President says he expects a vote on healthcare next year and says he may issue a ‘major’ executive order to allow the purchase of insurance across state lines

Donald Trump said on Wednesday he was open to working with Democrats on healthcare, following the collapse of yet another Republican plan to repeal and replace the Affordable Care Act.

Trump claimed that the GOP could corral enough votes to pass the measure – a last-gasp effort to deliver on a central campaign promise of the last seven years – but not in time for this week’s deadline, after which 60 votes would be needed instead of 51.

Donald J. Trump (@realDonaldTrump) We will have the votes for Healthcare but not for the reconciliation deadline of Friday, after which we need 60. Get rid of Filibuster Rule!

Trump, who has become increasingly frustrated with Republicans’ failure to repeal his predecessor’s healthcare law, told reporters on Wednesday that he would engage Democrats to “see if I can get a health plan that is even better”.

Senate Republicans admit defeat in latest effort to repeal Affordable Care Act Read more

Speaking to reporters outside the White House, Trump insisted that the repeal measure, authored by senators Lindsey Graham and Bill Cassidy, could not proceed because an unnamed Republican senator who supported the bill was in the hospital. However, three senators – all of whom were present this week - had already announced their opposition to the measure, leaving Republicans at least one vote short.



“I feel we have the votes; I’m almost certain we have the votes,” Trump told reporters. “But with one man in the hospital we cannot display that we have them.”

Trump repeated the claim several times during his exchange with reporters. “One of our ‘yes’ votes is in the hospital. I can’t take him out of the hospital,” he said.

After Trump’s comments, Thad Cochran, a Republican senator of Mississippi, said on Twitter that he was not in fact hospitalized but was “recuperating at home in Mississippi”.

Later on Wednesday, Trump told a crowd at a rally in Indianapolis that the senator is “home recovering from a pretty tough situation”. Trump drew laughter when he said he would refrain from singling out the senators who opposed the repeal effort.

“I was hoping this would be put on my desk right after we won the election, and I’d come in and sign,” Trump said. He promised: “In any even, long before the November election, we’re going to have a vote.”

Senator Thad Cochran (@SenThadCochran) Thanks for the well-wishes. I'm not hospitalized, but am recuperating at home in Mississippi and look forward to returning to work soon.

He also said he was considering using executive action to reform the health system and said that he may issue a “major” order to allow people to buy health insurance across state lines.



The idea, which is popular among Republicans, would allow people to purchase health insurance from other states. Proponents say would increase competition and drive down costs but critics say this would lead to a “race to the bottom” as insurance companies based themselves in states with the most lenient regulations and sold plans based on those rules throughout the country.

For nearly a decade, Republicans have climbed to power in Washington with a single promise: to repeal Barack Obama’s Affordable Care Act, the 2010 law that extended health coverage to millions of Americans but which they decry as unwarranted government intrusion. But Tuesday’s failure, which came after a previous repeal attempt was defeated in dramatic fashion in July, all but ensured the law would remain in place through the end of Trump’s first year in office.

While Trump and the Republicans have been unsuccessful at repealing the law, the uncertainty caused by eight months of fits and starts on a repeal plan and Trump’s threats to withhold payments to insurers has shaken insurance markets.In one estimate, the CBO projected that average premiums for health insurance purchased on the individual market would rise 15% as a result of uncertainty over whether Trump will fund the subsidies to insurers.



The deadline for health insurance companies to signal whether they will participate in ACA marketplaces is Wednesday and Trump has not announced whether he will continue the payments to insurers.

Furthermore, critics have accused the administration of undermining the healthcare law by refusing to enforce the individual mandate, which requires all Americans to have health insurance or face a penalty. His administration has also slashed spending on efforts to help people enroll people in the Obamacare exchanges, which could further undermine the law.

Meanwhile, the Department of Health and Human Services said it would shut down the health insurance exchange website – healthcare.gov – for “maintenance” for 12 hours during all but one Sunday in the upcoming enrollment period. It would also shut down the website on the first day of enrollment, on 1 November.

Citing “collapsing insurance markets” and rising premiums, Republicans vowed to press on with their drive to repeal the healthcare law.

“There’s a lot of fight left in the Republican party when it comes to repealing and replacing Obamacare,” said Graham, one of the latest failed bill’s co-sponsors. “The question is, is there any fight left in Washington when it comes to repealing and replacing Obamacare?”

In the short term, senators are open to resuming bipartisan negotiations to stabilize health insurance markets. Those talks stalled when Republicans revived the repeal plan with the aim to vote by the end of the week.

Senators Lamar Alexander, a Republican of Tennessee and the chairman of the Senate health committee, and Patty Murray, a Democrat of Washington and the vice-chair of the committee, both said they intended to continue working on legislation to stabilize insurance markets and keep down costs over the next few years.

Maybe unicorns will come around here and we’ll get some sort of bipartisan deal Republican senator John Thune

The bipartisan package under consideration would include funding for subsidies to insurance companies that would reimburse them for reducing deductibles and other out-of-pocket costs for low-income enrollees. It would also allow states more flexibility to change their insurance markets.

Senator John Barrasso, a senior Republican from Wyoming, said GOP leadership was supportive of the talks but was skeptical the endeavor would bear fruit.



“We want much more flexibility to the states than any Democrat has ever been willing to offer,” Barrasso said, pointing to a key fault line.

“If we can’t get the flexibility to the states so that people can buy in their own home state what works for them personally, then I’m not supportive of a direct continuation of those payments.”

Republicans had hoped to pass Graham-Cassidy by the end of the month, when the window to pass a repeal bill on a party-line vote closes. But they have raised other possible paths forward.

They could add a repeal plan to a 2018 budget bill created for tax reform. But a number of lawmakers are uncomfortable binding healthcare to tax reform, fearful that it would doom both. Another possibility is to return to healthcare in a 2019 budget bill, which would reopen the debate in the months before midterm elections.

“I’d like to do it in fiscal year 2018 but I sure don’t want to jeopardize tax reform either,” said Ron Johnson, a senator from Wisconsin and a supporter of the bill.

At this stage, however, Senator John Thune, a Republican of South Dakota and a member of the party leadership, said the goal was to find healthcare legislation that at least 50 of the party’s 52 senators would support.

“It’s all going to be when we get 50 votes for something, and when we do, we’ll find a process that fits,” Thune said, adding: “And, who knows. Maybe unicorns will come around here and we’ll get some sort of bipartisan deal.”