President-elect Donald Trump (R) in interviews last week indicated that he would consider leaving in place certain parts of the Affordable Care Act (ACA).
Trump has vowed to "immediately" and "completely" repeal the ACA once he takes office. He has advocated for replacing the law with a plan that would expand Americans' ability to use Health Savings Accounts to cover out-of-pocket health care costs and reduce barriers to selling health insurance across state lines, among other components.
Who's on Trump's HHS secretary short list? Here's what we know so far.
However, during an interview with the Wall Street Journal on Friday, Trump used more lenient language, saying, "Either Obamacare will be amended, or repealed and replaced."
Trump considers keeping popular ACA provisions
During his interview with the Journal, Trump said he "like[s]" ACA provisions that:
- Allow U.S. residents to remain on a parent's health plans until age 26; and
- Prohibit insurers from denying individuals coverage because they have preexisting medical conditions.
According to the Journal, "Trump said a big reason for his shift from his call for an all-out repeal was [his Thursday] meeting at the White House with Mr. Obama, who, he said, suggested areas of the Affordable Care Act ... to preserve."
Trump told the Journal, "I told him I will look at his suggestions, and out of respect, I will do that," Trump said.
Trump reiterated his support for the two provisions in a separate interview on CBS' "60 Minutes," which aired Sunday.
During that interview, Trump called the ACA's protections for people with preexisting conditions one of the law's "strongest assets." In addition, he said that although the ACA's provision that allows young adults to stay on their parents' plans "adds cost ... it's very much something" his administration is "going to try and keep."
Still, Trump said he will stick to his campaign promise to repeal and replace the ACA. He said, "We're going to do it simultaneously," adding, "We're not going to have, like, a two-day period and we're not going to have a two-year period where there's nothing. It will be repealed and replaced ... And it'll be great health care for much less money."
However, he did not offer specific details on a replacement plan.
Also on Sunday, when Fox News' Chris Wallace remarked that he "never heard [Trump] talk once on the campaign trail about amending Obamacare" and asked former Trump campaign manager Kellyanne Conway whether Trump "might amend [the ACA] rather than repeal it," Conway said, "We don't know because he also has to work with the Congress." She added that she nonetheless expects Republicans to take "some significant action on Obamacare."
Trump's comments in line with past stance
While Trump's openness to preserve those ACA provisions contrasts with his calls to fully repeal and replace the law, they are in line with his previous comments on the subject.
For instance, CNN reports that during the GOP debate in February, Trump said, "I want to keep pre-existing conditions. I think we need it. I think it's a modern age. And I think we have to have it."
Further, the two provisions have garnered some support from Republican lawmakers. Shortly after Trump's interview, a spokesperson for House Speaker Paul Ryan (R-Wis.) tweeted that Ryan's ACA replacement plan, called "A Better Way," also includes provisions to protect individuals with preexisting conditions and allow young adults to stay on a parent's health plan until age 26.
Trump comments on abortion care
During his interview with "60 Minutes," Trump also said he planned to appoint conservative, "pro-life" justices to the Supreme Court who could overturn the Roe v. Wade decision that legalized abortion in the United States.
Trump said that under such a change, the issue of whether abortion is legal would "go back to the states." Trump acknowledged that could mean some women might have to travel "to another state" to access abortion care.
Republicans divided over ACA repeal
In related news, Republican lawmakers appear divided over how to repeal the ACA, The Hill reports.
The 12 post-election questions every health care executive should be asking
Some lawmakers, including Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah), are seeking to completely and quickly repeal the ACA. For example, Rep. Andy Harris (R-Md.), said the law's individual mandate "should crumble immediately."
However, an abrupt change to the law likely would affect the entire U.S. health care system, Politico reports. As such, some lawmakers are pushing for a slower transition period that would provide individuals with advance notice of any potential changes.
Sen. Roger Wicker (R-Miss.), said, "We'll see if we can reach some sort of consensus with our Democrat friends on how to make this repeal and replace—clearly we don't want to do any harm to people who are in the system now. We want to be mindful of that."
While Trump in his "60 Minutes" interview said efforts to repeal and replace the ACA would happen "simultaneously," some Republican lawmakers are at odds over the timeline.
Rep. Chris Collins (R-N.Y.) on Friday said Republicans "have replacement ideas" to present to the Trump administration, but added that efforts to repeal and replace the law likely will occur in stages. He said Republicans "are not going to be pulling the rug out from anyone," adding that there will need to be "a transition."
Rep. Phil Roe (R-Tenn.) said replacing the ACA is "not going to be easy to fix," adding, "It's going to take one to two years to reconstitute a marketplace" (Langley/Baker, Wall Street Journal, 11/11; Ferris, The Hill, 11/11; Levey, Tribune Washington Bureau/Sacrament Bee, 11/11; Alonso-Zaldivar, AP/Sacramento Bee, 11/12; Bennett, Roll Call, 11/13; Lima, Politico, 11/11; O'Donnell, USA Today, 11/11; Schleifer/Tatum, CNN, 11/12; Hellmamm, The Hill, 11/13; Bolton, The Hill, 11/13; Haberkorn, Politico, 11/11; Vladimirov, The Hill, 11/11; Fox News transcript, 11/13).
Under a Trump administration, what will happen in the next era of health care reform?
The Republican sweep of Congress and White House could result in profound changes for the health care industry.
While much about the future of health policy and the Affordable Care Act remains uncertain, one thing hasn't changed as a result of the election: The health care industry is entering the next era of health care reform. Hospital and health system leaders must transform the delivery system to meet two profound and lasting market evolutions: population health and consumerism.
At this year's Health Care Advisory Board national meeting, we'll help you identify and prioritize the no-regrets investments that will support success toward these goals and more.
Register now to save your spot at a session near you.
Next in the Daily Briefing
US health system has 'more work to do' on interoperability, ONC says