
Far from a “death spiral,” Mr. Obama and congressional Democrats call the Affordable Care Act the best health law since the creation of Medicare and Medicaid in 1965. And the Obama administration reported on Tuesday that more than 11.5 million people nationwide had signed up for health insurance or been automatically re-enrolled under the Affordable Care Act as of Dec. 24, 2016. Of that total, officials said, more than 8.7 million people came in through HealthCare.gov, the online federal marketplace, and 2.8 million were enrolled in states using their own marketplace platforms.
“Today’s data show that this market is not merely stable, it is actually on track for growth,” Aviva Aron-Dine, a senior counselor to Sylvia Mathews Burwell, the secretary of Health and Human Services, said in a conference call with reporters. “Today we can officially proclaim these death spiral claims dead.”
The fourth annual open enrollment period started on Nov. 1 and ends on Jan. 31, 11 days after Mr. Trump’s inauguration.