Donald Trump's Health Care Policies

Image shows Donald Trump on Health Care: 2017: Halts reimbursing insurers for low-income deductibles and co-payment waivers 2018: Proposed a plan to loosen regulations on short-term insurance 2019: Signed a later blocked E.O. that required drugmakers to disclose prices in TV advertising 2020: No national strategy for COVID-19; states left in charge of their own response

Image by Julie Bang © The Balance 2020

During his term, President Donald Trump has 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 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.

COVID-19 Pandemic

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.

  1. The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 provided $8.3 billion to federal agencies to respond to the pandemic.
  2. The almost $3.5 billion Families First Coronavirus Response Act increased sick leave, unemployment benefits, and Medicaid funding. 
  3. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided up to $2 trillion to families and businesses impacted by the pandemic. 
  4. 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 Sept. 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, and states don't possess the same tools as the federal government. As a result, social distancing directives were inconsistent and not uniformly enforced.

Weakened Obamacare

The Trump administration has taken 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. 

Removing the mandate means health care costs may rise. 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. They 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 has 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, Trump 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-terms insurance plans cost less but are exempt from state regulations and aren't required to offer the ACA's 10 essential benefits. Many purchasers 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.

Limited Medicaid

The Trump administration allowed states to impose work requirements on Medicaid recipients unless they have a job, are caregivers, or are in school. The requirement won'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.

States are also now allowed to charge Medicaid recipients premiums, limit the time they can receive benefits, or enforce drug testing. 

Reduced Drug Prices

In 2017, Trump announced he wanted to allow Medicare to negotiate lower prescription drug prices with pharmaceutical companies. That would require 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.

As of 2020, the rule has not been implemented. It may require an act of Congress, according to David Henka, 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. 

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 increased, including a 2.5% rise in January 2020.

How Trump's Actions Affect You

If you're healthy, Trump’s actions could lower your near-term costs, as you'd no longer have to pay the tax penalty under the new tax plan.

You could purchase a short-term or association plan that costs less but may not offer ACA's benefits. However, if you become sick, you might exceed the association plan's annual or lifetime limit. Then you'd have to buy Obamacare insurance for a much higher price.

If you have a chronic illness, your costs will rise. You'll have to rely on the ACA plans available on the exchanges. As healthy customers leave those plans, the companies will raise prices to remain profitable.

Obamacare helped more people receive low-cost preventive care before they needed high-cost emergency room care. 

Trump's plan could also add to the debt. As insurance costs rise, so will the cost of the ACA subsidies, Medicare, and Medicaid. That increases the deficit and debt.

Trump Promises Are No Longer in His Current Plans

Here are four big promises Trump made on the campaign trail that have not been fulfilled.

  1. Replace the ACA with a better health care plan. He continued to promise it but has not delivered.
  2. 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 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.
  3. 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 are opposed to universal coverage.
  4. Allow consumers to access imported drugs. The competition would have driven down drug prices.

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