President Trump’s address to Congress this week marked a turning point in the fight to repeal and replace ObamaCare. Specifically, he provided a key element that the GOP reform effort has thus far desperately lacked — presidential leadership.
Until Tuesday, Trump’s position on healthcare reform was murky. At times, he even seemed to endorse some form of universal coverage — promising in one interview that he would provide “insurance for everybody.” Trump’s vagueness left room for a host of competing GOP visions to emerge and muddy the debate on Capitol Hill.
With the speech, Trump finally put his foot down by outlining in a roadmap the five central components of the Republican reform package. In so doing, he gave the repeal-and-replace effort the kind of focus and momentum that only a president can provide.
The basic contours of the GOP’s healthcare plan have been clear since well before Trump’s victory last November. House Speaker Paul Ryan’s “A Better Way” reform package, released in June 2016, and Secretary of Health and Human Services Tom Price’s “Empowering Patients First Act,” first introduced in May 2015, have a great deal in common. Together, they represent a consensus vision for replacing ObamaCare.
Both plans, for instance, would end ObamaCare’s system of exchanges and subsidies and replace them with age-based refundable tax credits to help Americans who don’t get coverage through work to purchase it on the individual market. Both proposals would roll back ObamaCare’s employer and individual mandates and its Medicaid expansion. Medicaid would be funded by block grants of some sort to the states. And both would legalize interstate insurance sales.
Nevertheless, getting House and Senate Republicans to rally behind this approach has proven difficult. That’s in large part because President Trump had not taken a strong position on what should replace ObamaCare.
This sense of uncertainty allowed the House Freedom Caucus and Sens. Mike Lee (R-Utah), Ted Cruz (R-Texas), and Rand Paul (R-Ky.) to reject the House leadership’s leaked repeal-and-replace effort earlier last week. They focused their opposition on the series of age-based tax credits that Ryan’s legislation would create — and that Price’s plan proposed as well.
Trump’s address should settle this intraparty debate. He called on Congress to “help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts.”
As president, Trump is the undisputed leader of his party. And with that one remark, he made it clear that those who oppose the Ryan plan’s tax credits have officially run afoul of the Republican Party line.
Most of Trump’s other healthcare “principles,” as he called them, only underscored his agreement with the Ryan-Price approach. For instance, he pledged to make coverage available for Americans with pre-existing conditions and to give states more flexibility to administer Medicaid — a chief aim of the block-grant approach to funding.
He also championed policies that allow insurance companies to sell their products across state lines and called for legal reforms that could bring down the price of insurance and prescription drugs.
In short, Trump made clear to his allies in Congress, as well as the American people, that his party has a specific vision for repealing and replacing ObamaCare — and that he is ready to do his part to make that vision a reality. As he emphasized, “ObamaCare is collapsing, and we must act decisively to protect all Americans.”