TRUMP: Repealing and replacing Obamacare is 'not a choice — it is a necessity'

REUTERS/Kevin Lamarque

President Donald Trump laid out a vision for the Affordable Care Act (ACA) on Tuesday that appeared to back away from earlier pledges to guarantee insurance coverage for people with pre-existing conditions and leaned on tax credits to ensure Americans can afford their premiums.Trump outlined the changes in a speech to both houses of Congress, laying out five principles for the replacement of the law better known as Obamacare.

Trump cited increasing premiums and the withdrawal of insurers from the ACA's individual insurance exchanges, as evidence that the health care law is in need of a revamp.

"Obamacare is collapsing — and we must act decisively to protect all Americans," Trump said. "Action is not a choice — it is a necessity. So I am calling on all Democrats and Republicans in the Congress to work with us to save Americans from this imploding Obamacare disaster."

Trump laid out five broad ideas that he wants the Republican Obamacare replacement to address. They are:

• "Ensure that Americans with pre-existing conditions have access to coverage": Importantly Trump refers to "access" for those with pre-existing conditions, not a guarantee that there will be coverage. This is backing down from previous statements Trump has made that everyone would be covered.
• "Help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts": Currently, Republicans are favoring block tax credits that would allow people to buy health coverage, rather than the current ACA tax cuts that are tied to a household's level of income.
• "Give our great State Governors the resources and flexibility they need with Medicaid": This is the biggest sticking point for many Republican lawmakers, as those states that have expanded Medicaid wish to keep it, while more conservative members of Congress want to remove funding for that expansion. Trump's speech did not particularly clarify which side of the issue the president falls on.
• "Implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance": This is unclear what Trump is referencing other than a promise to "bring down the artificially high price of drugs."
• "Give Americans the freedom to purchase health insurance across State lines": The ACA actually has a provision that already allows interstate insurance sales, though few insurers or states have taken advantage of the provision. Additionally, many healthcare experts think this will do little to bring down insurance costs.

Democrats booed and responded by holding their thumbs down during the speech. They are expected to respond to Trump's ACA pledge with former Kentucky governor Steve Beshear, who embraced the ACA during his time in office to a relatively high level of success.

Interestingly, Trump used the example of the current governor of Kentucky saying "Governor Matt Bevin of Kentucky just said Obamacare is failing in his State." Kentucky has seen the largest drop in the percentage uninsured people between 2013 and 2016 due to the ACA.

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