Trump: Obamacare replacement will follow health chief confirmation
Legislation to replace the Affordable Care Act will be ready within a week — or possibly an hour — of the confirmation of his nominee for Health and Human Services secretary, President-elect Donald Trump said Wednesday.
Trump, in a long-awaited press conference, didn't say what plan will be proposed or how quickly Congress could come together to support it.
Many aren't so confident on the timeline.
"Republicans are having a great deal of difficulty agreeing on a replacement for the Affordable Care Act," said health care economist John Goodman, who helped draft one of the Republican plans.
It took about two years to pass the ACA with overwhelming support among Democrats. Several Republican House and Senate members are already urging their Capitol Hill colleagues to slow down the process of replacing President Obama's signature health law.
"Every senator and many, many people in the House do not want to see 20 million people lose their health insurance," says Goodman.
But that's what Goodman and others predict would happen with proposals to repeal parts of the ACA that pay for the tax credits and cost-sharing subsidies make it possible for about 85% of those with ACA plans to afford them.
Trump spoke with conviction about the ACA's next steps — saying repeal and replace will be "essentially simultaneously" and soon. On the other hand, Senate Health, Education, Labor and Pensions Chairman Lamar Alexander, R-Tenn., on Tuesday advocated repealing and replacing the law at the same time — but also in due time.
"The American people deserve health care reform that’s done in the right way, for the right reasons, in the right amount of time," he said on the Senate floor. "It’s about working toward long-term solutions that works for everyone."
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Alexander's committee is scheduled to hold the first hearing on Feb. 18 on the nomination of physician Rep. Tom Price, R-Ga., to head the Department of Health and Human Services. The Senate Finance Committee is also expected hold a confirmation hearing for Price.
Among the challenges facing Trump and Republican opponents of the ACA is that most of the Republican plans include what is known as a "Cadillac tax" on especially generous health plans, which are especially common among those in the middle class who belong to unions. That makes the tax very unpopular with Trump's voters, who he promised would not be hit with a tax increase.
In a press conference Wednesday, Trump also advocated the creation of "new bidding procedures for the drug industry, because they're getting away with murder."
During the presidential campaign, Trump and Democratic nominee Hillary Clinton both supported the federal government being able to negotiate with drug companies over drug prices for the Medicare program.
The drug industry has "a lot of lobbyists and a lot of power, and there's very little bidding on drugs," Trump added.
Trump's comments helped sink pharmaceutical industry stocks Wednesday, but there's strong support for action to address high drug prices. Surveys have consistently shown consumers rank it as one of the very top health care concerns, and members of both parties have supported legislation to address drug prices.
Bidding "can help improve the efficiency of health care programs," agrees Paul Howard, director of health policy at the free-market Manhattan Institute.
Howard cites Medicare's Part D prescription drug program, which allows private insurance companies and their pharmacy benefit managers, to bid to cover seniors' drugs which helps hold down premium costs. He calls it a "tremendous success" for patients and taxpayers "with strong support on both sides of the aisle."
"The incoming administration should find ways to build on the Part D experience across Medicare," said Howard. That, he says, would speed innovation, improve competition and lead to better treatments for patients.
An ACA repeal could also jeopardize efforts to address drug prices. Among its many other provisions, the health law created a new independent nonprofit group, the Patient-Centered Outcomes Research Institute, which funds and disseminates what's known as comparative effectiveness research into drugs and other medical treatments.
There's also an Independent Payment Advisory Board which is supposed to control Medicare costs if they grow too fast. Authority for the board, which hasn't been set up yet, would also be killed with a repeal, pleasing health care industry lobbyists.
Alexander's comments Tuesday, while similar to Trump's, suggested he was concerned about moving too fast.
"When our reforms become concrete, practical alternatives, we will repeal the remaining parts of Obamacare in order to repair the damage it has caused Americans," Alexander said. "This is what I believe we mean when we say Obamacare should be repealed and replaced, simultaneously and concurrently."