Republicans fear Trump will revive war over ObamaCare

Senate Republicans are discouraging former President Trump from making another push for health care reform, fearing he could repeat the mistakes of 2017 and once again get embroiled in a dirty and unsuccessful fight over ObamaCare.

Republicans say Trump should instead focus on extending the tax cuts he signed in late 2017 that expire at the end of next year.

They warn that the Affordable Care Act (ACA), which deeply divided their party when Trump sought to repeal it, has now become deeply embedded in the fabric of the nation’s health care system, with more than 21 million Americans choosing their health insurance plans through the law’s Health Insurance Marketplace.

Trump declared at the September 10 presidential debate that “ObamaCare was a lousy health care reform” and promised that he would “replace” it if he wins the election in November, adding that he would “only change it if we find something better and cheaper.”

But Republican senators see the health care reform debate as a political minefield and are looking to avoid a repeat of the failure to pass a new affordable health care bill seven years ago, when three Republican senators joined Democrats in voting against an attempt to repeal key parts of that landmark law.

Two of the Republicans who opposed Trump – Senators Susan Collins (Maine) and Lisa Murkowski (Alaska) – are still in the Senate. The third, then-Senator John McCain (Arizona), died in 2018.

“I never hear many Republican candidates say we’re going to repeal and replace the ACA. Those are the kinds of statements from past campaigns,” Murkowski told The Hill.

She said his Republican colleagues who are urging Trump to focus on extending the 2017 Tax Cuts and Jobs Act rather than plunging into a new health care dilemma are offering “good advice.”

“I think we are preparing for the big tax discussions at the beginning of the next legislative session. That’s what I see, not health care reform,” she said.

Senator Kevin Cramer (R-N.D.), a Trump ally who was in the House the last time Republicans debated comprehensive health care reform, said Trump would be wise to focus on the economy and tax cuts if he wins in November.

Cramer said he was convinced Trump wanted to work “within” the framework of the ACA rather than tearing it up root and branch, as Republicans promised a decade ago.

“We need to take the situation as it is and work on concepts … like high-risk pools and providing more direct funds to states to deal with Medicaid,” he said.

However, he said the issue must be put on hold for now and Congress should focus on tax reform in 2025 if Republicans control the White House and both houses of Congress.

“I think tax relief. It has to be tax policy,” Cramer said. “I just wouldn’t approach [health care] than revising or repealing ObamaCare. We must improve the Tax Cuts and Jobs Act and make it permanent.”

Republican Senate leader Mitch McConnell (Kentucky), who led efforts to repeal the ACA during Trump’s first year in office, said earlier this year that the fight was “largely over.”

“We argued about this a few years ago,” McConnell said in March in response to Trump’s statement that he would “seriously look for alternatives” to ObamaCare if re-elected.

“If he can develop a basis for revisiting this issue, of course we would look at it, but it seems to me that that is largely done,” McConnell told reporters when asked about Trump’s health care reform plans.

Senator James Lankford (R-Oklahoma), a member of the Finance Committee, which has jurisdiction over many health-related issues, acknowledged that the ACA has become an integral part of the nation’s health care system and cannot simply be “turned off.”

“Healthcare has been in place for more than a decade, and every company has repositioned itself. Independent physicians no longer exist. They all work for major hospitals now. Labs have been shut down because ObamaCare shut them all down. So it’s not as easy as just turning it off and turning it back on. It’s well established,” he said.

Senator JD Vance (Republican of Ohio), Trump’s running mate, provided more details about what health care reforms Trump might seek if re-elected in a recent interview with NBC’s “Meet the Press.”

He floated the idea of ​​creating high-risk pools to isolate people with poorer health, who tend to be subsidized by the premiums paid by younger and healthier consumers.

“You want to make sure people have access to the doctors they need, and you also want to implement some kind of deregulation program so people can choose a health insurance plan that suits them,” he said.

“Think about it: A young American does not have the same health care needs as a 65-year-old American. A 65-year-old American in good health has very different needs than a 65-year-old American with a chronic illness,” Vance said.

Vance argued that the “best way” to reform the system would be to encourage greater choice in plans and “not to take a one-size-fits-all approach that puts a lot of people in the same insurance pools, the same risk pools.”

His comments describe a concept that Republicans debated in 2017 but that policy experts warned would lead to out-of-control insurance costs for sicker people in high-risk groups.

The independent institute for health policy research and opinion polls KFF found in a recent analysis that only five percent of the population with the highest health costs pay for about half of total health spending. The institute predicted that excluding these people from larger insurance pools without major increases in government subsidies would likely lead to a “significant” increase in their insurance premiums.

“High-risk pools could theoretically protect people with pre-existing conditions, but only with sufficient government funding that has never existed,” Cynthia Cox, director of the KFF program on the ACA, wrote in the analysis.

The Commonwealth Fund estimated in 2017 that the net cost of insuring all of the country’s uninsured patients with pre-existing conditions – then more than 15 million – in a national high-risk pool would be $178 billion per year.

John Thune (SD), the Republican Senate whip and leading candidate for Senate majority leader if Republicans win the Senate majority in November, said extending the Trump tax cuts must be a top priority, but left open the possibility of including health care reform in a budget package for next year.

“The tax reform has a deadline. I mean, we have to get it done next year. In 2025, everything expires, including all individual [tax bracket] things, so it has to be a high priority. Could a reconciliation bill if we have all three [control of the White House, Senate and House]to adapt to a particular health policy? Yes, probably,” said Thune.

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