WASHINGTON — President Donald Trump praised the House Republicans' proposal for replacing the Affordable Care Act as "wonderful," though he noted that he considered it the first phase of his planned health care overhaul and the beginning of a "negotiation."
It's not clear exactly how the White House would like to change the bill. Trump has never put forward a detailed health care proposal. Still, he has made plenty of promises on how he will improve the health care system.
As a candidate, Trump pledged to overhaul former President Barack Obama's signature health care law, rein in costs and help struggling Americans deal with skyrocketing premiums. But even with Republican majorities in both chambers, the issue has created divisions among GOP lawmakers and passage is not assured. Republican groups such as the Club for Growth and the Heritage Foundation criticized the bill, likening it to a modified version of Obamacare.
Here's a look at the Republican health care proposal and how it stacks up against Trump's campaign pledges:
Repealing the Affordable Care Act was a central campaign promise from Trump, who frequently spoke about "the disaster known as Obamacare" on the campaign trail.
The plan from House Republicans repeals key parts of the law: the mandate requiring Americans to buy health insurance, and the fines imposed on those who don't carry health insurance.
The plan does not eliminate other elements. It would loosen rules that Obama's law imposed for health plans directly purchased by individuals, while also scaling back — but not eliminating — insurance subsidies. Obamacare expanded Medicaid to cover more low-income people. The Republican bill would limit future federal funding for Medicaid, rather than repeal the expansion.
As a candidate, Trump said he would provide states with block grants for Medicaid funds to give governors more flexibility.
The Republican plan maintains the health care law's higher federal financing for expanded Medicaid through the end of 2019. After 2019, states can only continue to receive the enhanced federal payments for beneficiaries already covered by the expansion. The government would offer a lower level of financing for newly enrolled beneficiaries after that date.
The plan aims to make Medicaid more cost-efficient but could run into opposition in states that expanded their Medicaid coverage and are wary of a larger financial burden.
Candidate Trump said he wanted to maintain popular provisions of the law, including protections for people regardless of their health history and parents' ability to keep adult children on their insurance until age 26. The Republican legislation does that.
But it remains to be seen how costly that would be. Democrats contend the plan underestimates the costs of covering people with pre-existing medical conditions and lacks assurances that healthy people will also buy into the insurance pools, making the insurance premiums manageable.
Trump has been harshly critical of pharmaceutical companies for their pricing, saying they are "getting away with murder." During a news conference before he took office, Trump promised to take on drug companies, saying, "We're the largest buyer of drugs in the world, and yet we don't bid properly."
The health care plan from House Republicans does not address drug prices. Trump tweeted Tuesday that he was working on a new system to create competition in the drug industry and promised that prices would come down. In a letter to Republican House leaders, Health Secretary Tom Price also noted that lowering drug prices is among the president's goals.
SALE OF INSURANCE ACROSS STATE LINES
Trump often pointed to the need to eliminate regulatory barriers so insurance could be sold across state lines. He said that would promote competition and reduce cost.
Price told lawmakers that not all of Trump's plans — including selling insurance across state borders — could be achieved through the bill because of procedural rules. But he said it was an "important first step."
Offering his own piece of assurance, Trump tweeted, "Don't worry, getting rid of state lines ... will be in phase 2 & 3 of healthcare rollout."
Trump has long held that he would replace Obamacare with something cheaper and better. But the costs remain a major question mark at this stage.
The Congressional Budget Office has not released any cost estimates for the Republican replacement plan. Republicans argue the proposal will make Medicaid more cost-effective and may push insurers to offer better products, but Democrats say the plan could shift costs to states and hospitals.
On NBC's "Today Show" on Tuesday, White House Budget Director Mick Mulvaney said the bill will bring "tremendous long-term savings" by giving states more control over Medicaid. But for individuals buying coverage, Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation, said: "There's nothing in this bill that would seem to lower the cost of health insurance."
Trump has said that he wants an insurance plan that provides coverage to those who need it, and aides have emphasized the need to improve access and marketplace competition.
Just how the Republican plan will affect coverage levels is unclear. Under the current system, 11 million people are covered by expanded Medicaid in 31 states and another 12 million nationally purchase insurance through the government-run health exchanges.
Democrats argue that the plan will reduce the number of insured. Still, Mulvaney said coverage comparisons were unfair, arguing that the current law made "insurance affordable, but care impossible to actually afford."