Trump Promises To Repeal and Replace Obamacare Together, But Can It Be Done?
The Obamacare Challenge

Trump Promises To Repeal and Replace Obamacare Together, But Can It Be Done?

REUTERS/Jonathan Ernst

President-elect Donald Trump vowed on Wednesday to unveil proposals to repeal and then replace the Affordable Care Act literally within days or hours of each other by early next month. He insisted that GOP congressional leaders will have to pick up the pace to demonstrate to Americans that this is a seamless way to achieve the long-promised goal.

During his first major news conference since last summer, Trump said that within days of the Senate confirming Rep. Tom Price (R-GA) as Trump’s secretary of health and human services, the new administration will propose specific language for both repealing key provisions of Obamacare and replacing it with a new Republican-style health insurance program.

Related: Why Republicans Are Hitting the Brakes on Obamacare Repeal

Republican congressional aides say that dismantling the Affordable Care Act would be the easier task and will involve passing a budget resolution protected from a filibuster in the Senate under special budget reconciliation rules. Actually replacing Obamacare with a new health insurance program would be much tougher because Senate Republicans are eight votes short of the 60-vote super majority needed to pass major legislation. That means the Republicans will ultimately need help from the Democrats to push through a replacement.

 “It will be essentially simultaneously,” Trump explained to reporters gathered at the Trump Tower in New York. “It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day, could be the same hour. … And we’re going to get a health bill passed. We’re going to get health care taken care of in this country.”

Trump offered no clues as to the size, shape or details of a Republican replacement plan, although a number of Republicans including Price, the former House Budget Committee chair, House Speaker Paul Ryan and Senate Health, Education and Labor Committee chair Lamar Alexander of Tennessee have floated replacement plans.  None of these plans have been thoroughly vetted for cost and impact. And none has attracted widespread support within the GOP or among Democrats, whose support will be essential to enacting replacement legislation.

However, Trump made it clear in an interview with The New York Times yesterday that congressional Republicans’ plans to repeal Obamacare by late January or early next month but then take as long as two years to enact replacement legislation would be a non-starter with the president-elect.

The Senate was scheduled to approve a budget resolution by Thursday morning that would begin the process in committee of drafting the details of the repeal legislation -- with a Jan. 27 deadline for completing the work and reporting back to the Senate. Democrats hope to slow the process a little tonight by offering scores of “poison pill” amendments in a marathon “vote-a-rama.” The House will follow suit on Friday with a floor vote to get the ball rolling, and the same deadline for committees to report back with details of the repeal.

Related: 5 Big Promises Trump Won’t Be Able to Keep

Senate Majority Leader Mitch McConnell (R-KY) has pledged to bring up the replacement legislation as “quickly” as possible, and Ryan insists that “our goal is to bring it all together concurrently. But that sounds more like wishful thinking than an iron-clad strategy to accommodate an impatient incoming Republican president.

Virtually anyone who knows anything about the way Congress operates understands that replacement legislation of that magnitude takes many months, if not years, to assemble and enact. Even if McConnell and Ryan (R-WI) manage to ram through a budget resolution repealing Obamacare on an expedited basis, drafting replacement legislation that meets the approval of Republican and Democratic rank and file members, insurers and other special interests and the more than 20 million Americans currently covered by Obamacare will be a herculean effort.

It took President Obama and his Democratic allies nearly two years to negotiate the terms of the Affordable Care Act.

“Even the repeal part isn’t very easy because you have to think yourself through what provisions you really want to keep and what you can afford to change,” said Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute. “But replace is so much more complicated. There are layers and layers of policy decisions that have to be made, and they interact with each other.”

Related: Rand Paul Is Coming to the Rescue with an Obamacare Replacement Plan

“On any given topic, there might appear to be a policy change you want to make, but you have to think yourself through what does that mean for essentially everything else.”

Although it all seemed so simple for the Republicans coming off their startling Nov. 8 presidential and congressional election victories, the party since then has been splintering over whether to forge ahead with repealing Obamacare – and possibly stripping millions of Americans of their Obamacare and expanded Medicaid coverage – or move more cautiously. A growing chorus of interests, including the insurance industry, pharmaceutical companies, hospitals and other health facilities and Republican governors are warning of a dire situation if Congress moves ahead with repeal legislation without any idea of how to replace it.

Five Senate Republicans led by Foreign Relations Committee Chair Bob Corker of Tennessee are urging that the leadership wait until March to vote on repealing key aspects of the Affordable Care Act, while a handful of conservative Republicans in the House are also cautioning their party to slow down.

Sen. Alexander told reporters he only favors repealing Obamacare once "there are concrete, practicable reforms in place." "It's not about developing a quick fix,” he said. “It's about working toward a long-term recovery that works for everyone.”

Related: Obamacare Repeal Could Push Rural Hospitals to the Brink 

During his meeting with reporters today, Trump renewed his assault on Obamacare, dismissing it as a “disaster” with astronomical premium and copayment costs that must be dismantled. “The deductibles that are so high that after people go broke paying their premiums which are going through the roof, healthcare can’t even be used by them because the deductibles are so high.”

Trump said it would be easy for the Republicans to sit back for another year or two and watch Obamacare continue to implode rather than stepping in to ease the burden of average Americans facing soaring premium costs. “We don’t want to own it politically,” he said of the controversial program. “They [the Democrats] own it right now. So the easiest thing would be to let it implode in ’17, and believe me, we would get pretty much everything we wanted, but it would take a long time.”