The Detroit Post
Monday, 08 March, 2021

Donald Trump On Healthcare

author
Danielle Fletcher
• Monday, 07 December, 2020
• 13 min read

President Trump outlined his long-awaited health care plan on Thursday, signing a series of executive orders he said are aimed at protecting Americans with pre-existing conditions, ending surprise billing and introducing more affordable public options. The move comes as the Trump administration tries to overturn Obamacare in the Supreme Court after getting rid of the key enforcement tool of the law, the individual mandate, when Congress eliminated the penalty for not having insurance.

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Contents

The first executive order requires that health insurance companies cover all pre-existing conditions for all customers, a move he floated in August. President Barack Obama’s plan, formerly known as the Affordable Care Act, already includes a provision that prevents insurers from discriminating against Americans with pre-existing medical conditions.

But Trump ’s executive order does not carry the weight of an actual law if the Affordable Care Act is struck down by the Supreme Court. Health care has emerged as a major issue in Trump ’s first term, and in July he signed an executive order reducing the cost of prescription drugs.

The morning after Trump's town hall, White House chief of staff Mark Meadows said that an Obamacare-alternative health care plan is “all ready” after “tweaks” and “modification.” The plan will be done through an executive action, “with a legislative component that is more visionary,” Meadows said, and blamed Congress for the significant delay.

The Healthcare page at Whitehorse.gov offers only this about the supposed plan: “Replacing Obamacare will force insurance companies to compete for their customers with lower costs and higher-quality service.” Even if Trump proposed a comprehensive replacement plan for the ACA (aka Obamacare) tomorrow, there is a roughly 0% chance the legislative component would pass Congress before the election.

All of Trump's bravado about a plan that is perfect -- but no one can see just yet -- comes amid polling that shows health care is a majority of priority for voters in 2020. In a CNN-SSRS poll conducted last month, more than seven in 10 voters said health care was either “extremely” or “very” important to their vote this fall.

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And Trump trailed former Vice President Joe Biden by 13 points when voters were asked who would do a better job of handling health care issues in the country. Those numbers suggest the public has caught on to Trump's secret, which is this: There's no perfect health care plan that the President is about to drop.

Maybe less,” Trump told ABC's George Stephanopoulos at the time, adding: “You're going have the greatest health care that anybody's ever had.” Fast-forward 15 months to Wednesday night, when Stephanopoulos and Trump were together again, this time at a town hall in Philadelphia.

His health care policies also included a promise to repeal Obamacare.Although he wasn't successful, he has launched many initiatives that have weakened the law considerably. Among his other initiatives: allowing states to impose work requirements on Medicaid recipients and attempts to lower drug prices.

In March and April, Trump signed four stimulus laws that provided a record $2.5 trillion to agencies, businesses, and families dealing with the pandemic. The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 provided $8.3 billion to federal agencies to respond to the pandemic.

The almost $3.5 billion Families First Coronavirus Response Act increased sick leave, unemployment benefits, and Medicaid funding. The Paycheck Protection Program and Health Care Enhancement Act allocated $483.4 billion for small businesses, hospitals, and testing.

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Trump launched Operation Warp Speed, a program intended to develop and distribute safe vaccines and treatments in record time.He used the Defense Product Act to produce 100,000 ventilators. The New England Journal of Medicine said the U.S. didn't adequately test or provide health care workers and the public with enough protective equipment.

As healthy people drop coverage, health insurance companies may only enroll the sickest and costliest to treat, which increases costs for everyone. Without insurance, fewer people may get preventive care or treatment for chronic diseases.

Twenty states sued the federal government, saying that the TCA elimination of the individual tax penalty has made the rest of the ACA unconstitutional. In 2017, Trump stopped reimbursing insurers who waived deductibles and co-payments for low-income customers.

Subsidy costs to the federal government would rise by $194 billion between 2017 and 2027, according to the Congressional Budget Office (CBO). Association and short-terms insurance plans cost less but are exempt from state regulations and aren't required to offer the ACA's 10 essential benefits.

In his first 100 days, President Trump signed an executive order directing agencies to do what they could within the existing law to lift the ACA regulations. States are also now allowed to charge Medicaid recipients premiums, limit the time they can receive benefits, or enforce drug testing.

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In2017, Trump announced he wanted to allow Medicare to negotiate lower prescription drug prices with pharmaceutical companies. In May 2018, Trump revealed the “American Patients First” Plan to reform the rebates drug companies pay to pharmacy benefit managers (IBM).

It may require an act of Congress, according to David Henna, CEO of Active RADAR, in an interview for MedCityNews. A 2019 executive order required drugmakers to disclose their prices of certain drugs in TV advertising.

That would allow people to shop for the best value and the competition should drive prices down.Shortly afterward, several pharmaceutical companies won a lawsuit that blocked the order. In 2020, Trump's executive order required health centers to pass any discounts on insulin and epinephrine to their patients.

As of 2020, average monthly basic Medicare Part D premiums are at their lowest levels since 2013. Through participating enhanced Medicare Part D plans, a month's supply of insulin is available for a $35 copay.

As healthy customers leave those plans, the companies will raise prices to remain profitable. While on the campaign trail in 2016, Trump promised he wouldn't touch Medicare, Medicaid, and Social Security.

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Instead of keeping his promise, Trump supported efforts to weaken Medicaid expansion as offered by the ACA. “We will ensure the highest standard of care anywhere in the world: cutting-edge treatments, state-of-the-art medicine, groundbreaking cures and true health security for you and your loved ones,” he said.

Earlier this month, Trump also signed an executive order to lower drug prices in the United States by instructing Medicare to not pay more for certain medicines than other nations, prompting criticism from the pharmaceutical industry. During his 2016 presidential campaign, Trump pledged to “repeal and replace” the ACA, also known as Obamacare, but has after being elected has said he would continue protections for Americans with pre-existing conditions included in the healthcare plan.

A 2018 Trump rule expanded renewable and flexible plans not subject to Obamacare’s laundry list of expensive requirements. Another 2018 rule expanded Association Health Plans, permitting employers to band together and offer their workers more affordable coverage.

Trump ’s HRA rule will lead to four times as many people purchasing coverage in the individual market with no new federal spending. While increasing Americans’ coverage options and shoring up the individual market was mission number one, the Trump administration did much more to improve our health-care system.

For example, diabetics can make deposits to their health savings accounts for the first time even if they have a plan that covers insulin before meeting their deductible. The president has also taken action to increase kidney donations and dialysis provided in patients’ homes rather than predominantly in hospitals and clinics.

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“And when you add the pandemic into the mix, it only elevates it as one of those kitchen table issues that have a real salience for people.” Tricia Newman, SCD, a health policy analyst at the Kaiser Family Foundation, believes the coronavirus will continue to be the primary focus through the election and beyond.

But heading into 2021, she predicts the attention will expand to more conventional health policy issues -- such as drug costs, insurance coverage, Medicare, and Medicaid. “With 200,000 deaths due to COVID-19 so far, and the harsh economic consequences of the pandemic that are taking a toll on so many Americans, the shift in voter interest at this time is not all that surprising.

Many political pundits expect the coronavirus crisis -- and which candidate voters believe will do the better job fighting the virus and limiting the economic fallout -- to play a key role in the election. The virus has triggered historic economic fallout, leading to job losses, record stock market turbulence, and the closing of countless businesses.

It has also stoked heated societal and political clashes over mask-wearing, social distancing, and other measures scientists advocate to combat the crisis. Trump : The president has emphasized the development of a coronavirus vaccine and antiviral treatments as ways to combat and contain the virus.

In recent testimony before Congress, top public health expert Anthony Fauci, MD, said vaccinations could start as early as November or December. So far, the federal government has contracted with six drug companies -- spending nearly $11 billion -- as part of Operation Warp Speed.

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The president banned travelers from China on Jan. 31 and has said this shows he was quick to act to combat the virus and that the move saved American lives. But the ban had exemptions, and many public health experts have said the president did not act early or aggressively enough to contain the coronavirus, which by late January had already infected Americans.

He has publicly criticized health experts, such as Fauci and CDC officials, who have disagreed with many of his positions and statements on topics such as wearing masks. Biden : The former vice president has outlined a detailed coronavirus action plan he would launch, if elected.

Biden also advocates boosting pay for health care workers at risk on the front lines. In addition, the Democrat says he would give Fauci, director of the National Institute of Allergy and Infectious Diseases, free license to speak directly to Americans without restrictions.

In August, Biden called for a nationwide face mask mandate to slow the spread of the coronavirus. But he later walked that position back, pending a legal review of White House authority to issue such a mandate.

Few policy issues have divided Republicans and Democrats as significantly as the Affordable Care Act, also known as Obamacare. Trump kicked off his presidency in 2016 with a promise to end the law “on day 1,” saying that it unfairly requires people and large companies to buy insurance or pay a heavy fine.

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While that didn’t happen, he has worked with Congress and pushed administrative actions to weaken, modify, or remove some Affordable Care Act’s key provisions. Supreme Court Justice Ruth Bader Ginsburg’s passing this month, and the nomination of conservative judge Amy Coney Barrett, could upend the Affordable Care Act, Corvette notes.

“Republicans tend to believe the free market can address a lot of the issues in the health care system. For instance, both candidates say people with pre-existing conditions should be protected and advocate transparency in health care costs -- to avoid surprise medical billing.

Under the act, insurers cannot refuse coverage or charge higher premiums for Americans with prior health conditions, such as diabetes, cancer, and heart disease. Biden says he wants to bolster the Affordable Care Act with a variety of add-ons that will “insure more than an estimated 97% of Americans,” according to the Biden-Harris campaign site.

In 2017, he worked with the then-GOP-controlled Congress to eliminate the act’s tax penalty for Americans who do not buy health insurance. On the president’s campaign website, PromisesKept.com, Trump says his administration used alternative ways to expand health care access to Americans in need, including 2.5 million people in rural areas.

On Sept. 24, he signed an executive order -- called the America First Healthcare Plan -- that he said guarantees coverage of people with pre-existing conditions. Drug pricing is a subset of rising health care and insurance costs, which both candidates have pledged to address, if they win the election.

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This year alone, retail prices for 460 commonly prescribed drugs are increasing by an average of 5.2%, according to new analysis by 3 Axis Advisors, a health research firm. Trump : Two weeks ago, he issued an executive order aimed at lowering drug costs for people on Medicare.

The pharmaceutical industry denounced the plan, and experts say it is unclear if the White House can carry it out without congressional approval. The president has pushed another idea: requiring drug companies to disclose prices in television advertising.

The president has made his executive order on Medicare drug pricing a centerpiece of his campaign and his plan to lower health costs. In July, he signed executive orders to discount prices on insulin and epinephrine for low-income patients; allow imports of lower-priced drugs; combat profiteering by intermediaries known as “pharmacy benefit managers”; and guarantee Americans pay the lowest available prices among developed nations for Medicare Part B drugs.

Biden supports the idea of lifting bans on importing drugs from foreign countries with lower costs. Regardless of who wins in November, Newman says, the president will have some “really difficult decisions, as will Congress,” about how to preserve or modify Medicare and Medicaid in the new year.

In August, Trump signed an executive order unilaterally cutting payroll taxes, a primary funding vehicle for Medicare and Social Security. In April, Medicare’s trustees said that the Part A trust fund for the program, which pays for hospital and inpatient care, could start to run dry in 2026.

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(Source: www.politico.com)

Biden: He has criticized Trump ’s payroll tax cut and the administration’s budget proposals for Medicare and Medicaid. The former vice president also supports increased federal funding to states for Medicaid during the current economic crisis.

The budget proposals would change how Medicare providers are paid and put new limits on whose eligible for Medicaid. The administration has also supported new work requirements for Medicaid beneficiaries, caps on spending growth, and converting the program to block grants.

Trump : He has sought to expand a federal ban on funding for clinics that provide or refer women for abortion. The White House moved to cut funding for the Planned Parenthood Federation of America and other clinics that provide abortions, contraceptive services, and health screenings for millions of low-income Americans.

Earlier this year, the administration asked Planned Parenthood affiliates around the U.S. to return millions of dollars in loans from the federal government's coronavirus relief package. He has allowed employers to exclude Affordable Care Act contraceptive coverage for religious or moral reasons.

And he has reinstated and expanded the “Mexico City Policy,” which blocks federal international assistance for organizations that perform or promote abortions. As a senator, he also voted to support the “Hyde Amendment,” banning the use of federal funds for abortion except in cases of rape, incest, or life-threatening circumstances.

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U.S. Department of Health and Human Services: “HHS Adds $628 Million to Contract with Emergent Solutions to Secure Como Manufacturing Capacity for Operation Warp Speed.” Congressional Budget Office: “Repealing the Individual Health Insurance Mandate: An Updated Estimate.

The New York Times: “As He Woos Drugmakers on Virus, Trump Demands Drug Price Controls.” Forbes: “Dems Slam Trump ’s Executive Actions, Biden Calls Payroll Tax Cut ‘A Reckless War On Social Security.

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