MONDAY, AUGUST 3 , 2020. THE WASHINGTON POST EZ RE A
election 2020
BY ANNE GEARAN,
AMY GOLDSTEIN
AND SEUNG MIN KIMIt was a bold claim when
President Trump said that he was
about to produce an overhaul of
the nation’s health-care system,
at last doing away with the Af-
fordable Care Act, which he has
long promised to abolish.
“We’re signing a health-care
plan within two weeks, a full and
complete health-care plan,”
Trump pledged in a July 19 inter-
view with “Fox News Sunday”
anchor Chris Wallace.
Now, with the two weeks expir-
ing Sunday, there is no evidence
that the administration has de-
signed a replacement for the 2010
health-care law. Instead, there is
a sense of familiarity.
Repeatedly and starting before
he took office, Trump has vowed
that he is on the cusp of deliver-
ing a full-fledged plan to reshape
the health-care system along con-
servative lines and replace the
central domestic achievement of
Barack Obama’s presidency.
No total revamp has ever
emerged.
Trump’s latest promise comes
amid the outbreak of the novel
coronavirus, which has infected
millions, caused more than
150,000 deaths in the United
States and cost Americans their
work and the health benefits that
often come with jobs. His vow
comes three months before the
presidential election and at a
time when Trump’s Republican
allies in Congress may least want
to revisit an issue that was a
political loser for the party in the
2018 midterm elections.
Yet Trump has returned to the
theme in recent days.
“We’re going to be doing a
health-care plan. We’re going to
be doing a very inclusive health-
care plan. I’ll be signing it some-
time very soon,” Trump said dur-
ing an exchange with reporters at
an event in Belleair, Fla., on
Friday. When a reporter noted
that he told Fox’s Wallace that he
would sign it in two weeks,
Trump added: “Might be Sunday.
But it’s going to be very soon.”
Trump’s decision to revive a
health-care promise that he has
failed to deliver on — this time
with less than 100 days before
Election Day — carries political
risks. Although it may appeal to
voters who don’t like the ACA, it
also highlights his party’s i nabili-
ty to come up with an alternative,
despite spending almost a decade
promising one.
It also raises questions about
what exactly his plan would look
like and whether it would cover
fewer Americans than the cur-
rent system as the pandemic
ravages the country.
Nonetheless, some of Trump’s
allies said floating health-care
ideas is a smart move by the
president.
Sen. Lindsey O. Graham
(R-S.C.), who regularly meets and
golfs with the president, said the
health-care plan that Trump has
referred to would come in the
form of an executive order that
Graham called “fairly compre-
hensive.” However broad, an ex-
ecutive order would fall short of a
full legislative overhaul.
Graham said what Trump has
in mind now would ensure that
consumers do not risk losing
their health plans if they get sick,
but he did not give details.
“He’s pretty excited about it,”
Graham said of the president.
The ACA’s consumer protections
for people with preexisting medi-
cal conditions is one of its most
popular facets with the public,
and it is the one part of the law
Trump consistently says he
would preserve if he could get rid
of the rest. How he could do that
while containing costs after he
and congressional Republicans
remove the law’s requirement
that everyone has to purchase
health insurance remains the
question.
With the election nearing, Gra-
ham said, i t is politically astutefor the White House to present an
alternative to Democratic pro-
posals, including the idea of Joe
Biden, the party’s presumptive
nominee, to build on the ACA so
more people could get coverage.
Still, senior Republican aides
on Capitol Hill who are involved
in health-care policy said they
had little knowledge of any White
House planning for a comprehen-
sive replacement of the ACA.
The White House did not offer
details or parse the president’s
terminology, which has included
saying that the forthcoming plan
would be a bill. That implied
legislation rather than an execu-
tive order.
“President Trump continues to
act in delivering better and
cheaper health care, protecting
Americans with preexisting con-
ditions, lowering prescription
drug costs, and defending the
right of Americans to keep their
doctors and plans of their
choice,” White House press secre-
tary Kayleigh McEnany said in a
statement to The Washington
Post.
McEnany pointed out that
Trump issued four executive or-
ders in late July intended to lower
prescription drug prices. “There
will be more action to come in the
coming weeks,” she said withoutidentifying any.
On Capitol Hill, the president’s
promises of health plans and
legal efforts by the administra-
tion to scrap the ACA have creat-
ed dilemmas for some Republi-
cans. Of the GOP senators facing
competitive races this fall, only
Susan Collins (Maine) has said
that she opposes the Justice De-
partment’s decision to back an
effort to gut the law in the courts.
Other Republicans have strug-
gled to answer directly, walking a
tightrope between embracing a
position that would go against
popular provisions in the health-
care law and risking the wrath of
conservatives who want Obamac-
are repealed.
The ACA — politically polariz-
ing throughout the decade it has
existed — is favored by a slim
majority of Americans. A Kaiser
Family Foundation survey in July
found that 51 percent support the
law while 36 percent oppose it. A
Fox News survey in June showed
56 percent support and 38 per-
cent opposition.
For Trump, saying that he is
about to produce a health-care
plan to replace the ACA has
become a recurrent mantra of his
presidency.
During his 2016 campaign,
condemning the law was centralto Trump’s candidacy. During
that campaign’s final days,
Trump said he was so eager to
repeal and replace the 2010 law
that he might ask Congress to
convene a special session to do it.
“It will be such an honor for
me, for you and for everybody in
this country,” the then-Republi-
can nominee said, “because
Obamacare has to be replaced.
And we will do it, and we will do it
very, very quickly.”
The ACA was a significant
theme of the president’s joint
address to Congress just over a
month into his tenure. “Tonight I
am calling on this Congress to
repeal and replace Obamacare,”
he said, calling for measures that
would “expand choice, increase
access, lower costs and, at the
same time, provide better health
care.”
With GOP majorities in both
the House and the Senate, Con-
gress devoted much of 2017 to
trying to get rid of substantial
parts of the law. But a succession
of repeal bills ultimately faltered
in the Senate. When the last one
did, Trump said nothing.
Near the end of the year, Con-
gress took one big whack at the
health-care law. As part of a
major change in tax law, it elimi-
nated the penalty the ACA levied
on most Americans if they failed
to carry health insurance. The
penalty’s end neutralized the
law’s insurance mandate.
With little appetite after that
among Senate Republicans to
continue trying to gut the law,
and a Democratic House majority
a year later, the momentum for
replacing the ACA fell back to the
Trump administration. Cabinet
departments have, by turns, un-
dercut specific parts of the law
and tried to have it invalidated in
the courts, while emphasizing
that their concern for the nation’s
health-care system and America’s
patients reaches beyond the ACA.
And the president? He has
continued to periodically vow
that he would come up with a
better health plan.
In t he fall of 2017, Trump took a
major swipe at the law by ending
payments to insurance compa-nies that had helped them afford
to offer lower-income customers
discounts on their deductibles
and other out-of-pocket costs, as
the ACA requires.
During 2018, health officials
sought to shrink the law in sever-
al other ways. They wrote rules
that gave states greater latitude
in defining a set of 10 “essential
health benefits” that the ACA
requires many health plans to
cover. They widened the avail-
ability of short-term health plans
— originally intended as bridge
coverage when someone was, say,
between jobs — that do not meet
consumer protections or benefits
that the law otherwise requires.
The administration has joined
with a group of Republican attor-
neys general who are pursuing a
lawsuit, now before the Supreme
Court, that contends the entire
ACA is unconstitutional. At first,
the Justice Department argued
that only part of the law is
invalid, but the administration
hardened its position to argue
that the entire law should be
thrown out.
As these and other administra-
tion health-care actions have
played out, the drumbeat has
continued that the president was
about to reveal an ACA replace-
ment plan.
In June 2019, Trump said in an
interview with ABC News that he
would announce a “phenomenal”
new health-care plan “in about
two months, maybe less.”
Two months later, White
House counselor Kellyanne Con-
way told reporters that the presi-
dent was preparing to introduce
an elaborate plan to redesign the
nation’s health-care system in a
speech the following month.
“We’re working every single day
here,” Conway said last August.
“I’ve already been in meetings
this morning on the president’s
health-care plan. It’s pretty im-
pressive.”
No speech or plan came.
[email protected]
[email protected]
[email protected]Julie Tate and Scott Clement
contributed to this report.Trump’s proposal for health-care overhaul is yet to arrive
TOM BRENNER/REUTERS
President Trump has repeatedly vowed that he is on the cusp of
delivering a full-fledged plan to reshape the health-care system.
After his latest comments, a plan should’ve been unveiled Sunday.A sense of familiarity
arises as a promised
revamp fails to emergeSCALLOPED
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