President Donald Trump made a great sounding promise for future healthcare policy in his first television interview since taking office, but policy experts on all sides of the political spectrum said it's not really possible—or at least more complicated.
In interview Wednesday with ABC's David Muir, Trump said the Affordable Care Act has been a disaster and his administration will “come up with a new plan that's going to be better healthcare for more people at a lesser cost.”
Tom Miller, resident fellow at the right-leaning American Enterprise Institute, said that result would require trade-offs, some of which will be unpalatable to voters and any politicians worried about midterm re-election.
This could include losing popular provisions such as bans on annual and lifetime spending caps, no discrimination against people with pre-existing conditions and letting children stay on their parents' insurance until age 26. Most Republican replacement plans have excluded these provisions as a way to cut costs.
The GOP has been internally arguing all week about when and how to go through with their campaign promise to repeal and replace the ACA. Trump has pushed for quick action, but others have insisted a replacement plan be agreed upon before repeal is considered.
At the retreat for congressional Republicans Thursday in Philadelphia, Trump said he had considered waiting for a replacement for two years so “the Dems would come begging to do something.” He then said that delay shouldn't happen because it would hurt the American people.
Trump has never been clear about what he would like to see in an ACA replacement. He has said it would be “something terrific” and that people wouldn't be left to “die on the streets and the sidewalks” but hasn't given policy specifics. Economic analyses of plans that Republicans have put forward all provide coverage to fewer people than the up to 30 million people that the ACA has.
Larry Levitt, senior vice president of the Kaiser Family Foundation, said on Twitter that a single-payer plan could accomplish what Trump promised in his interview, but Republicans would never support such a plan.
"The government can certainly spend less money and provide health insurance to fewer people," he wrote. "Spending less and covering more is trickier."
Miller said lawmakers can try to pass something that appears to check all the boxes, but often they're only hiding costs and consequences, he said.
“We're very good at moving costs around and hiding them and making them seem like they're lower because they're showing up someplace that is less visible,” he said. “That's not the same as reducing them.”
Miller said Trump's statement isn't surprising considering his tendency to tell people whatever they would like to hear.
“As much as we blame officeholders and politicians ... they're responding to a political marketplace rather than a reality-based economic one,” he said. “And there's an audience for that. There's always been an audience for that.”