In an exchange with reporters, President Trump said on Wednesday that he has the votes to repeal the Affordable Care Act but that he will first negotiate a deal with Democrats.
WASHINGTON — Unwilling to accept defeat, President Trump insisted on Wednesday that Republicans “have the votes” to dismantle much of the Affordable Care Act, and he predicted that the Senate would vote on legislation to do that in the first three months of next year.
In the meantime, he said, he intends to negotiate with Democrats on a bipartisan health care bill and issue a “very major executive order,” probably next week. Under the order, Mr. Trump said, “people can go out, cross state lines, do lots of things and buy their own health care.”
Millions of people could benefit, he said.
Mr. Trump’s seemingly contradictory comments to journalists mystified members of both parties in both houses of Congress.
Senator John Thune of South Dakota, a member of the Senate Republican leadership, laughed when asked about Mr. Trump’s assertion that the votes were there for health care.
“I’d like to know where they are,” Mr. Thune said. “He must be using a different calculator than the rest of us.”
In the space of 10 minutes, the president said seven times that “we have the votes” on health care. But that appeared to be based on some erroneous or optimistic assumptions: That Senator Thad Cochran, Republican of Mississippi, was in the hospital and unavailable to vote, and that two other Republican senators, Lisa Murkowski of Alaska and Rand Paul of Kentucky, were ready to vote yes.
Mr. Cochran quickly corrected the president.
“Thanks for the well-wishes. I’m not hospitalized, but am recuperating at home in Mississippi and look forward to returning to work soon,” Mr. Cochran said on Twitter. The senator’s office said he had recently been treated for “a urological issue.”
Even if Mr. Cochran had been in Washington this week, Senate Republicans would not have had the votes to pass the Graham-Cassidy bill. Three of the 52 Republican senators — Susan Collins of Maine, John McCain of Arizona and Mr. Paul — had announced that they opposed the measure, which had no support from Democrats.
Ms. Murkowski said she had been unable to obtain “true, accurate data” about the bill’s effect on her state, which has exceptionally high health costs.
Yet Mr. Trump said that statements issued by Ms. Murkowski and others showed that Republicans had nearly enough votes. “We were only one off, maybe two,” he said.
Mr. Trump said that he was confident that the Senate would approve the guts of the bill, which would give each state a lump sum of federal funds, in place of the money states receive under the Affordable Care Act for insurance subsidies and the expansion of Medicaid.
“We will do the block grants,” Mr. Trump said Wednesday.
As journalists asked Mr. Trump about other issues like taxes, the N. F. L. and new restrictions on foreign visitors, he kept returning to health care.
“I feel we have the votes,” he said. “I’m almost certain we have the votes. But with one man in the hospital, we cannot display that we have them. Plus, some people want to go through a process just to make themselves feel better. That’s O. K.’’
It was also not clear what bipartisan health care bill Mr. Trump had in mind.
He recently struck a deal with the Democratic leaders, Senator Chuck Schumer of New York and Representative Nancy Pelosi of California, on government spending and disaster relief funds, and he came close to an agreement with them on protections for young undocumented immigrants.
Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, have been working on a bill to provide money for “cost sharing” subsidies for insurance companies. But some administration officials and some House Republicans have expressed deep reservations about that effort, which they say could prop up the Affordable Care Act.
Republicans have long wanted to make it easier for people to buy heath insurance across state lines, in the belief that such purchases could hold down prices and increase competition. Mr. Paul said he had been working with the administration on a rules change that would allow people to band together and buy insurance thorough “association health plans” formed by trade associations and civic groups.
