http://www.vox.com/policy-and-politics/2017/1/31/14455656/obamacare-trump-drug-prices

If Trump’s pharma comments are any clue, we have no idea what he wants on Obamacare

President Trump has apparently done some rethinking on his views of American drug pricing policy, offering confusing remarks that indicated he might not support Medicare negotiating drug prices.

“I’ll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market,” Trump said after meeting with pharmaceutical executives Tuesday. “That includes price-fixing by the biggest dog in the market, Medicare, which is what’s happening.”

This appears to contradict what he said a mere two weeks ago, at a press conference in Manhattan. “Pharma has a lot of lobbies, a lot of lobbyists, and a lot of power. And there’s very little bidding on drugs,” he said there. “We’re the largest buyer of drugs in the world, and yet we don’t bid properly.”

This back and forth on drug pricing is suggestive of what to expect from the president on the Affordable Care Act. There too, Trump has made big promises that most of his Republican colleagues on the Hill have not. The biggest one is that he will come up with a plan to cover everybody and do it at a lower cost than Obamacare.

In this drug pricing example, I see how Trump could break his promise to cover everyone. It boils down to three main reasons, all present in the drug pricing situation.

http://www.vox.com/the-big-idea/2017/2/1/14463904/obamacare-executive-power-trump-law

This month, Kellyanne Conway, senior adviser to President Donald Trump, was asked whether the administration would refuse to enforce the Affordable Care Act’s individual mandate — the requirement that people get health insurance or pay a penalty. “He may,” she said, instantly sending a shiver of fear down the spines of health reform’s supporters. Without the mandate, insurance markets in many states will teeter; some will probably collapse.

Would it be legal for Trump to decline to enforce the mandate?

The short answer is no. The longer answer is more complicated, but it’s also instructive. At key points, President Barack Obama delayed aspects of the ACA in an effort to put health reform on a sound footing. The delays were classic examples of executive overreach; they never should have happened. The Republican-led House of Representatives even sued the president over them.

And now the shoe is on the other foot. With Trump in office, some of Obamacare’s fiercest critics seem almost giddy at the prospect that he might use the same weapon against the act. Pick your favorite tagline: payback is a bitch, what goes around comes around, “I learned it from watching you, Dad!”

What Trump has hinted at, however, would be a far greater overreach than Obama ever attempted. But Obamacare’s critics are unlikely to care. There’s an important lesson here about the accretion of executive power in the 21st century, how law is enforced outside the courts, and what presidential power might look like in an age of Trump.

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Earlier this week, Kevin Glass, director of policy at the Franklin Center and contributor at The Washington Examiner, invited me to chat on his Bloggingheads show about the future of the ACA. We touch on the scope and implications of Trump’s executive order, the Cassidy-Collins plan, and the difficult politics of repeal and (particularly) replace. We also spend a fair bit of time talking about the market uncertainty created by those politics, which threatens to undermine access to coverage in 2018, regardless of policy outcome.

Kevin Glass (Franklin Center for Government and Public Integrity) and Adrianna McIntyre (The Incidental Economist)