- Associated Press - Monday, June 26, 2017

WASHINGTON (AP) - President Donald Trump is getting closer to fulfilling his bold promise to repeal the nation’s health care law. But Trump’s pledges of affordable care for all and curbs on drug costs are not reflected in the GOP legislation advancing in Congress.

Since his campaign days, Trump has bypassed the details on health care policy, laying out his ideas in broad, emphatic riffs. Yet he made some clear promises along the way.

On repealing the Affordable Care Act, better known as “Obamacare,” Trump seems to have a realistic chance to deliver. He’s nowhere close to enacting his own vision.

A look at some of the major Trump health care promises, and how they line up with the Republican legislation that could come to a Senate vote this week:

REPEAL ‘OBAMACARE’

Repealing Obama’s signature domestic achievement has been a clear and consistent promise from Trump, a slogan of his campaign. Under the Obama law, some 20 million people gained coverage through a combination of subsidized private insurance and a state option to expand Medicaid for low-income people. Costs have been a problem, as are shaky insurance markets for people buying their own policies. But the nation’s uninsured rate is at a historic low, about 9 percent.

Both the House and SenateGOP bills would largely fulfill Trump’s promise to repeal Obama’s law.

Both measures end the unpopular requirement for individuals to carry health insurance or risk fines. The legislation also phases down the Medicaid expansion and repeals hundreds of billions of dollars in taxes on upper-income people and health care industries, used under the current law to finance coverage. And it opens the way for states to seek waivers of federal health insurance requirements.

Some Republican critics on the right say the congressional bills leave other major parts of the law in place, such as subsidies for people buying private insurance, and too many rules. But much less taxpayer money is invested in subsidies.

“INSURANCE FOR EVERYBODY”

In a Washington Post interview before his inauguration, Trump distilled his vision for health care into a few visionary goals.

“We’re going to have insurance for everybody,” he said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

Trump said he was close to finishing a plan of his own that would have “lower numbers, much lower deductibles.”

The White House never delivered a health care plan from the president.

And the congressional plans are likely to increase the number of uninsured people, because even if all Americans have access to coverage, some may no longer be able to afford it.

Deductibles are likely to rise for many people with individual coverage for two reasons. First, insurance may cover a smaller share of medical expenses. Second, the congressional bills would end current subsidies that reduce out-of-pocket costs for those with modest incomes.

As far as premiums, the Congressional Budget Office has projected that in the long-run, they’d be lower on average for individual policies. But there would be winners and losers. Younger adults and those in good health are likely to find better deals. Older people and those requiring comprehensive coverage could well end up paying more.

TAKING AWAY THE LINES

During the presidential campaign, Trump called for a system in which insurance plans would compete nationally, offering Americans choice and lower premiums.

“What I’d like to see is a private system without the artificial lines around every state,” he said at one of the presidential debates.

Many experts say Trump’s vision of interstate competition is unrealistic because health insurance, like real estate, reflects local prices. In any case, it remains unfulfilled in the GOP legislation.

Some congressional leaders have promised that cross-state insurance will be addressed in follow-on legislation. Such a bill would likely have to clear a 60-vote hurdle in the Senate.

PRESCRIPTION DRUG PRICES

Trump has repeatedly called for government action to bring down the cost of prescription drugs. The GOP bills in Congress basically sidestep that.

At one point in the campaign, Trump called for giving Medicare the authority to directly negotiate prices with drugmakers, an approach favored to some extent by Obama and Democratic presidential candidate Hillary Clinton.

Trump also proposed letting Americans import prescription drugs from other countries, where prices are usually lower because of government regulation.

But Medicare negotiations are a nonstarter for most congressional Republicans, and Trump’s call for allowing drug importation has faded.

MEDICAID

In a 2015 Daily Signal interview, Trump said: “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

But last year, his campaign started backtracking on Medicaid, endorsing the idea of limited federal financing for the federal-state program that covers some 70 million low-income people, from newborns to elderly nursing home residents, from special-needs kids to part-time workers lacking job-based health insurance.

The Republican bills in Congress would phase out Obama’s financing for Medicaid expansion and limit future federal payments for the entire program as well. The Congressional Budget Office said the House bill would reduce federal Medicaid spending by $834 billion over 10 years, and enrollment would shrink by about 17 percent by 2026.

Several Republican governors have joined their Democratic counterparts calling that a massive cost-shift to the states.

OPIOID CRISIS

The Trump White House says it’s serious about confronting the nation’s opioid epidemic, which shows no sign of letup.

“The president is all in,” health Secretary Tom Price said on a recent visit to New Hampshire. “He has such passion for this issue because he knows the misery and the suffering that has occurred across this land.”

But state officials say rolling back Obama’s Medicaid expansion would deal a heavy blow to treatment. Among the group of low-income adults made eligible for Medicaid under Obama are many younger people struggling with drug problems. They’ve been able to get treatment and support services through Medicaid.

The Senate bill would set up a $2 billion fund to help states fight the epidemic; some GOP senators had sought $45 billion. The House bill does not address it.

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Associated Press researcher Jennifer Farrar contributed to this report.

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