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Trump Hints At Obamacare Replacement That Would Look Nothing Like What Republicans Have In Mind

Maybe he's channeling Bernie Sanders. Or maybe he has no idea what he's saying.

17/01/2017 1:57 AM AEDT | Updated 19/01/2017 6:15 AM AEDT

President-elect Donald Trump says he’s putting the finishing touches on his plan to replace Obamacare.

It sounds absolutely terrific, like the best health plan ever!

It also sounds wildly out of step with what Republicans in Congress, or even some of Trump’s own advisers, have said they would like to do.

Trump’s comments, which he made in an interview with The Washington Post that appeared Sunday, could mean he’s gone rogue and decided that, at least on health care policy, he has more in common with Sen. Bernie Sanders (I-Vt.) than House Speaker Paul Ryan (R-Wis.).

Or they could mean that, in reaction to public anxiety and recent protests over the possibility of more than 20 million people losing insurance, Trump is already misleading people about what he and his Republicans are planning to do.

Or Trump’s statements could mean that he has no idea what he’s talking about.

Speaking to the Post’s Robert Costa, Trump said his new health care plan would mean “insurance for everybody” with “much lower deductibles.”

Also, Trump said, he will call for the government to negotiate with pharmaceutical companies directly, forcing them to lower their prices.

“They’re politically protected but not anymore,” Trump said of the drug industry.

Trump didn’t offer more details about what he has in mind, or give a precise date for when his plan would be ready for the public to see. But, he said, “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 added that he would probably wait until his nominee for secretary of health and human services, Rep. Tom Price (R-Ga.), has gone through the confirmation process and taken office. The Senate Finance Committee, which has jurisdiction over Price’s appointment, has not yet scheduled a hearing.

Making sense of Trump’s comments on policy is never easy, and in this case the comments are more confusing than usual.

Providing everybody with health insurance and protecting them from excessive medical costs has been a longtime goal of the Democratic Party, going back to the 1940sThose efforts eventually led to the Affordable Care Act, which has brought the number of Americans without coverage to a record low, improving access to health care and reducing financial insecurity.

Obamacare has its trade-offs. The coverage that many consumers have obtained through the program includes high deductibles or other forms of out-of-pocket spending, fueling the political backlash against it. Primarily that’s because the law’s new requirements on insurance, such as guaranteeing coverage of pre-existing conditions, made insurance more expensive ― and the law’s financial assistance phases out with higher incomes.

It’s a problem that even many of the law’s supporters have said they want to fix. Both Obama and 2016 Democratic presidential nominee Hillary Clinton proposed offering consumers more assistance with out-of-pocket costs and using government leverage to bring down drug prices.

Sanders, meanwhile, has been a longtime advocate for single-payer health insurance ― that is, having the government provide everybody with insurance directly. The plan he introduced during his 2016 presidential bid would have entailed much more government spending and European-style price controls throughout the health care industry.

Republicans, who have more or less been fighting expansions of government health insurance for as long as Democrats have been proposing them, take a very different view of things. In the nearly seven years since Obamacare has become law, Republicans have talked about replacing it with a number of different approaches, and among the most detailed is the legislation that Price introduced to the House.

But none of the plans Republicans have discussed would come close to covering everybody with lower out-of-pocket spending, simply because doing so would require the kind of approach Democrats have in mind ― much more federal spending and much more regulation of prices.

A fundamental goal of every conservative plan in circulation, at think tanks and on Capitol Hill, is to reduce federal spending and regulation, in most cases dramatically.

And in the past, when there’s been serious discussion of direct government negotiation with pharmaceutical companies over drug prices, Republicans (and Democrats with ties to the drug industry) have fought such efforts, often arguing that they would stifle innovation and reduce access to life-saving medications.

Trump’s remarks about going after the drug industry raise the possibility that he’s not perfectly in sync with the rest of his party on that issue. And comments he’s made previously, like telling CBS’ “60 Minutes” that “everybody has got to be covered,” suggest he thinks universal coverage is important ― or, at least, more important than Republicans typically think.

If Trump were serious about these things, Democrats would likely embrace him. On MSNBC’s “Morning Joe” Monday, Rep. Elijah Cummings (D-Md.) said: “On the prescription drug issue, Bernie Sanders and [Sen.] Elizabeth Warren [D-Mass.] and I have been working on this issue for years and we have not been able to get any traction. When I read yesterday that the president-elect wanted to begin to deal with this issue, I said ‘Hallelujah.’”

But it’s not at all clear whether Trump’s comments should be taken at face value.

During the campaign, Trump didn’t commit to many specifics on health care. But when he finally issued a policy proposal, it consisted entirely of boilerplate Republican ideas, such as turning Medicaid over to the states.

That’s one reason to think that his talk of covering everybody may actually just be another way of supporting “universal access,” a euphemism that Republicans have long used to describe plans that would leave fewer people with health insurance.

Whatever Trump is thinking, a reckoning seems inevitable. Republicans have promised repeatedly not just to repeal the health care law but to replace it ― and now even members of their own party, including Trump himself, have stated they should show their replacement plan before voting on repeal.

But once that replacement plan is available, independent experts, including those at the Congressional Budget Office, will be able to measure its effects. And at that point, Republicans will have to defend their plans ― and chances are they’ll look very different from the plan Trump is describing right now.

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