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Elections 2016

Republicans Likely To ‘Give Themselves Time’ To Set Health Law Replacement

Julie Rovner, of Kaiser Health News, joined NPR’s Scott Horsley and USA Today’s Alan Gomez on PBS NewsHour on Thursday to discuss the Trump administration’s priorities in the first 100 days, including dismantling the Affordable Care Act.

Rovner notes that finding a replacement that Republicans can agree on will not be quick, especially if they try to find ways to maintain coverage for the 20 million people who gained insurance under the law.


HARI SREENIVASAN: After that transition to the White House, Donald Trump will settle in for his first day of work, January 21, 2017.

He’s already proposed the actions he wants to take within his first 100 days in office, but which campaign promises can he realistically tackle in that time?

For more on this, we’re joined now by Alan Gomez, immigration reporter for USA Today, Julie Rovner, senior correspondent for Kaiser Health News, and Scott Horsley, White House correspondent for NPR, who was at the White House today for Trump’s meeting with President Obama.

Scott, let me start with you.

He has specified — he has specified a contract with his voters that range — that has a lot of things on it. It ranges everything from repealing Obamacare to backing out of trade deals to undoing all the executive actions.

So, which of those are achievable in the first 100 days?

SCOTT HORSLEY, NPR: Well, some of the things, like repealing Obamacare, will take cooperation from Congress. And that may be more time-consuming.

But some of them, Donald Trump can at least start on, on day one, or maybe day three. Day one, I think, is a Saturday. But very early on, he can start to undo some of the executive orders that President Obama has put in place. And President Obama has used executive orders to advance a lot of things that he was unable to push through a Republican-controlled Congress in areas like immigration, where he granted a reprieve to young people who came into the country illegally as children, a reprieve from deportation.

That could be undone quickly by Donald Trump. The big area on those executive orders is climate change. Much of the president’s climate agenda has been executed administratively, or through the executive branch and through the EPA, and Donald Trump has promised to unwind that.

The clean power plan — the Clean Power Plan, which regulates coal-fired power plants, for example, that’s really the heart of what the U.S. did as part of the Paris climate accords. And that is something that could be reversed. It’s on hold anyway right now because of legal challenges, but that could be reversed really very quickly by president-elect Trump.

HARI SREENIVASAN: Julie Rovner, one of the key cornerstones to all the Republicans really that were running were to repeal and replace Obamacare.

Let’s listen to a clip of part of this contract that president-elect Trump made in his recent speech at Gettysburg.

DONALD TRUMP (R), President-Elect: The Repeal and Replace Obamacare Act.


DONALD TRUMP: Fully repeal Obamacare and replace it with health savings accounts. And we can do that.

HARI SREENIVASAN: Two parts to that.

First, the repeal, how easy is that?

JULIE ROVNER, Kaiser Health News: Not that easy.

It turns out, if you actually want the repeal the entire law, you will need 60 votes in the Senate, unless they get rid of the filibuster, which seems unlikely. They don’t have — the Republicans don’t have 60 votes. They can repeal parts of it using a budget process, but even that will take some time, because, in order to get to that bill, they have to do a budget resolution first. That will take at least a matter of weeks.

So, this is not something that’s likely, even a partial repeal, to be accomplished in the first 100 days.

HARI SREENIVASAN: Are there any things that they can do to try and create disincentives for insurance companies or to try and decrease the amount of Medicaid that’s going out?

JULIE ROVNER: Well, they could do a lot of things. Because the Republican Congress has been saying repeal and replace pretty much since the bill became a law in 2010, President Obama has had to do a lot of implementing it by executive order.

And President Trump could just reverse a lot of those executive orders. He could make all kinds of mischief for the law. But one of the things that they’re talking about doing in this — it’s sort of a two-step repeal, then replace, because, they can’t repeal all of it. They’d repeal part of it and they would let it stay in effect for some portion of time while they try to come up with a replacement.

So it’s hard to know whether they want to do a lot of disincentives if they’re intending to leave it intact, so they don’t end up taking health insurance away from 20 million people.

HARI SREENIVASAN: Alan Gomez, another one of the cornerstones of this campaign that resonated with so many of his voters was to build a wall between the United States and Mexico. Let’s take a listen to another clip.

DONALD TRUMP: End Illegal Immigration Act.


DONALD TRUMP: Fully fund the construction of a wall on our southern border. Don’t worry about it. Remember, I said Mexico is paying for the wall.

HARI SREENIVASAN: What are the walls in between that idea and reality?

ALAN GOMEZ, USA Today: Well, building a wall and getting — and figuring out how to get Mexico to fund that is absolutely something that he has to work with Congress on.

They have to create a whole legal mechanism to try to withhold the remittances that are going to go back to Mexico that he says are going to be the basis for paying for this wall. And just funding it is going to require a lot of work from Congress.

But this is one area where the president absolutely has a lot of discretion when it comes to deportations, to refugees, to who gets admitted into the country, those other things that he talked about throughout the campaign. He has a lot of power in that area.

HARI SREENIVASAN: Alan, about the deportations. Right now, how much — or how many people are allowed to stay in this country right now who are not actively being prosecuted to be deported because of what President Obama has done through executive action?

ALAN GOMEZ: Well, right now, it’s been about over 800,000 young undocumented immigrants who have been granted — it’s called the Deferred Action for Childhood Arrivals program, DACA.

So, there’s 800,000 kids who have that right now. That was created by a memorandum by the Department of Homeland Security. So, President Trump’s secretary of homeland security can just rescind that, institute a new one, and all of a sudden all those kids are open to deportation.

But there’s also the question of the entire Border Patrol, all of Immigration and Customs Enforcement. They can now be sort of refocused, retasked on going out and finding more people and getting them deported.

He would need more money to ramp up the deportations to the level that he’s talked about, but, in the short term, he can absolutely redirect them and really increase that deportation apparatus.

HARI SREENIVASAN: Scott Horsley, one of the things — one of the first things on that contract that Donald Trump has with his voters is to — he wants to impose term limits on Congress.

And, as we saw, as — Senate Leader Mitch McConnell yesterday, that’s not going to be something that the Senate takes up, not that this is a failure of his contract before he even gets into office, but this is a relationship business.

SCOTT HORSLEY: That’s right. And I think Senator McConnell called that a nonstarter, even though it’s right at the top of the 100-days agenda.

HARI SREENIVASAN: So, in terms of those things in that contract, what does the president-elect do, Scott Horsley, to try to figure out ways where things can be more palatable to a Congress that’s willing and interested in working with him?

SCOTT HORSLEY: Well, there was a lot of stuff on that list that Donald Trump hasn’t talked a lot about during the campaign. And a lot of that drain-the-swamp stuff wasn’t really a major focus of his campaign.

The term limits, the lobbying limits, that was not something that he campaigned on for months and months at a time. The real priorities — and these are the things that he talked about when he went up to the Hill today to meet with Mitch McConnell and House Speaker Paul Ryan. He focused on jobs, immigration, and health care.

By health care, he means repealing the Affordable Care Act. And, certainly, those are all issues that a Republican Congress will look on favorably.

HARI SREENIVASAN: All right, Julie Rovner, one of the things that we have learned is that it’s reported 100,000 people signed up for Obamacare after the results of the election came in.

And I say that because the replace is one part that is very complicated, as you mentioned. Paul Ryan seems to be fairly confident that, with a president who will not veto this, that it’s more possible.

But how complicated is it to try to come up with something that they’re going to have to have some bipartisan agreement on to get forward, going forward?

JULIE ROVNER: Well, it’s very complicated.

And, first, for the people who are signing up now for 2017, every indication is that that coverage will start on January 1, 2017, and continue probably even until the end of 2017, possibly until the end of the following year, because what Congress seems to want to do is do this partial repeal and pick a date out in the future, basically give themselves time, let the program exist as it is, give themselves time to come up with that replacement.

That replacement, though, as you mentioned, is going to be very difficult. Republicans have had six years to come up with the replace part of repeal and replace. And sort of the best they have been able to come up with is a still pretty outline outline that House Speaker Ryan came out with last summer.

But turning that into a real program might be difficult, and it might not be able to get through the Senate. So, it’s a pretty risky proposition, although they have vowed so hard to repeal the law that they pretty much can’t not.

HARI SREENIVASAN: And, politically, there’s 20 million people who are now issued that weren’t.

JULIE ROVNER: That’s right, and 20 million people whose insurance is tied directly to the Affordable Care Act, so who really would be at risk of losing that coverage if the law were simply repealed and nothing replaced it.

HARI SREENIVASAN: Alan Gomez, another thing that the president-elect has said repeatedly is about the concern that he has about refugees coming into the country.

He said he wanted to — quote — “begin removing the more than two million criminal illegal immigrants from the country, cancel visas to foreign countries that won’t take them back, and suspend immigration from terror-prone regions where extreme vetting can’t happen.”

So, the second part of that, how does he implement extreme vetting, or how do his advisers or his future Department of Homeland Security head do that?

ALAN GOMEZ: Well, that’s another area where he has a lot of power.

When it comes to refugees, first off, President Obama has increased the number of refugees that the U.S. has accepted each year from 70,000 to 85,000 to 110,000 in 2017. President Trump could bring that down to zero. That’s completely in the purview of the president.

And then, when it comes to blocking immigrants coming from other countries, at first, he called it a ban on Muslims. He later changed that to say that he wants to ban people who are coming from countries that sponsor terrorism, who are fostering terrorism.

And there’s a provision in the Immigration Nationality Act that allows a president to bar specific immigrants or whole classes of immigrants who are deemed detrimental to the interest of the United States.

So, right now, there’s a lot of immigration lawyers around the country sitting there saying, he could absolutely do that, and it would be really hard to challenge that in court, because courts have traditionally allowed presidents to really take the lead when it comes to immigration.

HARI SREENIVASAN: All right, Alan Gomez from USA Today, Scott Horsley from NPR, Julie Rovner, thank you so much for joining us.

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