No sign of Donald Trump’s replacement for obamacare
As a candidate for the White House, Donald Trump repeatedly promised that he would “immediately” replace President Barack Obama’s health care law with a plan of his own that would provide “insurance for everybody.” Back then, Trump made it sound that his plan — “much less expensive and much better” than the Affordable Care Act — was imminent. And he put drug companies on notice that their pricing power no longer would be “politically protected.” Nearly three years after taking office, Americans still are waiting for Trump’s big health insurance reveal. Prescription drug prices have edged lower, but with major legislation stuck in Congress it’s unclear if that relief is the start of a trend or merely a blip. Meantime the uninsured rate has gone up on Trump’s watch, rising in 2018 for the first time in nearly a decade to 8.5 percent of the population, or 27.5 million people, according to the Census Bureau. “Every time Trump utters the words ACA or Obamacare, he ends up frightening more people,” said Andy Slavitt, who served as acting administrator of the Centers for Medicare and Medicaid Services during the Obama administration. He’s “deepening their fear of what they have to lose.” White House officials argue that the president is improving the health care system in other ways, without dismantling private health care. White House spokesman Judd Deere noted Trump’s signing of the “Right-to-Try” act that allows some patients facing life-threatening diseases to access unapproved treatment, revamping the U.S. kidney donation system and the FDA approving more generic drugs as key improvements. Trump has also launched a drive to end the HIV/AIDS epidemic. “The president’s policies are improving the American health care system for everyone, not just those in the individual market,” Deere said. But as Trump gears up for his reelection campaign, the lack of a health care plan is an issue that Democrats believe they can use against him. Particularly since he’s still seeking to overturn “Obamacare” in court. This month, a federal appeals court struck down the ACA’s individual mandate, the requirement that Americans carry health insurance, but sidestepped a ruling on the law’s overall constitutionality. The attorneys general of Texas and 18 other Republican-led states filed the underlying lawsuit, which was defended by Democrats and the U.S. House. Texas argued that due to the unlawfulness of the individual mandate, “Obamacare” must be entirely scrapped. Trump welcomed the ruling as a major victory. Texas v. United States appears destined to be taken up by the Supreme Court, potentially teeing up a constitutional showdown before the 2020 presidential election. In a letter Monday to Democratic lawmakers, House Speaker Nancy Pelosi singled out the court case. “The Trump administration continues to firmly support the recent ruling in the 5th Circuit, which they hope will move them one step closer to obliterating every protection and benefit of the Affordable Care Act,” Pelosi wrote, urging Democrats to keep health care front and center in 2020. Accused of trying to dismantle his predecessor’s health care law with no provision for millions who depend on it, Trump and senior administration officials have periodically teased that a plan was just around the corner. In August, the administrator of the Centers for Medicare and Medicaid Services, Seema Verma, said officials were “actively engaged in conversations and working on things,” while Trump adviser Kellyanne Conway suggested that same month an announcement was on the horizon. In June, Trump told ABC News that he’d roll out his “phenomenal health care plan” in a couple of months, and that it would be a central part of his reelection pitch. The country is still waiting. Meantime Trump officials say the administration has made strides by championing transparency on hospital prices, pursuing a range of actions to curb prescription drug costs, and expanding lower-cost health insurance alternatives for small businesses and individuals. One of Trump’s small business options — association health plans — is tied up in court. And taken together, the administration’s health insurance options are modest when compared with Trump’s original goal of rolling back the ACA. Since Trump has not come through on his promise of a big plan, internecine skirmishes among 2020 Democratic presidential hopefuls have largely driven the health care debate in recent months. Bernie Sanders and Elizabeth Warren are leading the push among liberals for a “Medicare for All” plan that would effectively end private health insurance while more moderate candidates, like Joe Biden, Pete Buttigieg and Amy Klobuchar, advocate for what they contend is a more attainable expansion of Medicare. Brad Woodhouse, a former Democratic National Committee official and executive director of the Obamacare advocacy group Protect Our Care, said it is important for Democrats to “put down the knives they’ve been wielding against one another on health care.” “Instead turn their attention to this president and Republicans who are trying to take it away,” Woodhouse counseled. Some Democratic hopefuls appear to be doing just that. During a campaign stop in Memphis, Tennessee. this month, former New York Mayor Michael Bloomberg called out Trump on health care, saying the president is “determined to throw Americans off the boat, without giving them a lifeline.” Polling suggests Trump’s failure to follow through on his promise to deliver a revamped health care system could be a drag on his reelection effort. Voters have consistently named health care as one of their highest concerns in polling. And more narrowly, a recent Gallup-West Health poll found that 66 percent of adults believe the Trump administration has made little or no progress curtailing prescription drug costs. Prescription drug prices did drop 1 percent in 2018, according to nonpartisan experts at U.S. Health and Human Services. That was the first such price drop in 45 years, driven by declines for generic drugs, which account for nearly 9 out of 10 prescriptions dispensed. Prices continued to rise for brand-name drugs, although at a more moderate pace. Trump’s broadsides against the pharmaceutical industry might well have helped check prices, though drug companies have
Donald Trump touts support for medicare, slams “medicare for all”
President Donald Trump intends to tout his support for Medicare and slam left-leaning Democrats on their “Medicare for All” proposal when he visits Florida on Thursday. Administration officials say Trump plans to sign an executive order that calls for a series of changes, including a broader role for Medicare’s private insurance option, as he visits The Villages, a bustling community for adults in Central Florida. That part of the state overwhelmingly supported Trump in 2016. The trip is political messaging combined with a dose of health care policy, and it comes as the Republican president angrily defends himself against House Democrats’ impeachment inquiry. Trump is calling the Medicare for All plan from Vermont Sen. Bernie Sanders a “socialist” idea that would destroy Medicare. Sanders’ “single-payer” approach would cover people of any age under a new government plan for all. Medicare administrator Seema Verma said on Thursday that Trump is a “great protector of the Medicare program” and that Sanders’ plan would “eviscerate” it. She called Sanders’ idea not just impractical but “morally wrong,” saying it would “demote American seniors to little more than second-class status.” The Sanders plan would incorporate the Medicare program, but private health insurance _ including the Medicare Advantage option used by about one-third of seniors _ would no longer have a role. Sanders, who unexpectedly underwent a heart procedure this week, says Medicare for All would offer seniors broader benefits and lower costs. Sanders’ style of single-payer health care has long been popular among liberals, but polling lately has shown that a majority of Democrats and independents who lean Democratic prefer expanding coverage by building on the Affordable Care Act, or “Obamacare.” Trump is asking federal courts to overturn that law as unconstitutional, after a Republican-controlled Congress failed to repeal it his first year in office. Trump’s executive order does not involve a major overhaul of Medicare, which would require congressional approval. Instead, it pulls together a series of technical changes and administration priorities. The subject of prescription drug costs also is sure to come up. Trump enthusiastically endorsed a plan by Florida’s Republican Gov. Ron DeSantis to allow patients to import lower-cost medicines from abroad and is pursuing a federal version. But the impeachment inquiry has cast a cloud on prospects for major legislation to reduce drug prices. Trump’s executive order is basically a to-do list for the Department of Health and Human Services. It will require months of follow-up. Among the priorities are an expansion of telemedicine and changes to avoid overpaying for procedures just because they get done in a hospital instead of a doctor’s office. Much of the order focuses on Medicare Advantage, the private insurance option under Medicare. Medicare Advantage plans offer savings on premiums and an annual limit on out-of-pocket costs. They provide one-stop shopping, eliminating the need for separate supplemental insurance. Offered by major insurers, the plans also cover prescription drugs in most cases. But there are trade-offs. Seniors joining a Medicare Advantage plan generally must accept limits on their choice of hospitals and doctors as well as prior insurer approval for certain procedures. If they change their minds and decide to return to traditional Medicare, they’re not always guaranteed supplemental “Medigap” coverage, which is also private. Health and Human Services Secretary Alex Azar said Trump’s order directs his department to examine whether its current policies and practices put traditional Medicare ahead of the private Medicare Advantage option. Some advocates for older people say that it’s the other way around and that the administration is trying to put private plans ahead. The order also would seek to expand the range of additional services that can be offered by the private plans and would direct regulators to find more ways for seniors to financially benefit from plans that provide cost-efficient service. Many Medicare Advantage insurers offer some dental and vision coverage, along with basics like transportation to medical appointments. But the industry lately has started to experiment with in-home assistance, including nutritious meals, and financial help with safety-related home improvements. As a presidential candidate, Trump promised not to cut Medicare. As president, he has avoided calling for privatization of the program or raising the eligibility age beyond 65 or rolling back benefits. However, Trump’s latest budget proposed steep cuts in Medicare payments to hospitals and other service providers, prompting protests from the industry and accusations by Democrats that he was going back on his promises to seniors. The Medicare cuts have gone nowhere in Congress, as Republicans backed away from the president’s budget. By Kevin Freking and Ricardo Alonso-Zaldivar Associated Press. Republished with the permission of the Associated Press.
