Is the party promising access to insurance for everybody, as congressional Republicans have long pledged, or are they promising insurance for everybody, as Trump told WaPo last weekend? The latter implies making universal coverage a top priority in whatever comes next, the former doesn’t. Inquiring minds want to know, and by “inquiring minds” I mean the people on Capitol Hill who are right now trying to come up with a new system of health insurance for the United States.
“I think that syncs up with what our members have been saying, that we think everybody ought to have access to affordable health care insurance. I assume that’s what he means by that statement and that’s how we’re proceeding,” said Sen. John Thune, the third-ranking Senate Republican.
Pressed on the difference between health care for everyone and access to health care for everyone, Thune said reporters would have to ask Trump what he meant. He said he didn’t know if Trump’s transition team had explained the statement to Congressional Republicans.
Mike Pence told CNN that he took Trump’s comments to mean making insurance affordable for everybody, but he seems not entirely sure either.
Follow-up question: Is Trump planning to introduce his own replacement plan or is he leaving it to Ryan and McConnell to come up with a new system, with input from the White House? The WaPo story made it sound like he has his own plan in the works (“It’s very much formulated down to the final strokes”) but that was news to John Cornyn when he was asked about it yesterday while Rep. Chris Collins said, “It’s the first I’ve heard about it.” Cornyn and Collins aren’t random nobodies: Cornyn is number two in the Senate GOP caucus and Collins is the Trump transition team’s designated liaison to Congress. If anyone would have had an inkling that a Trump health-care plan was being prepared by the White House, they would have. Instead they were both blindsided.
Yuval Levin’s sources on the Hill say that they’re not only not sure if Trump is preparing his own plan or not, they’re not sure what sort of timeline he’s willing to accept for replacing ObamaCare:
After Rand Paul announced he had spoken with Trump, who agreed with him about making repeal and replace simultaneous, one congressional staffer suggested at a Capitol Hill meeting on health care that his boss could call Trump and get him to say the opposite. After Trump’s news conference last week, several members and staffers suggested (independently) that Trump must mean that repeal and replace should take effect simultaneously, rather than that they should be enacted simultaneously, in which case congressional Republicans were already on the same page as Trump. (And of course, that could very well be what Trump meant.) After Trump’s Washington Post interview this past Sunday, the conservative health-care universe, including some people on Trump’s own team, quickly concluded that the separate administration plan he described was entirely a figment of Trump’s imagination…
Beyond this adjustment in response to Trump’s remarks, congressional Republicans are still unsure how to work with the incoming administration. Trump’s style, some uncertainty about who is in charge on his staff, and a touch of resentment at his vague public criticism of their strategy has left many uneasy about committing to any path. They fear getting far down the road toward legislation only to have Trump hear it criticized on Morning Joe and then declare on Twitter that he’ll veto it.
If his own team hasn’t heard about the White House health-care plan that’s allegedly in the works, it means either (a) it doesn’t exist or (b) Jared Kushner’s been typing something up on his computer at odd hours that Trump’s going to end up handing to Paul Ryan with an instruction to “make it happen.” I’m leaning towards the first option (but wouldn’t rule out the second), especially since Trump himself seemed to back away from the “insurance for everybody” promise in an interview with Axios this morning, saying “he wanted to find a mechanism — Medicaid block grants, perhaps — to help the poorest get insurance.” The congressional GOP will work with him on that.
Take five minutes and read this short but interesting interview with Republican Sen. Bill Cassidy, who’s floating his own bill called the “Patient Freedom Act,” which Susan Collins has signed on to. His plan is to let states keep their ObamaCare exchanges if they like while giving them the option of getting rid of them and going in a different direction if they prefer. That’s the only way you’re going to get Senate Democrats to buy into a replacement plan, he reasons, which is important given that McConnell will need 60 votes to get one through. Cassidy wants to get rid of the federal mandate requiring Americans to buy insurance — presumably states that retain their O-Care exchanges would pass a state mandate? — and it’s unclear right now if the federal government would continue to subsidize premiums for exchange consumers. But if you’re thinking in terms of a compromise plan, that’s one starting point.