Trump flip-flops and calls for repeal of Obamacare without replacement

Repeal and then replace … eventually.

That’s President Donald Trump’s new Obamacare approach as of Friday, when he abruptly called on Senate Republicans to repeal Obamacare outright if they cannot pass the healthcare bill under consideration.

“They should immediately REPEAL, and then REPLACE at a later date!,” Trump tweeted.

That admonition reverses Trump’s previously stated position that repeal and replace must occur at the same time and would have far-reaching consequences on the American healthcare system if the Republican-led Senate follows through.

“We’re going to do it simultaneously,” Trump told “60 Minutes“ last November when asked about repealing and replacing Obamacare. “We’re not going to have, like, a two-day period and we’re not going to have a two-year period where there’s nothing.”

Trump’s new position comes after the Senate’s Better Care Reconciliation Act of 2017 stalled this week. Republican leaders in the Senate had hoped to vote on the bill before the July Fourth recess, but several Republicans announced their opposition with some arguing the bill is not conservative enough and others arguing it’s not sufficiently compassionate.

It’s unclear if Republicans can bridge this divide so the idea of repealing first and planning to replace later has been revived.

Republican Sen. Ben Sasse of Nebraska sent his Plan B to Trump Friday morning that called for them to “immediately repeal as much of ObamaCare as is possible” if the Senate cannot come to an agreement by the time they return from recess on July 10.

“On the current path, it looks like Republicans will either fail to pass any meaningful bill at all, or will instead pass a bill that attempts to prop up much of the crumbling ObamaCare structures,” Sasse wrote, suggesting repeal as a third option that would allow Republicans to honor their promise to voters.

The Koch Brothers–funded group FreedomWorks immediately endorsed Trump’s new approach. “We can come back later and work on patient-centered, free market–based replacement provisions,” the group’s president, Adam Brandon, said in a statement. The spokeswoman for the conservative House Freedom Caucus, Alyssa Farah, chimed in on Twitter that “this is essentially what the @freedom caucus pushed for beginning back in January.”

But the consequences of an immediate Obamacare repeal would be extraordinary and may be even harder to pass than the current legislation being considered. The nonpartisan Congressional Budget Office estimates that 18 million people would lose health insurance in the first year of a repeal with 32 million fewer insured people by 2026.

When the idea of repeal first and replace later was considered several months ago, even conservative senators, like Tom Cotton of Arkansas, rejected the idea. “I think when we repeal Obamacare, we need to have the solution in place moving forward,” Cotton said in early January. “I do not think we can just repeal Obamacare and say we’ll give the answer two years from now.”

With political pressure building for Republicans to fulfill their campaign pledge to do away with the Obama-era reform, however, some members of Congress may be willing to reconsider a full repeal if they cannot pass the current replacement. Senator Rand Paul of Kentucky changed his position Friday morning, tweeting that he now supports immediate repeal after speaking with the president and Senate leadership. Paul had said in January that repeal and replace must happen on the same day.

Cotton’s office did not immediately respond to calls or emails asking if the senator still believes repeal and replace should happen concurrently.

Meanwhile, the prospects of the current Trumpcare legislation appear dimmer by the day. Conservatives like Sen. Ted Cruz of Texas object to the bill for keeping in place Obamacare’s system of subsidizing people’s purchase of health insurance, while moderates like Maine Sen. Susan Collins worry that the cuts to the subsidy dollar amounts will result in skyrocketing premium increases for their older constituents.

Several senators also oppose the bill’s $770 billion cuts to Medicaid over the next decade. Senate Majority Leader Mitch McConnell’s attempts to address those concerns — like a proposed $45 billion fund to address the opioid crisis — have so far been unsuccessful.

Who knew healthcare was so complicated?