GOP laser-focused on unraveling health care if Trump returns to power: sources

Conservatives are plotting the demise of health care entitlements and health insurance subsidies ahead of the potential return of Donald Trump to the White House.

Republican sources told Axios there was more planning underway ahead of this year's election than there was in 2016, when Trump scored a surprise win, and a chaotic transition period and the lack of a replacement plan doomed efforts to repeal the Affordable Care Act in his first year in office.

"Several GOP lobbyists told Axios they've received intensifying requests from health care clients in recent weeks to game out the beginning of a new Trump term and build relationships with Trump world," Axios reported. "Insiders say they're generally skeptical that Republicans would pursue a major ACA overhaul or full repeal of new Medicare drug pricing negotiations, but conservative-preferred changes to those programs are possible."

If Republicans also win the House and Senate, they're planning to fast-track a reconciliation budget to extend the 2017 Trump tax cuts and push through partisan health care cuts.

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"The new reality is that you've got to push and you've got to really do reconciliation quickly," said one GOP lobbyist.

GOP majorities would not renew enhanced insurance subsidies that caused ACA enrollment to surge, and Republicans see this as an opportunity to crack down on Medicare Advantage overpayments to insurers and cutting back on Medicare payments for outpatient care at hospitals.

They're also looking at cuts to Medicaid and pushing through GOP-favored work requirements in a reconciliation package, and Trump-aligned groups Paragon Health Institute, America First Policy Institute and the Heritage Foundation are already fielding calls from the health care industry.

"You don't want to get ahead of your skis and give industry a chance to start figuring out what they're going to do and what actions are going to reduce government subsidies to industry," said Paragon president Brian Blase, a former Trump health official.