By
Robert Costa and Amy Goldstein
January
15, 2017
President-elect Donald Trump said in a weekend
interview that he is nearing completion of a plan to replace President 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, after 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.
“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 decision
rests with the Senate Finance Committee, which hasn’t 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 taken the first steps
toward repealing the law through budget reconciliation, a process by which only
a simple majority is needed in the Senate. The process would enable them to
dismantle aspects of the law that involve federal spending.
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 adopt more conservative health-care policies, which tend to
rely more heavily on the private sector.
“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.”
Republican leaders have said that they will not
strand people who 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 they intend to accomplish that.
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 drugmakers 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 is uncertain, however, with
respect to Medicaid, the insurance for low-income Americans run jointly by the
federal government and states. 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.
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