TRUMP: Repealing and replacing Obamacare is 'not a choice - it is a necessity'

President Donald Trump's vision for the Affordable Care Act (ACA) backs away from earlier pledges to guarantee coverage for people with pre-existing conditions, and leans on tax credits to ensure Americans can afford to pay for insurance premiums.

Trump is speaking to both houses of Congress and laid out five principles for the replacement of the law better known as Obamacare.

Trump cited increasing premiums, withdrawals of insurers from the ACA's individual insurance exchanges, and the promise from former President Barack Obama.

"Obamacare is collapsing - and we must act decisively to protect all Americans. Action is not a choice - it is a necessity," he said. "So I am calling on all Democrats and Republicans in the Congress to work with us to save Americans from this imploding Obamacare disaster."

Additionally, Trump laid out five broad ideas that he wants the Republican Obamacare replacement to address they are:

• "Ensure that Americans with pre-existing conditions have access to coverage": Importantly Trump refers to "access" for those with pre-existing conditions, not a guarantee that there will be coverage. This is backing down from previous statements Trump has made that everyone would be covered.
• "[H]elp Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts": Currently, Republicans are favoring block tax credits that would allow people to buy health coverage, rather than the current ACA tax cuts that are tied to a households level of income.
• "[G]ive our great State Governors the resources and flexibility they need with Medicaid": This is the biggest sticking point for many Republican lawmakers, as those states that have expanded Medicaid wish to keep it, while more conservative members of Congress want to remove funding for that expansion. Trump's speech did not particularly clarify which side of the issue the president falls on.
• "[I]mplement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance": This is unclear what Trump is referencing other than a promise to "bring down the artificially high price of drugs."
• "[G]ive Americans the freedom to purchase health insurance across State lines": The ACA actually has a provision that already allows interstate insurance sales, though few insurers or states have taken advantage of the provision. Additionally, many healthcare experts think this will do little to bring down insurance costs.

Democrats booed and responded by holding their thumbs down during the speech. They are expected to respond to Trump's ACA pledge with former Kentucky governor Steve Beshear, who embraced the ACA during his time in office to a relatively high level of success.

Interestingly, Trump used the example of the current governor of Kentucky saying "Governor Matt Bevin of Kentucky just said Obamacare is failing in his State." Kentucky has seen the largest drop in the percentage uninsured people between 2013 and 2016 due to the ACA.