In his first address to a joint session of Congress — a high-wattage moment to articulate his central goals — President Trump defied expectations he had repeatedly set that he was about to unveil a concrete plan to abolish the Affordable Care Act and steer federal health policy onto a more conservative path.
The five minutes Trump devoted to health care Tuesday night was largely a recitation of longtime Republican ideas that he has adopted, with an emphasis on removing the rules the Affordable Care Act placed on insurers to try to promote comprehensive health benefits.
“Mandating every American to buy government-approved health insurance was never the right solution for our country,” the president said, aligning with the prevailing GOP view that consumers should be allowed to buy skimpier plans that could be sold at lower prices.
Yet Trump did not echo conservatives — including his health and human services secretary, Tom Price — who are eager to convert Medicaid and Medicare from entitlement programs to ones providing “defined contributions” to help low-income and older Americans buy coverage. He only briefly referred to giving states more latitude over Medicaid and made no mention of Medicare.
Trump reiterated the broad contours of changes he has espoused since his campaign, including greater reliance on health savings accounts and letting health insurance be sold more readily across state lines.
In eschewing specifics, however, the president seemed to underscore his confession a day earlier to the nation’s governors that he now knows replacing the Affordable Care Act is “an unbelievably complex subject. . . . Nobody knew health care could be so complicated.”
So as two House committees scramble to flesh out legislative details for the first blow to the sprawling 2010 law, and as White House aides disagree internally on how far to go, the president stopped short of fulfilling promises of an imminent health-care plan — promises he made during the last stage of his campaign, the week before his inauguration and his first month in office.
Trump’s message, however, was emphatic: “Obamacare is collapsing — and we must act decisively to protect all Americans. Action is not a choice; it is a necessity.”
His tone was matched by that of the former governor whom Democrats picked for an immediate rebuttal. The choice of Steve Beshear of Kentucky reflected the party’s calculation that hammering the new president on his health-care intentions would make for good politics.
Under Beshear, fairly conservative Kentucky became a poster state of sorts for its full embrace of the Affordable Care Act. It created its own insurance exchange under the law, known as Kynect, and expanded Medicaid. As a result, Kentucky achieved one of the biggest reductions in uninsured residents in the nation. In a state of 4.4 million, 500,000 gained coverage because of Kynect — 80 percent of them through Medicaid.
In 2014, President Barack Obama invited Beshear to sit in the first lady’s box during his State of the Union address as an Affordable Care Act success story. Beshear’s Republican successor, Gov. Matt Bevin, has dismantled the state-run insurance marketplace and is trying to redesign the state’s Medicaid expansion, in part by requiring able-bodied adults to have a job, or be looking for one, to qualify for benefits.
In his response to Trump’s speech, Beshear blasted the president, saying that “you and your Republican allies in Congress seem determined to rip affordable health insurance away from millions of Americans who most need it.
“So far,” he continued, “every Republican idea to replace the Affordable Care Act would reduce the number of Americans covered, despite promises to the contrary. . . . These ideas promise access to care but deny the importance of making care affordable and effective. They would charge families more for fewer benefits and put insurance companies back in control.”
Beshear sought to reinforce the pain inflicted on some congressional Republicans last week during a recess in which town hall meetings were filled with angry constituents worried about losing their insurance coverage.
“Who are these 22 million Americans . . . who now have health care that didn’t have it before?” he asked. “They aren’t aliens from a distant planet. They’re our friends and neighbors. . . . They’re farmers, restaurant workers, part-time teachers, nurse’s aides, construction workers and entrepreneurs working at high-tech start-ups.”