WASHINGTON — Donald J. Trump calls for “a full repeal of Obamacare” but says that “everybody’s got to be covered.” Initially, he liked “the mandate,” a central feature of the Affordable Care Act that requires most Americans to have insurance or pay a penalty, but he backed off that position under fire from conservatives.
He would allow individuals to take tax deductions for insurance premium payments. But aides acknowledge that this tax break would not be worth much to people whose income is so low they pay little or nothing in federal income taxes. For them, Trump aides say, there would be Medicaid, which the billionaire businessman says he would not cut but would turn into a block grant to state governments.
Sign Up For NYT Now's Morning Briefing Newsletter
This whipsaw of ideas is exasperating Republican experts on health care, who call his proposals an incoherent mishmash that could jeopardize coverage for millions of newly insured people. But for Mr. Trump’s campaign, such criticism appears only to bolster the candidate’s outsider status. His chief policy adviser, Sam Clovis, said that Mr. Trump was running against the political establishment in Washington and was therefore not relying on advice from “traditional establishment Republican people.”
Instead, Mr. Clovis said in an interview, Mr. Trump is receiving advice on health care policy from at least a half-dozen “very prominent people,” but he declined to name them. “They are not ready to have their support of the Trump campaign known,” Mr. Clovis said.
Some experts outside Mr. Trump’s campaign have been unsparing.
“If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,” said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. “There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.”
Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”
Mr. Clovis, the national co-chairman of the Trump campaign, acknowledged that the ideas Mr. Trump has offered to replace the health law were just “a starting point,” a framework. He said that Mr. Trump would have a detailed, comprehensive plan to replace the law if Congress repealed it, and he added that any replacement “must be bipartisan.”
Asked if Mr. Trump’s plan would insure all those who have gained coverage under the health law, Mr. Clovis said: “That might be correct, but we really don’t know that. A lot of it depends on what initiatives we can get through Congress.”