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 Obamas 2010 law, which extended coverage to 20 million previously uninsured Americans.
While Trumps speech will likely win praise from congressional Republicans, and his general principles for health care may allay some in the general public, Trump didnt say anything likely to quell the discontent among the House and Senate GOP as they wade into policy specifics that have left them reeling.
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 Trumps 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 will be revealing that the president put the onus on Congress to resolve this issue.
Compare that vague, lead-from-behind approach to Trumps 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 Trumps 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 Trumps endorsement of tax credits. Conservatives are currently locked in a fight with GOP leadership over the idea of advance refundable tax credits.
But Trumps speech didnt 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.
And plans circulating on Capitol Hill so far would lead to far fewer people covered by health insurance and tohigher 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.