Trump, GOP Seek Actions To Undercut ACA

President Trump and his GOP allies are charting a new course in their push to undercut Obamacare, kicking off 2018 by eyeing actions the administration can take on its own, while avoiding a messy congressional fight ahead of the November elections.

Conservative pressure groups still want Congress to attempt a full repeal of the 2010 health law, but neither Senate Majority Leader Mitch McConnell nor House Speaker Paul D. Ryan appears eager for a repeat of last year's failed effort.

"The Republicans have no new ideas on the table to repeal and replace Obamacare and they have one less Senate vote than they had last year," said Robert Laszewski, a health policy constant in Alexandria, Virginia. "After last year's legislative debacle over Obamacare, House Republicans are not about to take controversial vote like repealing Obamacare without certainty that the Senate can move a bill."

Mr. Trump says he'd still like to replace the law, but he's also taking a victory law from the end of Obamacare's "individual mandate" — included in the tax-cut law — which he is treating as de facto repeal.

And his agencies are trying to chip away at other parts of the law, beginning with last week's proposal to let self-employed people and like-minded businesses duck Obamacare's exchanges by enlisting in "association plans" across state lines.

He also wants to let people rely on skimpy "short-term" plans for a year, instead of just three months, further sapping key customers from the exchanges.

Obamacare's expansion of Medicaid benefits remains, though Mr. Trump is urging states to require recipients to seek work as a condition of their taxpayer-funded coverage — a move that could trim the rolls.

The new approach is raising the stakes in the fight over Mr. Trump's pick to lead the Health and Human Services Department, Alex Azar, who faces a grilling before the Senate Finance Committee on Tuesday.

Democrats and their progressive allies have acknowledged Mr. Azar's deep resume, including time at HHS in the Bush administration and a decade at drug company Eli Lilly. But they say those experiences are reasons for worry, saying he won't take meaningful steps to cut drug prices.

Aides expect Democratic members to quiz Mr. Azar on Tuesday on the full array of Trump plans, and liberal pressure groups are already demanding Democrats try to defeat him.

"President Trump and Republicans in Congress are in search of a new leader for their war effort, to captain their repeal and sabotage campaign. And in a former pharmaceutical executive, they have found their man," Protect Our Care, a pro-Obamacare coalition, said in a new digital ad launched Monday.

Mr. Azar would replace HHS Secretary Tom Price, who was forced to resign amid questions about his use of pricey use of private jets for business travel.

Mr. Price was nudged out of the job shortly after Congress failed to replace Obamacare. The House approved a repeal, but the Senate GOP couldn't muster the votes.

Chances for a do-over this year rest on Republicans being able to prove they can forge a consensus.

"I think that McConnell has basically said to the guys who are really pushing for repeal and replace, 'Show me 50 votes and then I'll bring something to the floor.' So he's kind of put the onus on them," said John Desser, a former Bush administration health official and senior vice president for government affairs at eHealth, a website that connects users with insurance.

"That's a tall order, it's not impossible, but it's certainly not easy. They'll got to find something that both Rand Paul and Lisa Murkowski will vote for," Mr. Desser said, referring to a conservative from Kentucky and a moderate from Alaska.

Mr. Trump recently told the New York Times that he thinks repeal of the mandate and his decision to amplify association plans should force Democrats to the table on health care.