Erasing the Affordable Care Act and replacing it with a set of policies long favored by conservatives remain at the core of the agenda. But in his first interview as president-elect, Trump significantly softened his language for the ACA’s fate, telling the Wall Street Journal on Friday, “Either Obamacare will be amended or repealed and replaced.”
He mentioned just two parts of the law to keep, both favored by House Republicans despite their eagerness to axe the law. Trump reiterated his support for a rule forbidding insurers to refuse coverage to people with preexisting medical problems. And he said young adults should be able to stay on their parents insurance policies until 26 — an aspect he did not discuss during the campaign.
On the transition website, the first two lines in a set of bullet points say that the Trump administration will protect health-care workers from being required to perform services that violate their religious or moral beliefs and that it will “protect innocent human life from conception to natural death.” Neither had figured among the campaign’s health-care positions.
Conversely, the website omits what had been the Republican nominee’s call for Congress to allow Americans to import prescription drugs from countries where they are sold at lower prices. This idea has long been favored by Democratic lawmakers but repeatedly blocked by Republicans.
The idea of drugs crossing U.S. borders could be construed as conflicting with the president-elect’s support of trade barriers, said Michael Cannon, director of health policy studies for the Cato Institute, a libertarian think tank. But Cannon acknowledged that, overall, Trump’s “health-care machinations have been a black box for me.”
According to insiders to the transition, the shifts in the agenda primarily reflect the views of people chosen to help handle his ascension to the Oval Office, not a deliberate strategy by Trump to align with the GOP majorities in the House and Senate.
Many of the ideas, including the “conscience clause” for health-care workers, mirror the positions of the Heritage Foundation. Edwin Feulner, the conservative think tank’s former president, has a prominent role in the transition for domestic policy. So does Kenneth Blackwell, a former Cincinnati mayor and Ohio secretary of state who is a senior fellow at the Family Research Council and serves on boards of other conservative organizations.
The tweaked health-care agenda “is certainly moving in the direction of traditional Republican thinking,” said Gail Wilensky, a veteran health-policy expert who ran the Medicare and Medicaid programs under President George H.W. Bush and has not conferred with the Trump post-election team. “Not with a fulsome leap, but he’s definitely moved in that direction.”
During the campaign, for instance, the candidate’s platform did not address the future of Medicare, the vast federal insurance program for older or disabled Americans. The program has been strained financially for years, and the trust fund that pays for Medicare patients’ hospital care is forecast to become insolvent in a dozen years. Before his election, Trump said repeatedly that he would not cut or change the program. “I’m leaving it the way it is,” he said in May.
In contrast, the transition website says the Trump administration will “modernize Medicare so that it will be ready for the challenges with the coming retirement of the Baby Boom generation — and beyond.”
By adding Medicare modernization to the list, Trump is now employing the vocabulary of Republicans, notably House Speaker Paul D. Ryan (R-Wis.), Wilensky said. Ryan has long advocated converting Medicare from an entitlement program and giving its beneficiaries a certain amount of money to help buy private health plans.
For his part, Trump is borrowing “language that Ryan . . . has used about modernizing Medicare, but not with any specificity,” Wilensky said. She also noted that the president-elect’s time frame was slightly skewed, since the first baby boomers began to retire five years ago.
The president-elect’s agenda removes a separate campaign idea that the House speaker and other conservatives favor: changing tax law so that individuals can deduct the cost of health insurance. Critics say such a switch would weaken employer health benefits that have been the mainstay of coverage since the 1940s.
Over the years, including early in his candidacy, Trump’s position on abortion has fluctuated. But in July, he chose Indiana Gov. Mike Pence, a fervent abortion opponent, as his running mate. Two months later, Trump dispatched a letter to “pro-life leaders” in which he pledged to nominate Supreme Court justices who oppose abortion rights, remove funding from Planned Parenthood and permanently institute the Hyde Amendment, a controversial provision that limits federal funding of abortion.
In Tuesday’s election, exit polls suggest about 80 percent of white, evangelical voters supported the Republican ticket.