President Donald Trump says the Republican plan to repeal and replace the Affordable Care Act "guarantees" coverage for Americans with pre-existing conditions -- a claim that could undercut the legislation the White House is currently pushing on Capitol Hill.
"Pre-existing conditions are in the bill. And I mandate it. I said, 'Has to be,'" Trump told CBS's John Dickerson on "Face the Nation" Sunday.
Pressed further, Trump said that "we actually have a clause that guarantees" coverage for those with pre-existing conditions. Trump also said the health care legislation is "changing."
Trump's comments come days after moderate New Jersey Rep. Tom MacArthur and leaders of the conservative House Freedom Caucus cut a deal that would require insurers to cover those with pre-existing conditions; but, unlike the mandate under Obamacare, insurers could charge them higher rates than others in the plan if they allow their coverage to lapse.
Such a change could leave those with pre-existing conditions, such as diabetes and asthma, paying much higher premiums and potentially facing gaps in coverage, health care experts note.
Republicans would have states set up "high-risk pools" for those with pre-existing conditions. There is no Congressional Budget Office score of the proposal yet, but the AARP has projected that premiums in high-risk pools could cost as much as $25,700 per year.
The American Medical Association said in a letter urging lawmakers to oppose the legislation that the switch to high-risk pools "could effectively make coverage completely unaffordable to people with preexisting conditions."
At one point n the interview, Trump made clear that he saw the high-risk pools as the GOP's vehicle for coverage of those with pre-existing conditions. "We have now pre-existing conditions in the bill. We have -- we've set up a pool for the pre-existing conditions so that the premiums can be allowed to fall," he said.
However, at another point, Trump seemed to imply the MacArthur-negotiated legislation will change. Trump said "no" when asked if states would be able to opt out of requiring insurers to cover those with pre-existing conditions.
Dickerson asked: "But on that crucial question, it's not going to be left up to the states? Everybody gets pre-existing, no matter where they live?"
And Trump responded: "No, but the states are also going to have a lot to do with it because we ultimately want to get it back down to the states."
It wasn't clear whether Trump meant the deal MacArthur and the House Freedom Caucus made last week is not final or he was simply deflecting criticism of the high-risk pools.
In an interview on "Meet the Press," Vice President Mike Pence also vowed that the Trump administration is "keeping our promises to protect people who have pre-existing conditions."
However, unlike Trump, Pence made clear that states would be able to opt out of guaranteeing coverage for those with pre-existing conditions.
"You take people that have pre-existing and costly conditions and put them into a high-risk pool," Pence said to NBC's Chuck Todd. "And you subsidize that so that it is affordable to those individuals. And so, you're guaranteeing coverage for pre-existing conditions. And the flexibility that you're referring to in this latest MacArthur amendment, states can only apply for that waiver and flexibility if they have either a federal or state high-risk pool that guarantees that people will be able to have coverage, and it'll be affordable."
The first Republican push to repeal Obamacare fell short weeks ago, with House Speaker Paul Ryan saying at the time that former President Barack Obama's signature legislative achievement was here to stay.
But Trump began a new push as his 100th day in office approached. While enough moderate Republicans defected to keep a vote from taking place last week, with many pointing to the bill's treatment of pre-existing conditions as their reason, Trump told Dickerson he still wants a vote.
"This bill has evolved. And we didn't have a failure on the bill," Trump said. "You know, it was reported like a failure. Now, the one thing I wouldn't have done again is put a timeline. That's why on the second iteration, I didn't put a timeline."
Trump also complained about dealing with Congress -- and particularly with Senate Democratic leader Chuck Schumer of New York.
"It's just a very, very bureaucratic system," the President said. "I think the rules in Congress and in particular the rules in the Senate are unbelievably archaic and slow-moving, and in many cases, unfair. In many cases, you're forced to make deals that are not the deal you'd make. You'd make a much different kind of a deal."
"You're forced into situations that you hate to be forced into," he said. "I also learned -- and this is very sad, because we have a country that we have to take care of -- the Democrats have been totally obstructionist. Chuck Schumer has turned out to be a bad leader. He's a bad leader for the country. And the Democrats are extremely obstructionist," Trump said. "All they do is obstruct. All they do is delay."
