More than three-and-a-half years into his presidency and 40 days from an election, President Donald Trump last week launched what aides termed a “vision” for health care heavy on unfulfilled aspirations.
“This is affirmed, signed, and done, so we can put that to rest,” Trump said. He signed an executive order on a range of issues, including protecting people with preexisting medical conditions from insurance discrimination, eliminating “surprise” medical bills, and issuing prescription drug payment cards.
But the right to insurance coverage is already guaranteed in the Obama-era health law his administration is asking the Supreme Court to overturn, and the other initiatives lacked legislative authority. And Trump’s speech seemed more a chance to launch a political attack, as he accused Democrats of wanting to unleash a “socialist nightmare” on the U.S. health care system, complete with rationing.
On Monday, the two candidates for the 6th Congressional District, which comprises all of Chester County and part of Berks County, reacted to Trump’s health care ideas. Neither offered a ringing endorsement.
Incumbent U.S. Rep. Chrissy Houlahan, a Democrat, in a telephone interview called the president’s actions “cynical and hypocritical,” since his announcement comes so close to Election Day as his administration is actively trying to undo health care provisions in place.
“In my district, health care is issue No. 1, No. 2, and No. 3,” she said from her home in Easttown. “This issue could not be more important to our constituents, our Commonwealth, and our country. But the reality is that the only thing this administration has done is to undermine the Affordable Care Act (ACA),” which guarantees the rights of those with pre-existing conditions.
Houlahan said that bipartisan efforts to address some of Trump’s initiatives, such as a curb on “surprise” bills that lack transparency, have been wending their way through the Congress without help from the White House. “This is a president unwilling to come to the table,” she said.
Her Republican opponent, New London businessman John Emmons, said he supported Trump’s ideas, particularly his commitment to protecting those who have pre-existing conditions, but cast a cold eye on the president’s means for putting forth his “vision” — the executive order.
“I think it’s a conversation starter,” said Emmons of Trump’s speech in an airplane hanger in swing-state North Carolina. “In general, I am not in favor of a frequent use of executive orders. I’d like to see Congress take up those issues and work with a president to get these things resolved. Because Donald Trump is a good negotiator, it is very possible that this is part of a negotiating process.
“These are enormously complicated issues the Congress has been working on,” he said. “Our experience is that when the conference leans in on his conference, things start to work their way through the legislative system.” Signing executive orders as Trump did last week, is “almost like sending an internal memo.”
“But ultimately, it is Congress’s responsibility to figure this out,” said the GOP Trump supporter. “There are a number of things we need to do to improve out health care system, from a cost standpoint, and I think this is an great opportunity to improve our system. Bringing down the cost of health care is something I’ve done on my own in business, and I am eager to get in and start to work on these ideas.”
The president’s latest health care pitch won accolades from administration officials and political supporters but failed to impress others.
“Executive orders issued close to elections are not the same thing as actual policies,” said Katherine Hempstead, a senior policy adviser with the nonpartisan Robert Wood Johnson Foundation, which works on a range of health care issues, from coverage to quality.
“When I looked at it, I asked, ‘What does it change?’ said Dr. Mian Jan, a Chester County cardiologist and past-president of the Chester County Medical Society, a non-partisan organization dedicated to advancing healthcare in the local community and protecting resources available. “Is it any different than the way things stand now? To me, it seems like a rebranding of the ACA (Affordable Care Act).”
“Protecting insurance for people with pre-existing conditions, is a very important thing,” he said, but it is already established law. And Trump’s plan to send $200 prescription drug debit cards to seniors seemed unorganized. “How do you do that?” Jan wondered during an interview. “Do you do that one time, or multiple times? Once a year? There doesn’t seem to be any clarity on how they are going to be dispersed.
“I know that this has been a big concern of his, but I’m not sure a lot of those things are doable,” he added.
Trump returned to health care amid disapproval of his administration’s handling of the coronavirus pandemic and growing uncertainty about the future of the Obama-era law.
In a rambling speech last week, he promised quality health care at affordable prices, lower prescription drug costs, more consumer choice and greater transparency. His executive order would also to try to end surprise medical bills.
“’If we win we will have a better and less expensive plan that will always protect individuals with pre-existing conditions,” Trump declared.
But while his administration has made some progress on its health care goals, the sweeping changes Trump promised as a candidate in 2016 have eluded him.
The clock has all but run out in Congress for major legislation on lowering drug costs or ending surprise bills, much less replacing the Affordable Care Act, or “Obamacare.”
For Trump, health care represents a major piece of unfinished business.
Prescription drug inflation has stabilized when generics are factored in, but the dramatic price rollbacks he once teased have not materialized. In his speech the president highlighted another executive order directing Medicare to pay no more than what other nations pay for medications, but it remains yet to be seen how that policy will work in practice, if it can overcome fierce opposition from the drug industry.
Trump said millions of Medicare recipients will soon receive a card in the mail containing $200 that they can use to help pay for prescription medications. “I will always take care of our wonderful senior citizens,” he promised. No detail was immediately available on when seniors would get such a card or how the cost of the assistance would be paid for.
More broadly, the number of uninsured Americans started edging up under Trump even before job losses in the economic shutdown to try to contain the coronavirus pandemic. Various studies have tried to estimate the additional coverage losses this year, but the most authoritative government statistics have a long time lag. Larry Levitt of the non-partisan Kaiser Family Foundation says his best guess is “several million.”
Meanwhile, Trump is pressing the Supreme Court to invalidate the entire Obama-era health law, which provides coverage to more than 20 million people and protects Americans with medical problems from insurance discrimination. That case will be argued a week after Election Day.
This story includes information from the Associated Press.
To contact staff writer Michael P. Rellahan call 610-696-1544.