By Rachael Bade, Josh Dawsey, Seung Min Kim and John Wagner / The Washington Post
WASHINGTON — President Donald Trump is pressuring Republicans to produce a replacement for the Affordable Care Act, a request the GOP considers unrealistic in a divided Congress and politically perilous ahead of the 2020 elections.
Hours after meeting with Senate Republicans at the Capitol on Tuesday, Trump spoke on the phone with a handful of senators, urging them to write a new law – even though the party failed to coalesce around a plan when it controlled the House and Senate for two years.
The White House has no proposal in the works, according to administration officials, but Trump wants Republicans to pass a bill before his reelection effort that would do what Obamacare does – provide coverage to millions of Americans.
Trump spoke with Sen. David Perdue, R-Ga., on Tuesday evening and listed his priorities in a phone call with Sen. John Barrasso, R-Wyo., on Wednesday morning.
“He wants to preserve people being able to get their insurance through work … and focused on people with preexisting conditions,” Barrasso said. “He is 100 percent committed to ensuring that people with preexisting conditions get covered, and I understand that … and the president is also focused on lowering the cost of drugs.”
Trump’s push comes after his Justice Department, in a filing Monday in the U.S. Court of Appeals for the 5th Circuit, argued that the ACA should be thrown out in its entirety, including provisions protecting those with preexisting health conditions and allowing young adults to stay on their parents’ health-care plans.
If the case reaches the Supreme Court, it’s unclear how it would fare: Five justices who preserved the ACA during a previous case are still on the court.
But if the law is struck down, Republicans fret that the party will be blamed for more than 20 million people losing their health insurance — and they fear that crafting an alternative would prove unwieldy in a deeply divided Congress.
“Repealing the entire law — or knocking it down in the court system with no plan to address the impasse — leaves millions of Americans in harm’s way, and they didn’t do anything,” said Rep. Tom Reed, R-N.Y., a longtime Trump ally. “We owe it to the American people to have a solid plan in place before that occurs… . It’s not the smartest move.”
Trump’s request is being met with skepticism by most Republicans on Capitol Hill. House Minority Leader Kevin McCarthy, R-Calif., urged Trump to hold off on pushing for a court-ordered destruction of the ACA, advice the president ignored, according to a senior Republican official who spoke on the condition of anonymity to freely discuss the conversation.
The unheeded counsel, which McCarthy recounted to fellow lawmakers in recent days and was first reported by Axios, underscores the angst that has set in among Republicans now that Trump is pursuing the politically precarious strategy with no plan in hand to replace President Barack Obama’s signature health-care law.
McCarthy has complained privately to donors that the last GOP attempt to gut Obamacare — including its most popular provisions, such as protections for preexisting conditions — was the main reason the party lost at least 40 House seats in last year’s midterm elections. House Republicans privately worry it will cripple their attempts to reclaim the chamber and could even cost them additional seats in 2020, though few will admit so publicly because they fear Trump’s ire.
Trump has put a brave face on the effort, proclaiming that Republicans will become “the party of health care” and promising a replacement that will be well-received by voters.
“If the Supreme Court rules that Obamacare is out, we’ll have a plan that is far better than Obamacare,” he told reporters Wednesday during an event in the Oval Office.
If Republicans refuse, Trump is ready to force them by trying to create a “crisis moment” in the courts, according to one lawmaker in close contact with the White House who spoke on the condition of anonymity to describe the strategy.
White House aides said they are looking at a Barrasso plan that pushes short-term, limited-duration health insurance that the senator has said would be “free from Obamacare’s burdensome mandates.” Also in the mix is legislation from Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., that would provide block grants to states to provide coverage.
Graham pitched Trump on the push for a new health-care plan while golfing in Florida with the president last weekend.
The idea, Graham later told reporters, was to find a way to counter Democrats’ attacks on that issue in 2020, when Graham is also up for reelection. Graham said that he also counseled the president to work toward a bipartisan deal with House Democrats.
“We talked about it over the weekend, that if there’s a message to be learned from 2018 on policy, it’s health care,” Graham told reporters.
Graham said he didn’t realize Trump was paying attention until the president walked into the Senate GOP lunch Tuesday and said “let’s become the party of health care.”
But many of Graham’s colleagues are wary of the strategy, given their inability to agree on a health-care bill.
“We couldn’t repeal it and replace it with a Republican House,” said Sen. Lamar Alexander, R-Tenn., who started to laugh, referring to the now Democratic-controlled chamber.
Sen. Susan Collins, R-Maine, who is crafting a letter to the Trump administration urging the Justice Department to change its position, said the president was right when he said the GOP should be “the party of health care.” But upending the law in court without a replacement isn’t the way to do it, she argued.
“I believe that he’s sort of got the cart before the horse, that you need to have a plan for what a replacement would be that would improve upon the ACA,” Collins said. “There are some very important, good provisions of the ACA that have helped expand health insurance for low-income Americans… . I would not want to see those abandoned.”
While Trump has been hounding lawmakers to propose legislation, some GOP senators say it’s his responsibility to take the lead. Sen. Tim Scott, R-S.C., told Fox News on Wednesday that the White House — not Congress — should write the new GOP plan.
“We don’t need 12 of them. We need one solution,” Scott said, adding that he trusts Trump’s political instincts.
Sen. Mitt Romney, R-Utah, echoed those comments three times when asked his own opinion: “I’d like to see what the administration puts forward. The first step is to see what the president and the White House have with regard to their health care plan.”
In a reversal of White House guidance earlier in the day, Vice President Mike Pence’s chief of staff Marc Short told CNN Wednesday evening that Trump would be “putting forward plans this year [on health care] that we hope to introduce into Congress.”
So far, Senate Majority Leader Mitch McConnell, R-Ky., has said little publicly regarding Trump’s move. The issue was also essentially nonexistent in private Senate GOP strategy sessions on Wednesday.
Privately, McConnell has argued for lawmakers to move on. After the Senate failed to repeal the ACA in 2017, some Republican lawmakers sought to try again, but McConnell and then-Speaker Paul Ryan, R-Wis., shunned the idea.
Democrats, meanwhile, have welcomed the prospects of a health-care fight, confident that the issue will play well for them in next year’s elections. Polls have shown that the public trusts Democrats far more than Republicans to handle health care and that the Affordable Care Act has become more popular since Trump was elected.
Just before last fall’s midterm elections in which Democrats took control of the House, the party had a 16-percentage-point advantage over Republicans in trust to handle health care among registered voters, 50 percent to 34 percent, according to a Washington Post-ABC News poll.
Meanwhile, a Kaiser Family Foundation poll released Tuesday found that 50 percent of Americans have a favorable view of the Affordable Care Act, while 39 percent see it unfavorably. That compares with a 45-to-45 split the month before Trump won the 2016 presidential election.
Following the administration’s attempt to gut the ACA in court, Democrats immediately went on the offensive, particularly against swing-state GOP senators, including Thom Tillis of North Carolina.
“As long as Senator Thom Tillis is in office, Republicans in Washington will never stop attacking North Carolinians’ health care,” North Carolina Democratic Party spokesman Robert Howard said in a statement.
When asked Tuesday whether he supported the Justice Department’s argument that the entire health-care law should be dismissed, Tillis stressed that Republicans needed to present an alternative that preserves popular provisions of the Affordable Care Act, including allowing children to stay on their parents’ insurance until age 26.
“Every time we say that, we have to have a replace,” Tillis told reporters.
The Washington Post’s Scott Clement and Paul Kane contributed to this report.