President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Barack Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.
Trump declined to reveal specifics in the telephone interview late Saturday with The Washington Post, but any proposals from the incoming president would almost certainly dominate the Republican effort to overhaul federal health policy as he prepares to work with his party’s congressional majorities.
Trump’s plan is likely to face questions from the right, following years of GOP opposition to further expansion of government involvement in the health-care system, and from those on the left, who see his ideas as disruptive to changes brought by the Affordable Care Act that have extended coverage to tens of millions of Americans.
In addition to his replacement plan for the ACA, also known as Obamacare, Trump said he will target pharmaceutical companies over drug prices and demand that they negotiate directly with Medicaid and Medicare.
“They’re politically protected, but not anymore,” he said of pharmaceutical companies.
The objectives of broadening access to insurance and lowering health-care costs have always been in conflict, and it remains unclear how the plan that the incoming administration is designing – or ones that will emerge on Capitol Hill – would address that tension.
In general, congressional GOP plans to replace Obamacare have tended to try to constrain costs by reducing government requirements, such as the medical services that must be provided under health plans sold through the law’s marketplaces and through states’ Medicaid programs. House Speaker Paul D. Ryan (R-Wis.) and other Republicans have been talking lately about providing “universal access” to health insurance, instead of universal insurance coverage.
Trump said he expects Republicans in Congress to move quickly and in unison in the coming weeks on other priorities as well, including enacting sweeping tax cuts and beginning the building of a wall along the Mexican border.
Trump warned Republicans that if the party splinters or slows his agenda, he is ready to use the power of the presidency – and Twitter – to usher his legislation to passage.
“The Congress can’t get cold feet because the people will not let that happen,” Trump said during the interview with The Post.
Trump said his plan for replacing most aspects of Obama’s health-care law is all but finished. Although he was coy about its details – “lower numbers, much lower deductibles” – he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell. R-Ky.
“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said. He noted that he is waiting for his nominee for secretary of health and human services, Rep. Tom Price. R-Ga., to be confirmed. That confirmation rests with the Senate Finance Committee, which has not yet scheduled a hearing.
Trump’s declaration that his replacement plan is ready comes after many Republicans – moderates and conservatives – expressed anxiety last week about the party’s lack of a formal proposal as they held votes on repealing the law.
Once his plan is made public, Trump said, he is confident that it could get enough votes to pass in both chambers. He declined to discuss how he would court wary Democrats.
So far, Republicans have used budget reconciliation – where only a majority is needed – on the initial steps to repeal the health-care law. Removing or replacing other parts of the law is likely to require 60 votes to overcome Democratic filibusters. The GOP has a 52-to-48 edge in the Senate.
The plan that Trump is preparing will come after the House has taken more than 60 votes in recent years to kill all or parts of the ACA to kill to adopt more conservative health-care policies, which tend to rely more heavily on the private sector.
Republican leaders have said that they will not strand people who have gained insurance under the ACA without coverage. But it remains unclear from either Trump’s comments in the interview or recent remarks by GOP leaders on Capitol Hill how exactly they intend to accomplish that.
“I think we will get approval. I won’t tell you how, but we will get approval. You see what’s happened in the House in recent weeks,” Trump said, referencing his tweet during a House Republican move to gut their independent ethics office, which along with widespread constituent outrage was cited by some members as a reason the gambit failed.
As he has developed a replacement package, Trump said he has paid attention to critics who say that repealing Obamacare would put coverage at risk for more than 20 million Americans covered under the law’s insurance exchanges and Medicaid expansion.
“We’re going to have insurance for everybody,” Trump said. “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.”
People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
For conservative Republicans dubious about his pledge to ensure coverage for millions, Trump pointed to several interviews he gave during the campaign in which he promised to “not have people dying on the street.”
“It’s not going to be their plan,” he said of people covered under the current law. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people,” he said Saturday.
Trump did not say how his program overlaps with the comprehensive plan authored by House Republicans. Earlier this year, Price suggested that a Trump presidency would advance the House GOP’s health-care agenda.
When asked in the interview whether he intends to cut benefits for Medicare as part of his plan, Trump said “no,” a position that was reiterated Sunday on ABC by Reince Priebus, Trump’s incoming chief of staff. He did not elaborate on that view or how it would affect his proposal. He expressed that view throughout the campaign.
Timing could be difficult as Trump puts an emphasis on speed. Obama’s law took more than 14 months of debate and hundreds of hearings. To urge lawmakers on, Trump plans to attend a congressional Republican retreat in Philadelphia this month.
Moving ahead, Trump said that lowering drug prices is central to reducing health-care costs nationally – and that he will make it a priority as he uses his bully pulpit to shape policy.
When asked how exactly he would force drug manufacturers to comply, Trump said that part of his approach would be public pressure “just like on the airplane,” a nod to his tweets about Lockheed Martin’s F-35 fighter jet, which Trump said was too costly.
Trump waved away the suggestion that such activity could lead to market volatility on Wall Street. “Stock drops and America goes up,” he said. “I don’t care. I want to do it right or not at all.” He added that drug companies “should produce” more products in the United States.
The question of whether the government should start negotiating how much it pays drug-makers for older Americans on Medicare has long been a partisan dispute, ever since the 2003 law that created Medicare drug benefits prohibited such negotiations.
Trump’s goal, however, with respect to Medicaid, the insurance for low-income Americans run jointly by the federal government and states is uncertain. Under what is known as a Medicaid “best price” rule, pharmaceutical companies already are required to sell drugs to Medicaid as the lowest price they negotiate with any other buyer.
On his plan for tax cuts, Trump said that “we’re getting very close” to putting together legislation. His advisers and Ryan met last week and have been working from his campaign’s plan and from congressional proposals to slash current rates.
“It’ll probably be 15 to 20 percent for corporations. For individuals, probably lower. Great middle-class tax cuts,” Trump said.
On corporate tax rates, “We may negotiate a little, but we want to bring them down and get as close to 15 percent as we can so we can see a mushrooming of jobs moving back.”
Trump said he would not relent on his push for increasing taxes on U.S. companies that manufacture abroad – and insisted that the upcoming tax cuts should be enough reason for companies to produce within the United States.
“If companies think they’re going to make their cars or other products overseas and sell them back into the United States, they’re going to pay a 35 percent tax,” he said.
Briefly touching on immigration, Trump said that building a border wall and curbing illegal immigration remain at the top of his to-do list and that he is spending significant time looking at ways to begin projects, both with Congress and through executive action. He did not disclose what was to come on those fronts.
(c) 2017, The Washington Post · Robert Costa, Amy Goldstein