WASHINGTON — Even as he asked a court to cancel his predecessor’s signature domestic achievement, President Trump reassured Americans last week that they need not worry about the demise of the Affordable Care Act because Republicans would replace it with something better.
The fine print came Monday night: They will not have a replacement plan for at least 19 more months — and then only if Republicans win the 2020 election.
A series of late-night Twitter messages seemed to ensure that health care will take its place among the central issues of next year’s presidential race, a prospect that Democrats welcomed and at least some Republicans dreaded. Mr. Trump said his party will not come up with its own plan until after next year’s election, meaning he will make no effort to work with Democrats and will only try to fulfill his first-term “repeal and replace” promise if he wins a second term.
“The Republicans are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare,” the president wrote in a string of three tweets posted Monday night. “In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win back the House.”
Democrats seized control of the House in last year’s midterm elections at least in part on the issue of health care, and they are eager to make defending the most popular parts of the Affordable Care Act a prominent part of the debate in 2020.
“Last night the president tweeted that they will come up with their plan in 2021,” Senator Chuck Schumer of New York, the Democratic leader, said on Tuesday at a rally in front of the Supreme Court. “Translation: they have no health care plan. It’s the same old song they’ve been singing. They’re for repeal. They have no replace.”
Mr. Trump appears to be gambling that he can turn the tables on an issue that has long favored Democrats by portraying them as increasingly extreme. Even as party liberals, including some presidential candidates, embrace the idea of “Medicare for all,” Republicans have seized on it to accuse Democrats of favoring a socialist, government-run health care system that would close down all private insurers.
“Democrats are controlled by the far radical left wing of their party and they are a total contrast to what we need and what the president wants to see happen when it comes to health care,” Sarah Huckabee Sanders, the White House press secretary, said on Fox News on Tuesday. “They want to see this Medicare-for-all government takeover of health care.”
Wary of such attacks, the Democratic congressional leadership has downplayed a single-payer system run by the government and advanced incremental measures to shore up former President Barack Obama’s health care law and lower prescription drug prices.
Many Republicans in Congress have been exasperated by Mr. Trump’s decision to thrust health care into the framework of the next election, seeing it as a vulnerability, not an asset. Even some of the president’s own advisers have been confounded by his move.
Soon after the president decided last week to intervene in a Texas court case on the side of invalidating the entire Affordable Care Act without a ready replacement, Mr. Trump and Vice President Mike Pence held a conference call with the Ronna McDaniel, chairwoman of the Republican National Committee, and Mr. Trump’s campaign manager, Brad Parscale.
Both Mr. Parscale and Ms. McDaniel tried to tell the president they could not understand what he was doing, according to a person familiar with the call.
Mr. Trump replied that if they did nothing, Democrats would continue to own the issue and that the other option was being known as the party that cannot figure out how to properly craft a health care legislative package, the person said.
Senator Mitch McConnell of Kentucky, the majority leader, has also signaled concern to Mr. Trump. In several private conversations since last week, he told the president that he believed Democrats owned the dysfunction around to the Affordable Care Act and that Mr. Trump was essentially letting them off the hook by inserting himself into the debate again, according to a person briefed on the discussions.
Democrats welcomed the president’s decision to postpone action on health care and elevate it as a political issue. The House will vote this week on a resolution urging the Justice Department to reverse its position and defend the 2010 health care law in court, forcing lawmakers to take a side on the court case.
“The American people deserve to know exactly where their representatives stand on the Trump administration’s vicious campaign to take away their health care,” Ms. Pelosi said.
The resolution, offered by a freshman Democrat, Representative Colin Allred of Texas, says that the Justice Department should “cease any and all efforts to destroy Americans’ access to affordable health care, and reverse its position” in the court case, Texas v. United States.
It was not immediately clear on Tuesday what the Trump administration would do if courts ruled in favor of abolishing the health care law. Last week, the Trump administration broadened its effort to unravel the Affordable Care Act by arguing that the entire law should be invalidated. If that happened, at least 20 million people could lose their health insurance. A court battle could stretch past the 2020 election.
Some of the president’s senior advisers pushed him to join a lawsuit in Texas challenging the constitutionality of the entire current health care law, a more expansive position than it had taken previously, when the administration argued that protections for people with pre-existing conditions should be struck down.
While some of Mr. Trump’s aides encouraged joining the lawsuit, others raised concerns, including the White House counsel, Pat Cipollone. Mr. Cipollone said that Attorney General William P. Barr had issues with joining the suit too. But once the president made clear his mind was made up, the Justice Department went along without complaint, people familiar with the events said.
Among those objecting was Senator Susan Collins, a moderate Republican from Maine who sent a letter to Mr. Barr expressing her “profound disagreement” with the move.
“Rather than seeking to have the courts invalidate the ACA,” she wrote, referring to the Affordable Care Act, “the proper route for the administration to pursue would be to propose changes to the ACA or to once again seek its repeal. The administration should not attempt to use the courts to bypass Congress.”
Mr. Trump has basically commissioned four Republican senators to devise a replacement for the Affordable Care Act. The group consists of two doctors, John Barrasso of Wyoming and Bill Cassidy of Louisiana, as well as Senator Lindsey Graham of South Carolina, a close ally of the president, and Senator Rick Scott of Florida, who was the chief executive of a large for-profit hospital company before he entered politics.
In his budget request to Congress last month, Mr. Trump reaffirmed his desire to repeal the Affordable Care Act and said he wanted to replace it with a version of legislation offered in 2017 by Mr. Graham and Mr. Cassidy.
In place of the open-ended federal contribution to Medicaid, Mr. Trump would give states “market-based health care grants” — lump sums of federal money or allotments for each person covered. Congress rejected this idea when Republicans proposed it in 2017.
The nonpartisan Congressional Budget Office said at the time that “millions of additional people would be uninsured” under the Graham-Cassidy bill, compared with the number of people expected to lack coverage under current law.
Mr. Scott said on Tuesday that he was focused on bringing down health costs, especially prescription drug prices. “Obamacare has made health care way more expensive,” he said. “Co-payments are up. Deductibles are up. Premiums have skyrocketed.”
When asked about developing a wholesale replacement for the Affordable Care Act, Mr. Scott did not answer directly. “I’m a business guy,” he said. “I didn’t try to do grand bargains.”
And Mr. Trump’s pronouncement that a broad plan would wait until after next year’s election? “You’ll have to ask the president,” Mr. Scott said. “I know what I’m going to focus on. I’m going to focus on drug prices.”