Trump Concedes Health Law Overhaul Is ‘Unbelievably Complex’

— President Trump,
meeting with the nation’s governors,
conceded Monday that he had not
been aware of the complexities of
health care policy-making: “I have to
tell you, it’s an unbelievably complex
subject. Nobody knew that health care
could be so complicated.”
The president also suggested that the
struggle to replace the Affordable Care
Act was creating a legislative logjam
that could delay other parts of his
political agenda.
Many policy makers had anticipated
the intricacies of changing the health
care law , and Mr. Trump’s demands
in the opening days of his
administration to simultaneously
repeal and replace President Barack
Obama’s signature domestic
achievement made the political
calculations far more complicated.
Governors of both parties added still
more confusion on Monday when they
called for any replacement to cover all
the people already benefiting from the
landmark law.
“Of course I am concerned,” said Gov.
Brian Sandoval, the Republican
governor of Nevada, where about
300,000 people have gained Medicaid
coverage. “I am someone who elected
to expand Medicaid. That’s been very
beneficial to my state, and I want to
be sure those individuals can keep
their coverage.”
“Governors are all in agreement,” said
Gov. Terry McAuliffe of Virginia, a
Democrat who is the chairman of the
National Governors Association. “We
do not want one single one of our
citizens to lose access to quality health
care. We are all unified on that.
Actually, we want to expand, so
everybody has access to quality health
care.”
Mr. Trump brushed aside opinion
polls suggesting that the 2010 health
law was becoming somewhat more
popular . “People hate it,” the
president said, “but now they see that
the end is coming and they’re saying,
‘Oh, maybe we love it.’ There’s
nothing to love. It’s a disaster, folks.”
Because of the intricate procedures
that govern budget legislation and the
inherent complexity of health care,
Republicans appear unlikely to undo
the health law as quickly as they had
hoped. Mr. Trump said Congress must
tackle the Affordable Care Act before
it can overhaul the tax code, also a
high priority for Republicans. And
those delays could slow work on other
priorities like a billion-dollar
infrastructure push.
“Statutorily and for budget purposes,
as you know, we have to do health
care before we do the tax cut,” Mr.
Trump told governors.
After his session with the governors,
Mr. Trump met on Monday with
executives from health insurance
companies. He apparently hopes they
will stay in or return to the Affordable
Care Act’s insurance marketplaces,
where more than 10 million people
obtained coverage last year.
If the governors’ meeting in
Washington was supposed to clarify
the future of the health law, it fell
short. If anything, it exposed deep
divisions among state executives,
especially Republican leaders.
Gov. Gary R. Herbert of Utah, a
Republican, said: “We did not expand
Medicaid. Many states are divided on
what the right approach is to take
under the Affordable Care Act.” Some
Republican governors, he said, are
concerned about the “sustainability”
of the Medicaid program, which
covers more than 70 million low-
income people.
And no governor was ready to say
publicly that he or she could accept a
replacement health law covering
fewer people than the Affordable Care
Act, which has extended coverage to
20 million Americans.
A bill drafted by House Republicans
could cover fewer people. It would roll
back the heath law’s expansion of
Medicaid, eliminate tax penalties for
people who do not have health
insurance and end taxes imposed by
the Affordable Care Act on certain
high-income people, insurers, drug
companies and manufacturers of
medical devices.
To help people buy insurance, if they
do not have coverage at work or under
a government program, the bill would
offer tax credits ranging from $2,000
to $4,000 a year, depending on age.
But the credits would not fluctuate
with a recipient’s income, raising the
prospect that insurance might be less
affordable for lower-income people.
The House Republican bill would also
eliminate minimum federal standards
for “essential health benefits,” and it
could require some people with
particularly expensive employer-
sponsored coverage to pay taxes on
some of its value.
The emergence of that draft has
produced cries of opposition among
Democrats and nervousness in some
Republican quarters. Conservatives
added their objections on Monday,
saying the tax credits could become a
permanent entitlement.
Representative Mark Walker of North
Carolina, the chairman of the
conservative Republican Study
Committee, said he could not vote for
the bill in its current form because it
could create “a new health insurance
entitlement with a Republican stamp
on it.”
Mr. Herbert said he could support the
Republican proposal to give each state
an allotment of federal money with a
set amount for each Medicaid
beneficiary — what he and other
officials described as a per capita cap.
Some experts believe that could be
“the best thing for us to do in Utah,”
Mr. Herbert said.
But Democratic governors generally
oppose efforts by congressional
Republicans to give each state a fixed
allotment for each beneficiary or a
lump sum, known as a block grant, for
its entire Medicaid program.
“Block grants or per capita caps would
throw state finances into disarray”
and shift costs to the states,
Democratic governors said in a letter
to congressional leaders.
Two House committees may try to vote
next week on legislation to repeal the
Affordable Care Act and put in place
some elements of a replacement. But
the disagreements among Republicans,
in the Trump administration and on
Capitol Hill, suggest a difficult road
ahead.
In recent days, some senior White
House officials have come to believe
that the timetable House Republicans
have laid out for the health care
overhaul is overly ambitious, said one
person who has been briefed on their
thinking, given the apparent public
opposition to what is known of the
plan already and the likelihood that
an independent cost-benefit analysis
could make it even less attractive to
low-income voters.
If the House plan fails, these officials
may introduce a White House version
of the repeal-and-replace legislation
later in the year, with the hope that it
will be better received, added the
person briefed on the matter.
Gary Cohn, the director of the
president’s National Economic
Council, and his staff have spent
significant time studying the
Affordable Care Act and its
weaknesses. Mr. Cohn and Jared
Kushner, the president’s son-in-law
and a senior adviser, have emerged as
skeptics of the plan being developed
by House Republicans, said the person
briefed on the matter. The White
House had no immediate response to a
request for comment.
The White House chief of staff, Reince
Priebus, is more aligned with the
House speaker, Paul D. Ryan, and the
secretary of health and human
services, Tom Price, who are
championing the current repeal-and-
replace bill.
Mr. Trump’s Treasury secretary,
Steven Mnuchin, said as recently as
Thursday that the administration
hoped to pass tax cuts for both
businesses and middle-class
Americans in time for Congress’s
recess in August. But since health care
must be addressed first, tax legislation
could easily be pushed into 2018,
according to members of Congress and
administration officials.