During his term, President Donald Trump faced the worst health crisis since the 1918 flu pandemic—COVID-19.
His health care policies also included a promise to repeal Obamacare. Although he wasn't successful, he launched many initiatives that weakened the law considerably. Among his other initiatives: allowing states to impose work requirements on Medicaid recipients and attempts to lower drug prices.
On March 13, 2020, Trump proclaimed a national emergency to control the spread of the COVID-19 virus. The declaration suspended travel from China, Iran, and Europe to stop the spread of the coronavirus.
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 Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided up to $2 trillion to families and businesses impacted by the pandemic.
- The Paycheck Protection Program and Health Care Enhancement Act allocated $483.4 billion for small businesses, hospitals, and testing.
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.
Two-thirds (67%) of Americans said that the administration's response was too slow, according to a September 13, 2020, poll by ABC/Ipsos. More than 186,000 Americans had died by the time the poll was launched.
Trump's claims that the virus would go away on its own may have led many people to underestimate the threat.
The New England Journal of Medicine said the U.S. didn't adequately test or provide health care workers and the general public with enough protective equipment. The administration delegated disease control to the states instead of launching a national strategy; however, states don't possess the same tools as the federal government. As a result, social distancing directives were inconsistent and not uniformly enforced.
The Trump administration took many steps to weaken the Affordable Care Act (ACA). The three major ones include eliminating the ACA mandate, refusing to reimburse insurance companies for certain benefits, and allowing less-expensive insurance plans with fewer benefits.
Eliminated the ACA Mandate
The Tax Cuts and Jobs Act repealed the Obamacare tax on those who don't get health insurance. That removed the incentive for healthy people to get covered. The Congressional Budget Office estimated 13 million people would drop coverage by 2027 as a result.
The removal of this mandate could lead to continually rising health care costs in the future. As healthy people drop coverage, health insurance companies may only enroll the sickest and costliest to treat. This increases costs for everyone.
Without insurance, fewer people may get preventive care or treatment for chronic diseases. They may use expensive emergency rooms as a substitute for primary care.
Twenty states sued the federal government, saying that the TCJA elimination of the individual tax penalty made the rest of the ACA unconstitutional. In a highly unusual move, the Trump administration submitted a brief that agreed with the plaintiffs.
Stopped Reimbursements for Low-Income Customers
In 2017, the Trump administration stopped reimbursing insurers who waived deductibles and copayments for low-income customers. The ACA had required insurance companies to provide these waivers. Without federal reimbursement, insurance companies raised premiums up to 20% in some states, just to cover the costs.
The ACA subsidies covered those increases for many people. Subsidy costs to the federal government would rise by $194 billion between 2017 and 2027, according to the Congressional Budget Office (CBO).
Allowed Plans with Fewer Benefits
Trump's 2018 executive order further weakened Obamacare by allowing cheaper, less regulated plans.
The order expanded access to association health plans formerly only available to trade groups, small businesses, and other associations. The order also allowed individuals to purchase policies in other states, extended the ability to purchase short-term insurance from three months to 12 months, and authorized states to use ACA subsidies to develop such plans.
Association and short-term insurance plans cost less, but they are exempt from state regulations and aren't required to offer the ACA's 10 essential benefits. Many consumers don't realize they aren't fully covered.
The plans may siphon off younger, healthier people, leaving the sickest for more comprehensive plans. Insurance companies will be forced to raise premiums.
Other Trump Efforts to Weaken the ACA
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.
In 2017, the Trump administration cut resources needed to help people enroll.
The Trump administration allowed states to impose work requirements on Medicaid recipients unless they had a job, were caregivers, or were in school. The requirement didn't affect 95% of Medicaid recipients, since almost 60% are either younger than 18 or older than 65. The requirement targeted the small percentage of childless, single adults to whom the ACA expanded benefits.
Reduced Drug Prices
In 2017, Trump announced he wanted to allow Medicare to negotiate lower prescription drug prices with pharmaceutical companies. That would have required an act of Congress.
The Congressional Budget Office found that Medicare wouldn't save much by negotiating. Health insurance companies already do a lot of negotiation.
In May 2018, Trump revealed the "American Patients First" Plan to reform the rebates drug companies pay to pharmacy benefit managers (PBM). Historically, the rebates have created incentives for PBMs to suggest higher-cost drugs. PBMs are also allowed to charge insurers more than they're charging pharmacies. As a result, everyone pays different prices for drugs.
However, this rule was not implemented before Trump left office.
A 2019 executive order required drugmakers to disclose their prices of certain drugs in TV advertising. That would have allowed people to shop for the best value, with the competition meant to 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. By late 2020, average monthly basic Medicare Part D premiums were at their lowest levels since 2013. Through participating enhanced Medicare Part D plans, a month's supply of insulin was available for a $35 copay.
Prescription drug prices declined in 2019, according to the Consumer Price Index published by the Bureau of Labor Statistics. Prices fell 2% in June when compared to June 2018. Since then, prices have continued to fluctuate.
Trump Promises That Were Never Fulfilled
Here are four big promises that Trump made on the campaign trail that were never fulfilled:
- Replace the ACA with a better health care plan. He continued to promise it but it was not delivered.
- Keep existing Medicare and Social Security benefits intact. While on the campaign trail in 2016, Trump promised he wouldn't touch Medicare, Medicaid, and Social Security. These benefits are part of the Federal mandatory budget. They were created by prior Acts of Congress and cannot be changed by a president. Instead of keeping his promise, Trump supported efforts to weaken Medicaid expansion as offered by the ACA.
- Offer a universal, “market-based” plan. While running for president, Trump promised to take care of everyone who could not afford coverage. But many conservatives were opposed to universal coverage.
- Allow consumers to access imported drugs. The competition would have driven drug prices down.