President-elect Donald J. Trump pressed Republicans on Tuesday to move forward with the immediate repeal of the Affordable Care Act and to replace it very quickly thereafter, saying, “We have to get to business. Obamacare has been a catastrophic event.”
Mr. Trump’s position undercuts Republican leaders who want a quick vote to repeal President Obama’s signature domestic achievement but who also want to wait as long as two to three years to come up with an alternative. But he was also challenging the resolve of nervous Republicans in Congress who do not want any vote on a repeal until that replacement exists.
Mr. Trump, who seemed unclear about the timing of already scheduled votes in Congress this week, demanded a repeal vote “probably some time next week,” and said “the replace will be very quickly or simultaneously, very shortly thereafter.”
That demand is very likely impossible. Republicans in Congress are nowhere close to agreement on a major health bill that would replace President Obama’s signature domestic achievement. A number of Republicans in the House and Senate have said publicly that they wanted to hold off on voting to eviscerate the health law until a replacement measure could be negotiated.
For now, the Senate is planning to vote Thursday morning on a budget resolution that would set up parliamentary protections for a health care repeal bill that would have to emerge from House and Senate committees by Jan. 27. The House would vote on Friday if that budget measure clears the Senate.
That plan is under pressure from Republicans who want to slow the process as they struggle for an agreement on what would follow repeal.
But Mr. Trump said there was no cause for delay. And he said he would not accept a delay of more than a few weeks before a replacement plan was voted on. “Long to me would be weeks,” he said. “It won’t be repeal and then two years later go in with another plan.” That directly contradicts House Speaker Paul D. Ryan’s plans.
Mr. Ryan, who met privately on Monday with top transition officials, agreed with Mr. Trump on the state of the Affordable Care Act, saying Tuesday that its marketplaces were in a “death spiral.” But he has argued that lawmakers need time to write a bipartisan health bill that would replace it.
In fact, new enrollment numbers from the Obama administration undercut that claim. Despite increasing premiums and a torrent of negative news about the future of the health law, enrollment under the act’s health care plans has continued to grow. There are now 11.5 million people who have chosen the marketplace plans for this year, nearly 300,000 more than at this time last year.
Those numbers do not represent surprising enrollment growth — they are roughly in line with projections put out by the administration a few months ago — but they do suggest that higher prices have not scared away consumers. The proportion of young adults signing up has held steady, a sign that the mix of people buying insurance this year is unlikely to be substantially sicker and more expensive than the people enrolled in plans last year.
“Today’s data show that this market is not merely stable, it is actually on track for growth,” Aviva Aron-Dine, a senior counselor to Sylvia Mathews Burwell, the secretary of Health and Human Services, said in a conference call with reporters. “Today we can officially proclaim these death spiral claims dead.”
The data released Tuesday did not capture all Americans who buy their own insurance plans. While enrollment in health care plans under the act is growing, it will take time to know whether people are continuing to purchase similar plans sold directly by health insurance companies. Those plans have also been subject to large price increases, and the people buying them do not have access to federal subsidies to bring down their premiums and deductibles.
But Mr. Trump showed no sign of willingness to accept the health law any longer.
“It’s a catastrophic event,” he said. “I feel that repeal and replace have to be together, for very simply, I think that the Democrats should want to fix Obamacare. They cannot live with it, and they have to go together.”
Mr. Trump issued a political warning to Democrats who might stand in his way, saying he would campaign against lawmakers, especially in states that he won in November.
“It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, warning that “they have 10 people coming up” for re-election in 2018. That alluded to Democratic senators in states he won.
“I won some of those states by numbers that nobody has seen. I will be out there campaigning,” he said.