Saturday, 20 February 2016

Donald Trump in Triage Mode After Shocking Conservatives With Health Care Comments

        Donald Trump addressing a rally on Friday at the Pawleys Plantation Golf and Country Club in Pawleys Island, S.C. In comments televised on Thursday, Mr. Trump expressed support for the main tenet of the Affordable Care Act. Less than 24 hours later, he distanced himself from the remark .

He has broken with many Republicans on taxing the rich, threatening trade wars and keeping Planned Parenthood alive. On Friday, Donald J. Trump faced criticism for an even bolder act of conservative heresy: embracing the core tenet of the Affordable Care Act.

      Mr. Trump has to date offered only bits and pieces of his health agenda, generally presenting a vow to repeal “Obamacare” and replace it with “something great.”

In a town-hall meeting hosted by CNN on Thursday night, he shared some more expansive views on the subject, and unlike most Republicans he did not call for removing the individual mandate that requires Americans to have health insurance.

Asked how people with pre-existing medical conditions would purchase insurance if the health law and the mandate were eliminated, Mr. Trump said, “I like the mandate.”

“So here’s where I’m a little bit different,” he continued. “I don’t want people dying on the streets.”

Less than 24 hours later, Mr. Trump backed away from his remarks, proclaiming himself to be the fiercest opponent of the health law. It was the latest example of a candidate who has been impervious to inconsistencies again emerging unscathed from a misstep that would probably be damaging to anyone else.

The Affordable Care Act has sometimes put Republicans in an awkward position on the campaign trail. While the popularity of the law remains mixed nationally, many Americans have benefited from the aspects of the legislation that would be lost if it is repealed.

     Senator Ted Cruz of Texas faced an uncomfortable silence in Iowa last month when a supporter of Hillary Clinton explained to him how a relative who was riddled with tumors had not had insurance before the law. While Gov. John Kasich of Ohio, like his Republican opponents, wants to repeal the law, he has also been criticized by conservatives for using it to expand Medicaid in his state.

For years, President Obama’s health care overhaul, and the individual mandate specifically, have been anathema to Republicans who cite it as a vivid example of government overreach.

Without providing many details, Mr. Trump said this week that he would promote health savings accounts and spur interstate competition among insurance companies to reduce prices. As for patients who could still not afford insurance, Mr. Trump said, “We’re going to take care of them through maybe concepts of Medicare,” suggesting an expansion of that government program.

Conservatives were taken aback. Senator Ben Sasse, a Republican from Nebraska who opposes Mr. Trump, said in a series of posts on Twitter that the billionaire businessman appeared to embrace most of the health law and wondered what kind of Supreme Court justices he would appoint if elected. The legality of the mandate, and the government’s power to impose fines on people who ignore it, was central to the Supreme Court decision that upheld the law in 2012.

Many Republicans have called Chief Justice John G. Roberts Jr., a George W. Bush appointee, a turncoat for having written that decision. Mr. Trump has been one of the loudest.

    “Would you nominate a Supreme Court justice who agrees with you that federal government can mandate purchasing specific products?” Mr. Sasse asked Mr. Trump on Twitter.

Rush Limbaugh, the conservative radio host who has been a defender of Mr. Trump in many instances, was also incensed. And he took issue with Mr. Trump’s suggestion that other Republicans are not disturbed by the idea of people dying in the street.

“You can’t talk about repealing Obamacare and like the mandate,” Mr. Limbaugh said during his show on Friday.

In the face of that backlash, Mr. Trump fired back on Twitter that he had been misunderstood. He said he only liked the provision in the law that requires insurers to provide coverage for people who are already ill. He then promised that he intended to repeal the entire piece of legislation, including the mandate.

The mandate underpins the law by spreading insurers’ risk between the young and healthy and the older part of the population that needs costlier medical care. Without that requirement, insurers have said, the market could collapse.

    Mr. Trump’s expression of support for the mandate was not the first time that he has struck a left-leaning tone on health care. In an interview with CBS last year he said, “Everybody’s got to be covered” and said he would cut deals with hospitals to care for people who could not afford treatment. Asked how it would be paid for, Mr. Trump responded, “The government’s going to pay for it.”

He also recently began talking about allowing the government to negotiate with drug companies to cut prices.

“If we negotiated the price of drugs,” he said in a town hall-style debate on MSNBC this week, “we’d save $300 billion a year.”

Both Mrs. Clinton and Senator Bernie Sanders have called for allowing Medicare to negotiate the cost of medicines with drug companies. President Obama has also sought the authority to negotiate prices for some expensive drugs through the Medicare Part D program. But he has faced fierce opposition from Republicans in Congress and pharmaceutical lobbying groups.

     Health care analysts have said that allowing the government to have more influence in the market this way could have unintended consequences, like suppressing drug company revenues so much that they would cut back on research. In any event, hearing the idea come from a Republican raised eyebrows.

“It’s a proposal that’s normally associated with Democrats, so for a Republican, in fact the leading Republican candidate, to say that was a surprise,” said John Rother, executive director of the Campaign for Sustainable Rx Pricing, an advocacy group working to cut drug prices.

On Friday, Mr. Trump said that his independence on the issue was more evidence that he was not beholden to “special interests” and lobbyists

Sunday, 21 February 2016

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