President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama\u2019s signature health-care law with the goal of \u201cinsurance for everybody,\u201d while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.
Trump declined to reveal specifics in the telephone interview late Saturday with The Washington Post, but any proposals from the incoming president would almost certainly dominate the Republican effort to overhaul federal health policy as he prepares to work with his party\u2019s congressional majorities.
Trump\u2019s plan is likely to face questions from the right, after years of GOP opposition to further expansion of government involvement in the health-care system, and from those on the left, who see his ideas as disruptive to changes brought by the Affordable Care Act that have extended coverage to tens of millions of Americans.
In addition to his replacement plan for the ACA, also known as Obamacare, Trump said he will target pharmaceutical companies over drug prices.
\u201cThey\u2019re politically protected, but not anymore,\u201d he said of pharmaceutical companies.
The objectives of broadening access to insurance and lowering health-care costs have always been in conflict, and it remains unclear how the plan that the incoming administration is designing \u2014 or ones that will emerge on Capitol Hill \u2014 would address that tension.
In general, congressional GOP plans to replace Obamacare have tended to try to constrain costs by reducing government requirements, such as the medical services that must be provided under health plans sold through the law\u2019s marketplaces and through states\u2019 Medicaid programs. House Speaker Paul D. Ryan (R-Wis.) and other Republicans have been talking lately about providing \u201cuniversal access\u201d to health insurance, instead of universal insurance coverage.
Trump said he expects Republicans in Congress to move quickly and in unison in the coming weeks on other priorities as well, including enacting sweeping tax cuts and beginning the building of a wall along the Mexican border.
Trump warned Republicans that if the party splinters or slows his agenda, he is ready to use the power of the presidency \u2014 and Twitter \u2014 to usher his legislation to passage.
\u201cThe Congress can\u2019t get cold feet because the people will not let that happen,\u201d Trump said during the interview with The Post.
Trump said his plan for replacing most aspects of Obama\u2019s health-care law is all but finished. Although he was coy about its details \u2014 \u201clower numbers, much lower deductibles\u201d \u2014 he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell (R-Ky.).
\u201cIt\u2019s very much formulated down to the final strokes. We haven\u2019t put it in quite yet but we\u2019re going to be doing it soon,\u201d Trump said. He noted that he is waiting for his nominee for secretary of health and human services, Rep. Tom Price (R-Ga.), to be confirmed. That decision rests with the Senate Finance Committee, which hasn\u2019t scheduled a hearing.
Trump\u2019s declaration that his replacement plan is ready comes after many Republicans \u2014 moderates and conservatives \u2014 expressed anxiety last week about the party\u2019s lack of a formal proposal as they held votes on repealing the law. Once his plan is made public, Trump said, he is confident that it could get enough votes to pass in both chambers. He declined to discuss how he would court wary Democrats.
So far, Republicans have taken the first steps toward repealing the law through budget reconciliation, a process by which only a simple majority is needed in the Senate. The process would enable them to dismantle aspects of the law that involve federal spending.
The plan that Trump is preparing will come after the House has taken more than 60 votes in recent years to kill all or parts of the ACA to kill to adopt more conservative health-care policies, which tend to rely more heavily on the private sector.
\u201cI think we will get approval. I won\u2019t tell you how, but we will get approval. You see what\u2019s happened in the House in recent weeks,\u201d Trump said, referencing his tweet during a House Republican move to gut their independent ethics office, which along with widespread constituent outrage was cited by some members as a reason the gambit failed.
As he has developed a replacement package, Trump said he has paid attention to critics who say that repealing Obamacare would put coverage at risk for more than 20 million Americans covered under the law\u2019s insurance exchanges and Medicaid expansion.
\u201cWe\u2019re going to have insurance for everybody,\u201d Trump said. \u201cThere was a philosophy in some circles that if you can\u2019t pay for it, you don\u2019t get it. That\u2019s not going to happen with us.\u201d People covered under the law \u201ccan expect to have great health care. It will be in a much simplified form. Much less expensive and much better.\u201d
Republican leaders have said that they will not strand people who gained insurance under the ACA without coverage. But it remains unclear from either Trump\u2019s comments in the interview or recent remarks by GOP leaders on Capitol Hill how they intend to accomplish that.
For conservative Republicans dubious about his pledge to ensure coverage for millions, Trump pointed to several interviews he gave during the campaign in which he promised to \u201cnot have people dying on the street.\u201d
\u201cIt\u2019s not going to be their plan,\u201d he said of people covered under the current law. \u201cIt\u2019ll be another plan. But they\u2019ll be beautifully covered. I don\u2019t want single-payer. What I do want is to be able to take care of people,\u201d he said Saturday.
Trump did not say how his program overlaps with the comprehensive plan authored by House Republicans. Earlier this year, Price suggested that a Trump presidency would advance the House GOP\u2019s health-care agenda.
When asked in the interview whether he intends to cut benefits for Medicare as part of his plan, Trump said \u201cno,\u201d a position that was reiterated Sunday on ABC by Reince Priebus, Trump\u2019s incoming chief of staff. He did not elaborate on that view or how it would affect his proposal. He expressed that view throughout the campaign.
Timing could be difficult as Trump puts an emphasis on speed. Obama\u2019s law took more than 14 months of debate and hundreds of hearings. To urge lawmakers on, Trump plans to attend a congressional Republican retreat in Philadelphia this month.
Moving ahead, Trump said that lowering drug prices is central to reducing health-care costs nationally \u2014 and that he will make it a priority as he uses his bully pulpit to shape policy. When asked how exactly he would force drug manufacturers to comply, Trump said that part of his approach would be public pressure \u201cjust like on the airplane,\u201d a nod to his tweets about Lockheed Martin\u2019s F-35 fighter jet, which Trump said was too costly.
Trump waved away the suggestion that such activity could lead to market volatility on Wall Street. \u201cStock drops and America goes up,\u201d he said. \u201cI don\u2019t care. I want to do it right or not at all.\u201d He added that drug companies \u201cshould produce\u201d more products in the United States.
The question of whether the government should start negotiating how much it pays drugmakers for older Americans on Medicare has long been a partisan dispute, ever since the 2003 law that created Medicare drug benefits prohibited such negotiations.
Trump\u2019s goal is uncertain, however, with respect to Medicaid, the insurance for low-income Americans run jointly by the federal government and states. Under what is known as a Medicaid \u201cbest price\u201d rule, pharmaceutical companies already are required to sell drugs to Medicaid as the lowest price they negotiate with any other buyer.
On his plan for tax cuts, Trump said that \u201cwe\u2019re getting very close\u201d to putting together legislation. His advisers and Ryan met last week and have been working from his campaign\u2019s plan and from congressional proposals to slash current rates. \u201cIt\u2019ll probably be 15 to 20 percent for corporations. For individuals, probably lower. Great \u00admiddle-class tax cuts,\u201d Trump said.
On corporate tax rates, \u201cWe may negotiate a little, but we want to bring them down and get as close to 15 percent as we can so we can see a mushrooming of jobs moving back.\u201d
Trump said he would not relent on his push for increasing taxes on U. S. companies that manufacture abroad \u2014 and insisted that the upcoming tax cuts should be enough reason for companies to produce within the United States.
\u201cIf companies think they\u2019re going to make their cars or other products overseas and sell them back into the United States, they\u2019re going to pay a 35 percent tax,\u201d he said.
Briefly touching on immigration, Trump said that building a border wall and curbing illegal immigration remain at the top of his to-do list and that he is spending significant time looking at ways to begin projects, both with Congress and through executive action. He did not disclose what was to come on those fronts.<\/p>\n

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