Months ago, President Trump said that approach to the Affordable Care Act was unacceptable. Now, as Republicans struggle to reach a new agreement, that old idea has appeal.
WASHINGTON — With Senate Republicans already bogged down over how to dismantle the Affordable Care Act, President Trump on Friday tossed in a new complication with an old idea, suggesting the Senate could repeal President Barack Obama’s signature domestic achievement now, then replace it later.
Mr. Trump gave his blessing in a Twitter post after a Republican dissatisfied with the current repeal bill, Senator Ben Sasse of Nebraska, floated it as a backup plan. Mr. Sasse sent a letter to the president and made a pitch on Fox News on Friday as an agreement on a new version of the Senate’s repeal bill remained elusive.
Other conservatives quickly picked up the idea — including Senator Rand Paul of Kentucky and the group Americans for Prosperity — presenting a new headache to Senate leaders who are trying to focus their conservative and moderate troops on finding a compromise.
Republican leaders in Congress had embraced the repeal-now-replace-later mantra in January, envisioning legislation that would end the Affordable Care Act in several years as they work on a replacement. But that plan was blown up quickly when Mr. Trump publicly demanded a replacement be adopted simultaneously. Since then, the Senate majority leader, Mitch McConnell of Kentucky, and House Speaker Paul D. Ryan have meticulously set up a timeline using special Senate rules to fulfill Mr. Trump’s repeal-and-replace wishes.
Now, those wishes have changed — again.
In his letter to the president, Mr. Sasse said that if a deal on a revised health care bill had not been struck by the time the Senate returns from its Fourth of July recess on July 10, Mr. Trump should call on Congress to “immediately repeal as much of Obamacare as is possible” under the rules that must be followed to avoid a filibuster, with a one-year delay on the repeal bill’s implementation.
Then, he said, lawmakers should get to work on replacing the health law, and should scrap their planned August recess.
“On the current path, it looks like Republicans will either fail to pass any meaningful bill at all, or will instead pass a bill that attempts to prop up much of the crumbling Obamacare structures, ” Mr. Sasse wrote. “We can and must do better than either of these — both because the American people deserve better, and because we promised better.”
Not long after Mr. Sasse’s appearance on Fox News, Mr. Trump wrote on Twitter, “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!”
Mr. Trump’s post came as Senate Republicans struggled to decide how much of the Affordable Care Act should be eradicated and how much should be retained. In the Senate this week, Republicans veered away from their original approach and said they were discussing whether to keep a tax imposed by the Affordable Care Act on the investment income of the most affluent Americans. The revenue could be used to increase insurance subsidies for lower-income people.
Subsidies in the Senate bill were already beginning to look like those in the Affordable Care Act, which are tied to a person’s income and local insurance costs. However, the Senate subsidies are less generous than those under current law.
The repeal bills written by House and Senate Republicans would both provide tens of billions of dollars in assistance to health insurance companies to help stabilize insurance markets and hold down premiums. Many of the same Republicans attacked such payments, when made by the Obama administration, as a bailout for the insurance industry.
But as senators tried to come to an agreement, Mr. Trump effectively tossed in a distraction that may not be possible anyway. This winter, Congress passed a budget resolution for the current fiscal year that included special parliamentary language that allows passage of one health care bill without the possibility of a filibuster in the Senate. If senators use that language to repeal the Affordable Care Act without a replacement, Congress would have to go through the entire process again, with another budget, another set of instructions and now a bill to replace the Affordable Care Act.
But the parliamentary language — known as reconciliation instructions — in the next budget was supposed to ease passage of an overhaul of the tax code, not health care.
Besides, a clean repeal of the Affordable Care Act with no replacement could have even more trouble clearing the Senate than the current effort.
Mr. Trump’s foray on Twitter only underscored to some Republicans how inconsistent he has been as a partner. In May, he cheered passage of a House plan to repeal and replace the Affordable Care Act, only to later denounce the House bill as “mean.”
Mr. Trump and congressional Republicans have also vacillated over how to sequence the repeal and replacement of the Affordable Care Act.
In December, House Republican leaders outlined an extended timetable to repeal now, replace later, only to watch Mr. Trump reject that in January as unacceptable.
“It’ ll be repeal and replace, ” Mr. Trump said. “It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably, the same day, could be the same hour.”
