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Why Trump says he'll keep parts of Obamacare, after all

After repeatedly vowing to repeal the Affordable Care Act on the campaign trail, Donald Trump now says he'll keep parts of the Act. It's a decided shift in approach, but it's not clear that he could repeal these provisions if he wanted to.

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    Republican presidential candidate Donald Trump speaks about healthcare in King of Prussia, Pa., in November.
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Donald Trump is willing to keep key parts of Obamacare, he told The Wall Street Journal on Friday.

In his first interview since the election, President-elect Trump indicated that he might compromise on the Affordable Care Act. Though he maintained that “you can’t use it” in its current state, Mr. Trump said he would consider keeping the part of the law that allows children to stay on their parents’ plans until the age of 26, as well as the provision that prevents insurers from denying coverage to individuals with pre-existing conditions.

“I like these very much,” he said.

This is a marked shift from Trump’s approach on the campaign trail, where he repeatedly vowed to repeal the law. One reason for this may be Trump’s conversation with President Obama at the White House on Thursday – though he might struggle to repeal these particular provisions anyway.

“I told him I will look at his suggestions, and out of respect, I will do that,” Trump told The Wall Street Journal, explaining that Mr Obama had indicated certain areas of the Act to keep.

The Affordable Care Act, known as Obamacare, is Obama’s signature healthcare reform law. Introduced in 2010 to provide a path to health coverage for uninsured Americans, the ACA now serves more than 20 million Americans. The percentage of Americans without health insurance fell from 18 percent to 9 percent since the program began two years ago. However, the Act has been contentious, with Republicans pointing to the 25 percent increase in the average price of a plan this year as a sign that the law is unworkable. Congressional Republicans have attempted to appeal Obamacare more than 50 times since it was signed into law.

Uncertainty about Trump’s healthcare plans led more than 100,000 Americans to sign up for coverage on Wednesday during the open enrollment period.

Insurance companies have also been thrown for a loop by the election of Trump. Having spent hundreds of millions of dollars to reorient their business models toward the Affordable Care Act, they stand to lose significant amounts of money if the Act is repealed.

Nor do they have contingency plans, because most didn't expect a Trump victory.

“This wasn’t on the sheet” of election outcomes that executives considered, Mark Bertolini, the CEO of Aetna, told the New York Times. “We had no idea how to approach it.”

Trump’s willingness to keep important parts of the bill may come as a relief, then. He has also indicated a commitment to replacing Obamacare, promising a seamless transition between the Affordable Care Act and his healthcare law.

“We’ll repeal it and replace it,” Trump said in a interview with CBS’s “60 Minutes” to be broadcast on Sunday. “We’re going to do it simultaneously — it’ll be just fine,” he added, saying that Americans would not be without coverage for even two days.

In his interview with the Wall Street Journal, he even suggested that Obamacare could be “amended.”

It’s not clear that Trump could repeal the parts of the Act Obama suggested even if he wanted to.The Democratic minority in the Senate can block the repeal of the Affordable Care Act. And though parts of the bill can be defunded under a process called reconciliation, those provisions cannot, meaning they’re likely to remain law.

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