President Donald Trump renewed his call to repeal and “replace” the Affordable Care Act during his address to a joint session of Congress Tuesday, but he once again did not offer any real details about what should succeed the landmark health care overhaul.
Throughout his campaign and ever since his surprising Election Day victory, Trump has promised to produce a plan that would reduce cost and increase access, a vow he restated Monday. But outside of some general platitudes that Trump has long endorsed, the president offered no new guidelines for a replacement to former President Barack Obama’s 2010 law, which extended coverage to 20 million previously uninsured Americans.
While Trump’s speech will likely win praise from congressional Republicans, and his general principles for health care may allay some in the general public, Trump didn’t say anything likely to quell the discontent among the House and Senate GOP as they wade into policy specifics that have left them reeling.
“He talked about repeal and replace tonight. Fine. He needs to present something,” Tuesday Group Chairman Charlie Dent (R-Pa.) said after the speech. “He provided some detail; we’ll need more.”
In his remarks to lawmakers, Trump disappointed anyone hoping he would take the lead on the Obamacare repeal and “replace” effort amid the increasingly difficult political atmosphere characterized by angry citizens storming lawmakers’ town halls and the suddenly rising popularity of the health care law.
Republicans applauded Trump’s exhortation to gut Obamacare, and they found other things to cheer during the five-minute health care portion of his speech. But for the lawmakers actually familiar with the complexity of “replacing” the Affordable Care Act, it was revealing that the president put the onus on Congress to resolve this issue.
Compare that vague, lead-from-behind approach to Trump’s section on a tax overhaul, where he said, “My economic team is developing historic tax reform.”
Where tax reform is his, Obamacare is on Congress, Trump seemed to be saying.
Tellingly, Trump also made a plea for bipartisan action on health care reform. “I am calling on all Democrats and Republicans in the Congress to work with us to save Americans from this imploding Obamacare disaster,” he said.
Part of this is mere math: Republicans hold a slim majority in the Senate and will need Democratic votes to advance major parts of their health care agenda.
But it also calls to mind Trump’s repeated statements ― including just a day ago ― that his best political course would be to stand pat and do nothing to address the health care system, in hopes any further troubles will be blamed on the Democrats who created the Affordable Care Act.
Trump mostly recounted common talking points about the shortcomings of the Affordable Care Act and the promises that Republican policies would be superior. Unlike he repeatedly has vowed, however, Trump shied away from promising universal health care coverage.
As he did during his presidential campaign, Trump hit several major themes that broadly adhere to Republican orthodoxy on health care policy:
Health insurance costs are too high. Consumers have too few insurers to choose from. States need more flexibility to alter their Medicaid programs. Americans should have greater access to tax-free health savings accounts. Health insurers should be permitted to sell policies to out-of-state customers. Trump also called for limits on medical malpractice lawsuits and lower prescription drug prices.
One part that Republicans will certainly take note of will be Trump’s endorsement of tax credits. Conservatives are currently locked in a fight with GOP leadership over the idea of advance refundable tax credits.
But Trump’s speech didn’t wade deeply enough into the weeds for anyone to really determine whether he supports the specific tax credits proposed by House Speaker Paul Ryan (R-Wis.) and opposed by conservative factions in Congress, or some other type of tax credit.
Trump said he favors tax credits to defray the cost of insurance and access to coverage for people with pre-existing conditions, but failed to say how.
“There were no specifics on that end,” House Freedom Caucus member Rep. Gary Palmer (R-Ala.) said, referring to Trump’s call for tax credits in a replacement, “and I think that’s an important thing to note.”
The Freedom Caucus has come out forcefully against any Obamacare alternative that uses advance refundable tax credits, arguing that it would create a new entitlement program. Trump endorsed the idea of “tax credits” in a replacement, but he didn’t clarify what that means, leaving Republicans free to interpret that principle as whatever they want.
“I don’t believe we heard any specific legislative endorsements,” Sen. Ted Cruz (R-Texas) said Tuesday night in response to a question about the tax credits.
Plans circulating on Capitol Hill so far would lead to far fewer people covered by health insurance and to higher out-of-pocket costs, especially for older people and those with low incomes. A draft House Republican bill ― since disavowed by GOP leadership ― would offer financial assistance to some Americans and a form of protections for people with pre-existing conditions, but they fall far short of what the Affordable Care Act already provides.
Trump’s address Tuesday night may get a warm Republican reception, and his lack of specifics may mean that every corner of the GOP conference can claim that Trump is really on their side, but it did nothing to bring Republicans out of their Obamacare quagmire and won’t provide the protection that GOP leadership may have wanted from Trump owning a repeal.
This story has been updated to include comment from Palmer, Cruz and Dent.