(Bloomberg) -- Donald Trump on Friday said that if Republican senators can’t strike a deal on their health bill, they should immediately repeal Obamacare and then replace it later, a reversal of the president’s earlier position.
Trump’s suggestion on Twitter came as Senate Majority Leader Mitch McConnell of Kentucky was trying to reach a compromise by the end of the week with Republican senators who are withholding support of his draft bill to repeal and replace Obamacare at the same time.
Trump’s tweet was posted after Senator Ben Sasse, a Nebraska Republican and frequent Trump critic, floated the idea on the "Fox and Friends" TV program Friday morning. Sasse, in a separate statement, said if there isn’t a health deal by July 10, when the Senate returns to session, Trump should call on Congress to “immediately repeal as much of Obamacare as is possible under congressional budget reconciliation rules.”
With his tweet, Trump also appears to be aligning himself with at least one of the conservative holdouts, Senator Rand Paul of Kentucky.
‘Keep our word’
Paul said Friday on Twitter that he’d spoken to Trump and “Senate leadership about this and agree. Let’s keep our word to repeal then work on replacing right away.”
But conservatives aren’t the only ones holding out on a deal. Several more moderate members of the Senate Republican conference also oppose McConnell’s bill, which the nonpartisan Congressional Budget Office said would result in 22 million fewer Americans having health insurance over 10 years.
One idea under discussion Thursday to win over moderates to backing McConnell’s plan: keeping Obamacare’s 3.8 percent tax on net investment income to bolster subsidies for low-income people in the law’s exchanges. Senator Bob Corker, a Tennessee Republican, said he expects the party’s Senate leaders will scrap their effort to repeal that tax.
Leaders are also considering a proposal by Republican Senator Ted Cruz of Texas to allow health insurers to sell cheaper plans as long as they also sell policies that meet Obamacare standards -- but that idea, too, could run into moderate opposition.
McConnell can only afford to lose two of the 52 Senate Republicans in the 100-member Senate, with Vice President Mike Pence able to cast a tie-breaking vote for the GOP if necessary. McConnell delayed a vote he had planned to hold this week after five Republican senators said they’d vote against a key procedural motion. Several others said they opposed his bill after the vote was delayed.
Complicating negotiations
McConnell’s spokesman, Don Stewart, provided little insight about whether the leader will file a new bill today with the Congressional Budget Office. Asked if that will happen, Stewart pointed to earlier comments from McConnell that he’s been seeking to build support for the legislation this week and hopes to bring a health-care bill to the Senate floor “a couple weeks after this week.”
The new suggestion by Trump, Paul and Sasse to do a repeal-only bill first could complicate GOP negotiations further.
Republican leaders had originally planned to bring up a lightning-strike repeal bill in January to get it to the president’s desk shortly after he took office, with replace to come later. But moderates and conservatives, including Paul, balked at the idea, for different reasons.
Trump also shot the idea down. Back on Nov. 13, right after winning the election. Trump said that "we’re going to do it simultaneously," speaking in an interview on CBS’s "60 Minutes."
“We’re not going to have a two-year period where there’s nothing,” he said. “It will be repealed and replaced.”
Moderates who had voted for earlier repeal bills when there was no chance of them becoming law suddenly wanted a replacement to be ready first, and feared pulling the rug out from millions of people who had gotten insurance under the Affordable Care Act. And conservatives wanted a broader repeal than the one President Barack Obama had vetoed a year earlier, which left in place the ACA’s regulatory framework but gutted its financial underpinnings.
The Congressional Budget Office scored that earlier bill three days before Trump took office, and the results were ugly: 32 million would lose insurance over a decade and premiums would double, the office said.
Even so, a key conservative in the House said he was open to the suggestion.
“Putting the repeal bill on the president’s desk that all current Republicans senators but one have already voted for would be a prudent first step,” House Freedom Caucus chairman Mark Meadows of North Carolina said Friday. “That said, I do think we still have an opportunity to do repeal and replace in one bill if Leader McConnell will keep members engaged.”
Sasse said in that scenario, Trump should also call on Congress to cancel its August recess and work “through regular order, six days per week” to write a health package that can be voted on by Labor Day in September.
Trump’s tweet could embolden conservatives groups that have backed full repeal, including the small-government Club for Growth, to push harder against replacement efforts.
Some groups on a conference call with reporters on Friday said they support repeal-only legislation, and were critical of what they saw as the Senate bill’s failure to fully end Obamacare. Still, the groups also backed Cruz’s proposal to include in McConnell’s plan a provision allowing insurers to sell plans that don’t meet Affordable Care Act regulations alongside compliant plants.
Repeal is the “best option” but Cruz’s plan would “give us the best opportunity to actually keep a private health care market in existence in this environment,” said Jim DeMint, the former president of the Heritage Foundation.
Andy Roth, the vice president of government affairs at Club for Growth, said he likes the president’s new position but is concerned a repeal bill might not touch Obamacare’s consumer-protection regulations that groups have complained drive up costs of individual policies.
“We do not want to do partial repeal now, leave the regs in place and then allow moderates and Democrats to conspire to pass a replacement,” Roth said.
