Ryan sidesteps Trump’s goal of health coverage for all

WASHINGTON (AP) — House Speaker Paul Ryan sidestepped an opportunity Friday to embrace President Donald Trump's goal of "insurance for everybody," saying instead that congressional Republicans are aiming for "universal access."

Ryan, R-Wis., made the remark in an interview with Politico after Republicans ended a three-day policy retreat in Philadelphia. The meetings left them still facing decisions about exactly how they will scuttle President Barack Obama's health care overhaul and replace it with a system of their own.

Trump told The Washington Post this month that he was "down to the final strokes" on a package that will have "insurance for everybody." He provided few details.

Asked about that Friday, Ryan said, "Universal access is what our goal is." Congressional Republicans have been using that phrase for several weeks, words that suggest a more modest number of people would be covered than under Trump's more expansive term.

"We believe in giving everybody the ability and the resources to buy affordable health care coverage," Ryan said. He added, "If you choose not to do that, we're not going to have government make you do something."

The so-called individual mandate — under which people are fined if they don't buy insurance — is one of the most unpopular features of Obama's statute. However, many analysts consider it crucial because it pressures younger, healthier people to purchase coverage, putting downward pressure on rates.

Instead of the mandate, Republicans have discussed creating separate, subsidized high-risk insurance pools for sicker people, who tend to be more expensive to cover. They've also considered letting insurers charge higher premiums for people who've let their coverage lapse, creating a financial incentive for them to buy policies.

Ryan reiterated that the GOP's goal is to enact bills this year dismantling Obama's law and replacing it. The new policies would be phased in over a period of time that Republicans have yet to decide.

A flow chart distributed to lawmakers at the Philadelphia meetings shows a target of congressional completion of initial bills by early spring. Follow-up measures would take months longer and administrative actions and a communications campaign would last all year.

But there's no guarantee they'll be able to stick to that schedule.

Complicated decisions Republicans must make include how much of the tax increases in Obama's law to repeal, how to protect insurers and consumers during a transition period, and how to reshape Medicaid, the health care program for the poor that Obama expanded.

Republicans know their party would be blamed if their effort results in high rates, poor health care access and angry voters.

"The mood is pretty optimistic, but also sobering because we know how much is at stake politically," said Rep. Tom Cole, R-Okla., who attended this week's meetings.