Trump’s rejoinder to Senate GOP: repeal Obamacare now, replace it later; or just forget the whole thing.

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The News:

US President Donald Trump urged Republican senators on Friday (June 30, 2017) to repeal Obamacare immediately if they cannot agree on a new healthcare plan to replace it, potentially sparking confusion as congressional leaders struggle for a consensus on healthcare legislation.

@realDonaldTrump urges #Republican senators to repeal #Obamacare Click To Tweet

Senate Republican leaders had set Friday as the target for rewriting legislation that would repeal extensive parts of the 2010 Affordable Care Act, the law dubbed Obamacare that expanded health insurance coverage to 20 million people. But that deadline seemed unlikely given that by Friday most senators had already left town ahead of this week’s recess without an agreement on a clear direction for the healthcare bill.

Later Friday afternoon, a GOP aid said Senate Republican leaders are working with congressional budget officials to examine the impact of various changes they’re considering, a process that could take about two weeks, according to Bloomberg.

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump wrote in a Twitter post.

The current legislation would repeal major elements of Obamacare, shrink the Medicaid government healthcare program for the poor and elderly, eliminate most of Obamacare’s taxes, and set up a system of government tax credits to help individuals buy private health insurance.

Conservative and moderate Republicans spent the latter part of the week twisting and tugging the bill in opposite directions as Senate Majority leader Mitch McConnell sought common ground. Moderates want more equity for low-income Americans, while conservatives are fighting to loosen insurance regulations.

Republican efforts were also complicated on Thursday by a Congressional Budget Office (CBO) report that said the existing Senate proposal would cut spending on government Medicaid for the poor by 35% by 2036.

McConnell spokesman David Popp said Republicans will continue healthcare discussions through the recess that lasts until July 10. He did not comment on Trump’s call for a full repeal of Obamacare.

Steve’s Take:

The chaotic legislative scene in Washington last week, with Republicans scrambling around in what now appears like just another weekly fire drill, reminded me of one of Yogi Berra’s many witticisms: it’s déjà vu all over again.

Just three days after holding a widely praised meeting among GOP senators devoted to repealing Obamacare, President Donald Trump threw Senate Majority Leader Mitch McConnell’s already ailing bill into total disarray Friday.

Mr. Trump, who has previously said that he would prefer Obamacare be repealed and replaced at the same time, reversed course Friday morning, and began echoing conservative senators who want to take up a 2015 bill that would have scrapped Obamacare without providing an immediate replacement.

The GOP-led Congress passed the 2015 bill, Politico.com reminds us, but it was vetoed by President Barack Obama. Every Republican senator at the time supported it except Sen. Susan Collins of Maine, though some Republicans likely backed it in part because they knew it would be vetoed.

The irony of Trump’s latest Twitter retort is that it isn’t new at all for the party, which has struggled to fulfill its 7-year vow to dismantle the health law.

GOP leaders initially planned to repeal Obamacare in January by following the outline of their 2015 effort. But lawmakers themselves recoiled at the idea of slashing benefits to their constituents with no clear plan to replace them.

Sen. Rand Paul of Kentucky lobbied robustly for simultaneous repeal and replace efforts, and Trump told him he “completely” agreed with him “completely.” But the party merely shrugged, then went off on a six-month expedition to attempt a complete overhaul of the law.

On Friday, however, Sen. Paul made clear on Twitter that he now wants to again separate the two: “I have spoken to @realDonaldTrump & Senate leadership about this and agree. Let’s keep our word to repeal then work on replacing right away.”

Another challenge for Republicans hoping to pursue a two-step strategy: If Republicans use reconciliation to only repeal Obamacare, they would almost certainly need Democratic support to replace it at a 60-vote threshold. GOP leaders are hoping to use reconciliation twice this year, but are earmarking the second one for tax reform, says Politico.com.

Trump’s comments on Friday and earlier last week suggested he has doubts that McConnell will ever get 50 of the 52 votes needed to repeal the law under a party-line budget reconciliation process. Trump also said it would be “OK” if the bill failed at the top of a meeting with the Senate GOP on Tuesday, a gathering that otherwise seemed to motivate Republicans to try again to find agreement.

Republicans left town on Thursday seemingly still mired in an intractable disagreement over how much to cut Medicaid and which regulations to cut.

“We’re kind of at a stalemate right now I would say,” said Sen. Shelley Moore Capito (R-W.Va.).

Those issues may mean the Senate bill may fail or take a very long time to pass, increasing pressure to follow with the president’s repeal idea, says Max Nisen at Bloomberg. The issues dividing Republicans won’t go away, meaning there’s a real possibility a replacement will never come. That’s a potentially disastrous prospect for hospitals and insurers.

Because of the rules of the budget-reconciliation process that lets the GOP pass a bill with only 50 Senate votes, a straight ACA repeal won’t get rid of its regulations, including those that prevent insurers from denying coverage, require insurance meet some minimum standards and protect people with pre-existing conditions.

The problem is that, without ACA subsidies to help people buy insurance and its mandate pushing healthy people to sign up, those regulations don’t work; enrollment is too low and costs are too high. Sicker people would be more likely to buy insurance than healthy ones. Insurers would flee the ACA exchanges in droves.

An immediate repeal of the Affordable Care Act would result in substantially more coverage losses than repeal-and-replace proposals. But the odds are turning against Republicans now, and Trump is facing the prospect, once again, of an embarrassing failure that would force upon him an unpalatable alternative: working with Democrats he has ridiculed crudely and relentlessly over for many months.

Bottom Line:

On the one hand you have president Trump, bound and determined to erase the name “Obama” from the human lexicon, wherever it exists, whether in video, audio, or print format. Thus the obsession with repealing Obamacare.

Steve's Take: @realDonaldTrump really wants to erase anything with #Obama's name on it Click To Tweet

On the other hand, there’s Mitch McConnell, the GOP’s Senate leader, struggling mightily to bring his party’s moderate and conservative ranks together to fashion a new healthcare bill that makes massive cuts to Medicaid in order to fund a tax cut for the wealthiest Americans but which somehow, doesn’t leave millions of Americans without any health insurance coverage. The CBO says forget that.

I’ve become convinced that Pres. Trump doesn’t fancy the notion of being responsible for millions of the poor, young children, the elderly, and the sick with chronic (and pre-existing) illnesses becoming uninsured under his watch. He doesn’t want Trumpcare to be remembered for that. But by the same token he really wants to erase the name “Obama” from anything and everything in which his administration is involved.

I believe being a true capitalist businessman first, even Mr. Trump can sense when it’s finally time to throw in the cards on healthcare reform, for now, and move ahead to the next hand, which in this administration’s brief tenure, would be “tax reform.” At least he probably wouldn’t hear the word “Obamacare” as often as he now does.

Pressing the Senate to repeal Obamacare now, and replace it sometime in the future, to me signifies defeat. McConnell certainly will continue the legislative process to eventually fashion a healthcare bill that assuages the disparate factions–left, right, and center– not just in his own party, but increasingly more likely, with members from the other side of the aisle.

Working with Democrats. Now that’s a novel idea that would indeed be galling and embarrassing for this President.

But that possibility, if it comes to pass, almost sounds like governance; you know–the way we used to do it in our particular democracy. I can still hope.