Kellyanne Conway was on television Tuesday morning, talking about Obamacare in a way that could signal differences between President-elect Donald Trump and congressional Republicans ― or that could mean nothing at all.
During an appearance on MSNBC’s “Morning Joe,” Conway, a key Trump adviser, said that simultaneously repealing and replacing the Affordable Care Act ― rather than repealing it first ― is “the ideal situation. Let’s see what happens practically. Some experts say it could take years to complete the process.”
Conway also said that “We don’t want anyone who currently has insurance to not have insurance.”
During a separate interview on CNBC, she went out of her way to note that the health care law had done “some good things.”
Republican leaders like House Speaker Paul Ryan rarely acknowledge the importance or value of coverage that Obamacare has provided.
They’ve also made clear their intentions to repeal the law right away, even though no replacement plan is ready ― although they envision a transitional period during which elements of the law’s coverage expansion would remain in place while Republicans worked on hammering out an alternative.
Whether these subtle differences in messaging actually matter is anybody’s guess.
It’s entirely possible Conway simply chose different, softer-sounding words than GOP leaders, including the president-elect, typically do.
Her comments could also represent an early effort at image control ― an attempt to make Trump seem compassionate and reasonable right before he signs a law stripping away health coverage from more than 20 million people.
But Conway’s quotes could be the first signs of a divide between Trump and all the Capitol Hill Republicans who are determined to gut Obamacare as quickly and completely as they can.
Trump’s pledge to cover everybody is not new, after all. During a Fox News debate he said, “We have to take care of the people that can’t take care of themselves.” And during an interview on CBS’s “60 Minutes,” he said, “Everybody’s got to be covered.”
And after the administration announced two weeks ago that this year’s signups for Obamacare coverage were actually outpacing last year’s, Phillip Blando, another Trump spokesperson, said that “the enrollment numbers announced today show just how important health care coverage it to millions.”
Of course, Trump has also been known to harshly criticize Obamacare ― and was doing so on Tuesday morning, even as Conway was appearing on television.
Any potential differences over Obamacare strategy are likely to come up on Wednesday, when Vice President-elect Mike Pence is slated to meet with Capitol Hill Republicans to discuss the strategy for repealing the law.
The current plan, GOP leaders have said, is to strip out Obamacare’s funding and spending right away, using expedited legislative procedures for budget-related matters. But the money that provides tax credits to people buying coverage, along with the money to support state expansions of Medicaid eligibility, would continue to flow for a few years.
But in the last few weeks, a chorus of experts, consumer advocates and groups representing major health care industry players have warned that repealing Obamacare without a ready replacement could lead to disarray, with insurers fleeing the market and potentially millions losing insurance within the first year.
As for an Obamacare replacement, the plans in circulation at conservative think tanks and among Republican legislators all envision fewer people with insurance and weaker financial protection for people with serious medical conditions. Of course, it’s not even clear if Republicans can find consensus on an Obamacare replacement, given that a large chunk of the party objects to the principle of the federal government playing a significant role in health care.
Recent polls have shown little enthusiasm for fully repealing Obamacare, even though the law as a whole has more critics than supporters. And there’s loads of evidence to suggest even many Trump supporters want him either to keep the law in place or to provide them with more comprehensive coverage at lower costs ― something he promised on the campaign trail, but would be inconsistent with the plans Republicans have considered so far.
So far, GOP leaders haven’t indicated they worry about such concerns. And Trump might be content to go along. His appointment for secretary of Health and Human Services, Rep. Tom Price (R-Ga.), has been among Obamacare’s most vocal and relentless critics ― and has a history of hostility to not just that law but Medicare and Medicaid as well.
But the primary job for HHS secretary is managing that department’s bureaucracy, and it’s an open question how much influence Price would have over Obamacare repeal strategy.