What?” by Véronique Debord-Lazaro

January 15, 2017; Washington Post

It should come as a surprise to no one that repealing the Affordable Care Act (ACA, or Obamacare) is at or near the top of Donald Trump’s “to do” list upon taking office this Friday. “Repeal and replace” has been a recurring GOP campaign theme since the ACA was signed into law in 2010. In fact, the GOP-led House of Representatives has voted 60 times to repeal all or parts of the ACA, only to have each effort die for lack of a filibuster-proof 60-vote majority in the Senate.

In an interview with the Washington Post late Saturday, Trump said he is nearing completion of his own repeal-and-replace plan. As always, specifics on the plan are not yet available. However, it is suspected that Trump’s plan will look a lot like one developed by Rep. Tom Price (R-GA), Trump’s nominee to be the next Secretary of Health and Human Services (HHS). Price’s plan includes several features that have been part of GOP efforts to reform health care since the 1990s—individual health savings accounts (HSAs), the ability for consumers to purchase insurance across state lines (and insurance companies to offer multistate products), age-based instead of income-based tax credits to purchase insurance, and “tort reforms” intended to make it harder to bring lawsuits against doctors. Trump has said that he’ll be ready to announce his plan once Price is confirmed by the Senate. Confirmation hearings have not yet been scheduled.

In an opinion piece also published in the Post, Paul Waldman, a senior writer at the American Prospect, claims that Trump’s weekend interview has made it far more difficult for Republicans to vote on ACA repeal. “We’re going to have insurance for everybody,” Trump said—a claim Waldman claims will be impossible to fulfill. The ACA doesn’t provide insurance for everyone, and it’s widely believed that at least some people covered under the ACA will lose that coverage under any version of repeal and replace being discussed. In the absence of a specific bill, or set of bills, from either Trump or Congressional Republicans, both proponents and opponents can argue their points.

In discussing his plans, Trump implies that pharmaceutical companies will help pay the costs of a new plan. “They’re politically protected, but not anymore,” Trump said. One option being discussed is forcing drug companies to negotiate directly with the federal government over medication prices paid by Medicaid and Medicare—a practice currently forbidden under law.

Those who remember the insurance industry’s “Harry and Louise” advertising campaign against the Clinton administration’s attempt to reform healthcare in 1993-1994 can easily imagine how PhRMA, the pharmaceutical industry’s 501(c)(6) nonprofit network of trade organizations, might place pressure on Congress to oppose key aspects of Trump’s plan. PhRMA’s 2014 Form 990 shows a $200 million organization with 24 pages of donations to political campaigns and PACs. Their CEO’s $2.5 million salary is equaled by PhRMA’s 2014 payments to one contractor, Covington & Burling, arguably the preeminent law firm and lobbying compliance group in Washington.

The President-elect believes that policy questions others have found intricate and impenetrable will be reconciled and resolved using his business-honed intelligence and unique ability to generate popular support through social media communication with the public. Obamacare repeal and replace is an early, high-stakes test of that ability.—Michael Wyland