Trump on replacing healthcare law that took years to craft: 'Nobody knew it could be so complicated'

Donald Trump told a room full of state governors on Monday that “nobody knew” replacing the massive Affordable Care Act, which expanded health coverage to 20 million Americans, would prove to be so “complicated”.

Trump reaffirmed his administration’s commitment to repealing and replacing the ACA, better known as Obamacare, and took a jab at new polls that show that its popularity is rising.

Uncertainty about how Republicans will replace the ACA has unnerved health insurers, hospitals, community clinics, doctors, constituents and even Republican governors.

“We have come up with a solution that’s really, really, I think, very good,” Trump said. “It’s an unbelievably complex subject. Nobody knew that healthcare could be so complicated.”

Trump also claimed that Barack Obama’s approval ratings rose only because he was leaving office, a phenomenon he said was also affecting public sentiment about the former president’s signature law.

“I see it happening with Obamacare – they hate it – but now they see the end is coming, and they say, ‘Oh, maybe we love it,’” Trump said. “There’s nothing to love, it’s a disaster, folks.”

Public approval for the healthcare law reached a new high last week, a Pew Research Center poll showed. The poll found 54% of Americans approved of the law and 43% disapproved, a significant change from a low of 35% approval in 2011, just after the law’s passage.

The ACA expanded public health insurance to millions of poor Americans through Medicaid, established subsidized state marketplaces for health insurance, set out what coverage insurers must offer, and barred insurance companies from excluding the sick from coverage.

Rising monthly fees in state exchanges have proved a potent problem, however, and Republicans have repeatedly sought to shrink the number of benefits that insurers are required to provide.

Trump’s assertion came before a meeting with health insurance executives and after a weekend of lobbying by Republican governors, some pushing to maintain provisions of the ACA.

Governor John Kasich of Ohio, one of Trump’s former Republican rivals for the presidential nomination, told the Washington Post he pushed Trump not to cut Medicaid.

Kasich’s pitch was significantly less drastic than plans being crafted by the House Republican leadership, which would cut Medicaid spending. The public program covers poor Americans and was expanded by the ACA. It now insures millions of constituents of Republican governors.

Other GOP governors, including Rick Scott of Florida, have advocated a full repeal of the law. Florida refused to expand Medicaid under the ACA, even though the federal government would have paid for the expansion. According to the Kaiser Family Foundation, an expansion would provide insurance to an estimated 279,000 Floridians.

A leaked House Republican ACA replacement plan proposed major changes to Medicaid, including changing the program to a so-called block grant, or a set cash allocations for states that experts agree would amount to a huge cut in spending.

In addition, the leaked Republican plan would limit what services insurers are required to cover; allow insurance companies to charge the elderly five times more than the young; reduce subsidies and distribute them by age (not income); repeal taxes on the pharmaceutical industry; defund Planned Parenthood; and cut billions of dollars in funding for preventative medicine.

Trump also suggested on Monday that Republicans would benefit from letting the law “implode” and “blame that on the [Democrats]”. He said, however, that the party needed to repeal the ACA in order to achieve “the fair thing for the people”.

“They will come begging for us to do something, but that’s not the fair thing for the people,” Trump said.

“As soon as we touch it, if we do the most minute thing, just a tiny little change, they’re going to say it’s the Republicans’ problem. But we have to do something because Obamacare is a failed disaster.”