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Trump’s ‘Pinky Promise’ on Health Care

Yuval Rosenberg
·5 mins read

The White House and President Trump made some big promises about his speech on health care Thursday afternoon in Charlotte, North Carolina. The White House said Trump would be laying out “his comprehensive health care vision.” The president himself, early in his speech, said his plan “expands affordable insurance options, reduces the cost of prescription drugs, will end surprise medical billing, increases fairness through price transparency, streamlines bureaucracy, accelerates innovation, strongly protects Medicare, and always protects patients with preexisting conditions.”

If you’re reading this or have paid any attention to health policy over the last four years, you know what’s coming next (but keep reading because some of the details might still surprise you and the responses to Trump are worth it). There was, of course, no comprehensive plan. As for vision, to the extent that there was one undergirding Trump’s announcements, seemed to be more about cynical political maneuvering than genuine health care reform.

Trump has long promised to unveil a health care plan that would be less expensive than Obamacare while offering superior coverage. On Thursday, he suggested he had already accomplished those goals, touting an assortment of actions taken or proposed by his administration as his vision, billed as the “America First Healthcare Plan.” (Trump has, for example, pushed for lower drug and hospital prices, increased price transparency and expanded the use of less expensive, short-term plans that critics call “junk insurance” because of their limitations. See this overview of his record for more.)

“Obamacare is no longer Obamacare, as we worked on it and managed it very well,” Trump said. “What we have now is a much better plan. It is no longer Obamacare because we got rid of the worse part of it — the individual mandate.”

But health care experts found Trump’s “plan” sorely lacking in details. “It's not a plan, it's a mirage. It's a series of aspirations with no specific policy proposals to back them up,” tweeted Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, a non-partisan non-profit focused on health.

“The actual policies they announced,” STAT News’s Lev Facher and Nicholas Florko wrote, “are simple, superficial, and non-binding executive orders. Neither will improve the quality of Americans’ health care or lower its cost.”

What Trump did: The president signed executive orders that appear designed to win over voters — but that experts say are likely to have little impact on American’s actual health care.

Trump’s executive orders pledge to protect Americans with preexisting conditions; promote new rules allowing states to import lower-cost prescription drugs from Canada; and direct the Health and Human Services secretary to push for legislation banning surprise medical bills by the end of the year and pursue administrative action if that effort fails.

Trump also promised to send $200 discount cards to 33 million Medicare beneficiaries, though it’s unclear whether he has the legal authority or the funding to do so.

Here’s a look at some problems and questions surrounding Trump’s orders.

Preexisting conditions: Trump’s pledge on preexisting conditions carries no legal weight — unlike the protections provided under the Affordable Care Act, which Trump is seeking to invalidate. White House officials reportedly acknowledged that Trump’s protections would not bear the weight of law but were a "defined statement of U.S. policy.” That doesn’t mean much.

“It’s as if I was walking around with a memo that was titled ‘Executive Order,’ and claimed that the policy of the United States is that everybody gets a cheeseburger on Tuesdays,” Nicholas Bagley, a professor at University of Michigan’s law school and Obamacare supporter, told Reuters. Levitt of the Kaiser Family Foundation compared it to a “pinky promise.”

That promise, as ineffectual as it may be, was made necessary by the Trump administration’s support for the ongoing lawsuit seeking to wipe out Obamacare in its entirety.

The executive order “is yet another example of Trump's political gaslighting on the subject,” writes Axios’s Caitlin Owens. “Republicans have never come up with another way to offer the same level of protection the ACA does. If Trump succeeds in stripping the ACA's protections away, people with preexisting conditions would have every reason to worry about their coverage.”

The $200 prescription drug coupons: STAT’s Facher and Florko calls this a "political ploy to curry favor with seniors who view drug prices as a priority."

Trump said the discount cards “will be mailed out in coming weeks” but there are plenty of questions that make it unclear whether that will happen, including whether Trump has the authority to do it and where the money might come from.

The White House reportedly said it is getting its authority to send the coupons from a Medicare demonstration program, with the $6.6 billion cost of the plan covered by savings from Trump’s plan to lower drug prices — a plan that has not yet been implemented. But The Wall Street Journal’s Stephanie Armour reported Friday that, according to an administration official, the proposed funding would come from a Medicare trust fund under the waiver program for testing new initiatives. “These waiver programs have generally been required to show they won’t increase federal spending beyond what would have occurred without the test,” Armour notes.

The bottom line: Trump’s big health care rollout likely served to highlight what Trump hasn’t done more than what he has. “The speech and executive order stood as a tacit admission that Trump had failed to keep his 2016 promise to replace his predecessor’s signature achievement with a conservative alternative,” The Washington Post’s Toluse Olorunnipa writes. “Unable to repeal the law, Trump appeared open to simply rebranding it.”

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