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Today in Obamacare: Trump quickly changed his mind on drug prices. Expect the same on Obamacare.

Trump Meets Representatives of PhRMA Photo by Ron Sachs - Pool/Getty Images

If Trump’s pharma comments are any clue, we have no idea what he wants on Obamacare

President Trump has apparently done some rethinking on his views of American drug pricing policy, offering confusing remarks that indicated he might not support Medicare negotiating drug prices.

“I’ll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market,” Trump said after meeting with pharmaceutical executives Tuesday. “That includes price-fixing by the biggest dog in the market, Medicare, which is what's happening.”

This appears to contradict what he said a mere two weeks ago, at a press conference in Manhattan. “Pharma has a lot of lobbies, a lot of lobbyists, and a lot of power. And there’s very little bidding on drugs,” he said there. “We’re the largest buyer of drugs in the world, and yet we don’t bid properly.”

This back and forth on drug pricing is suggestive of what to expect from the president on the Affordable Care Act. There too, Trump has made big promises that most of his Republican colleagues on the Hill have not. The biggest one is that he will come up with a plan to cover everybody and do it at a lower cost than Obamacare.

In this drug pricing example, I see how Trump could break his promise to cover everyone. It boils down to three main reasons, all present in the drug pricing situation.

  1. Trump’s position is out of line with current Republican policy proposals. Trump’s views on allowing Medicare to negotiate drug prices were out of line with his Republican colleagues on the Hill. His pick to run Health and Human Services, Rep. Tom Price, notably demurred from defending the position in his confirmation hearing. Once again, this is similar to where we are on the debate over how many people an Obamacare replacement will cover: His Republicans colleagues have not been willing to commit to that — and have generally shied away from questions about whether they can cover the 20 million people the current health care law does.
  2. Trump’s position is a really hard one to achieve. The Affordable Care Act was a significant expansion of health insurance in the United States — but it still leaves 29 million people without coverage. Getting to full coverage would be a massive lift, one that Democrats were not able to pull off. The only way other countries have found to cover everybody is either with a single-payer system (which Trump has said is not right for the United States) or with much stricter mandates to purchase coverage.
  3. Trump’s positions are malleable. Drug pricing is one of the starkest examples we have right now of Trump walking back his position quickly, in a way that creates significant confusion. He did this after speaking with a group of pharmaceutical executives who do not like the idea of allowing Medicare to negotiate drug prices.

In summary, we’ve seen Trump change his mind quickly on a signature health policy position that would have been difficult to deliver on and out of line with his Republican colleagues on the Hill. It’s easy to see how his promise to cover everyone could end much the same way.

Today is the last day of Obamacare open enrollment

Americans who lack coverage have until midnight to purchase a plan for the rest of 2017. The government continues to send out emails like this to encourage enrollment:

Some state marketplaces have already decided to extend open enrollment by a few days to give those without coverage a bit more time to sign up. California announced Tuesday afternoon it would extend open enrollment, for example, until February 4 for those who have already started their applications — and Minnesota has extended the deadline until February 8.

This is something the Obama administration often did as well, for the dozens of states that rely on the federal Healthcare.gov marketplace. But I would not expect a similar move from the Trump administration as it oversees its first open enrollment period.

Kliff Note’s: Today’s top 3 health policy reads

“Why hospitals really don’t want to go back to pre-Obamacare days”: “Dennis Dahlen, chief financial officer of Banner Health in Phoenix, recently said there could be ‘dire consequences’ if Medicaid expansion is rolled back and if Republicans move toward Medicaid block grants. That would threaten revenue immediately and lead to more uninsured patients walking into the emergency room.” —Bob Herman, Axios

“AETNA CEO: We may ditch all Obamacare markets next year 'given the unclear nature' of the law”: “‘We have no intention of being in the market for 2018,’ said Bertolini. ‘Currently, where we stand, we'd have to have markets worked up ... prices worked up for April 2017 to apply, and there is no possible way that we’ll be able to do that given the unclear nature [of where] that regulation is headed.’” —Bob Bryan, Business Insider

“Rep. Dave Brat: ‘The women are in my grill no matter where I go’”: “Rep. Dave Brat, R-7th, is feeling some political pressure as Republicans in Congress move to repeal the Affordable Care Act. ‘Since Obamacare and these issues have come up, the women are in my grill no matter where I go,’ Brat told an audience Saturday at a meeting of conservative groups at Hanover Tavern.” —Patrick Wilson, Richmond Times-Dispatch

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