President Donald Trump really, really wants to fool voters into thinking he has a plan to make the health care system great again. But he really, really doesn’t.
In Charlotte, North Carolina, on Thursday, Trump signed executive orders he claims address two of the biggest concerns Americans have about the health care system: coverage for people with preexisting conditions and surprise medical bills.
The orders don’t do anything about anything, though. It’s just more vaporware from the Trump administration. Slogans, lies and exaggerations aren’t policies. Trump pitched his phantom plan by saying it rests on three pillars: “more choice,” “lower costs,” and “better care,” and that it would “put patients first.”
Those focus-group-tested slogans sound great! Except they’re hogwash.
The truth is that, like in so many other areas, Trump doesn’t want to do the work. After all, as Trump once said, health care is “complicated!” Who needs the headache when there are people of color to insult and golf to play?
Executive orders like these are little more than campaign press releases printed on fancier stationery. Since Trump doesn’t have the interest or patience to actually work with Congress to make laws, he tosses off toothless executive orders and farms out his Obamacare repeal efforts to a court system he’s packed with his own judges.
There’s no evidence that Trump cares about health care at all beyond his intense desire to undo anything President Barack Obama did in office. Has there been anything about Trump’s response to the novel coronavirus pandemic to suggest that the health and well-being of Americans is a priority for him? Two hundred thousand dead say otherwise.
Trump barely engaged in the 2017 legislative fight to repeal the Affordable Care Act and replace it with a GOP plan that would have kicked tens of millions of Americans off their health care. After that failed, he gave up even trying to legislate on health care, and instead, his administration turned its focus to sabotaging the ACA’s health insurance marketplaces, imposing onerous new requirements on Medicaid beneficiaries, promoting the sale of junk health insurance policies that, unlike ACA plans, do exclude people with preexisting conditions, and getting the courts to kill the ACA for him.
Empty Promises And Falsehoods
Trump rattled off a litany of policies his administration has implemented or proposed, ranging from relaxing health insurance regulations to attempting to lower drug prices, few of which have amounted to anything.
In fact, some of his supposed accomplishments further give the lie to his claim that he supports protections for preexisting conditions. The Trump administration has expanded access to several kinds of health “insurance” that aren’t available to people with preexisting conditions, like short-term health plans.
The term “gaslighting” gets overused these days, but there’s no better way to describe what Trump is perpetrating. His claims about these executive orders are entirely detached from reality and his claims about his own record on health care range between completely made-up to highly exaggerated.
A president whose primary health policy objective is scrapping his predecessor’s law that brought the uninsured rate to a historic low can’t plausibly claim to be fixing the health care system. “Obamacare is bad” is not a policy, and anyone who expected Trump to finally, at long last, explain to the public how he would replace that law ― if such a person still exists ― has been disappointed yet again.
It’s worth being extremely clear about why anyone is worried about people with preexisting conditions in the first place. After all, it’s been a full decade since the Affordable Care Act made it illegal for health insurance companies to deny coverage or charge higher rates to people based on their medical histories.
Well, it turns out that protection might disappear, along with the rest of the ACA, because Trump and the Republican Party want it to.
Trump is part of a lawsuit the Supreme Court is scheduled to take up in November (after Election Day, of course) that could eliminate the whole law. This, in fact, is Trump’s “vision” for health care reform, not whatever bogus claims he makes to get him out of a political jam he put himself in by joining a legal case originated by a bunch of Republican state officeholders.
If the Republican plaintiffs win ― an outcome made more likely by the death of Supreme Court Justice Ruth Bader Ginsburg last week ― an estimated 20 million people would lose their health coverage, and everyone with a preexisting condition, no matter how minor, would be at risk.
There is nothing on the table to mitigate the vast harm that ruling would create, despite assertions from Trump like this: “If we win, we will have a better and less expensive plan that will always protect individuals with preexisting conditions.”
So, again, his plan is to not have a plan. If he had one, he would tell us.
“The president is declaring that it is the policy of the United States to provide protections to ensure that Americans with preexisting conditions are protected regardless of whether the Affordable Care Act is unconstitutional and its protections for preexisting conditions invalidated,” Health and Human Services Secretary Alex Azar said during a conference call with reporters prior to Trump’s speech.
“The policy of the United States” is an empty phrase. It’s not a law. It’s not even an actual policy. Also, the current real policy of the United States on this issue is encoded in a law called the Affordable Care Act that Trump is trying to get rid of.
Simply declaring in an executive order that people with preexisting conditions should be able to buy health insurance if the high court knocks down the ACA is entirely meaningless. If it were that simple, some other president would have done it already and become extremely popular. More than that, no president can just order an entire industry to not do something. That’s why there’s a Congress that passes laws.
“The term “gaslighting” gets overused these days, but there’s no better way to describe what Trump is perpetrating. His claims about these executive orders are entirely detached from reality and his claims about his own record on health care range between completely made-up to highly exaggerated.”
Almost unbelievably, Trump’s action on surprise billing is even more fake than his preexisting conditions nonsense. “We will end surprise billing,” he said. No, they won’t.
Surprise bills are one of the worst aspects of the U.S. health care system, and that’s really saying something considering how awful it is in so many other ways. Over the past couple of years, Congress has tried and failed to devise a solution to this problem that would protect patients from unexpected bills from out-of-network providers the patients often don’t even know treated them.
But Congress and the administration failed to come to a deal after intense lobbying by hospital and physician groups, and the private equity companies that own medical practices that make tons of money from surprise bills.
Trump’s new solution? An executive order that directs the Department of Health and Human Services to start coming up with some kind of plan next year if Congress doesn’t pass a bill by Jan. 1, 2021. “He will instruct me to investigate executive actions and regulatory actions that we can take that will ensure that patients are nonetheless protected against surprise medical bills,” is how Azar described it.
That’s not a plan. It’s a plan to come up with a plan that won’t work because the White House can’t just order hospitals not to bill people. Again, that’s why lawmaking exists.
Lies About Biden
Trump also took aim at Democratic presidential nominee Joe Biden’s health care plan ― or a caricature of it, anyway.
“The [Democratic] Party is pushing a socialist nightmare. Their plans will result in rationing care, denying choice, putting Americans on waitlist, driving the best doctors out of medicine permanently and delaying cures,” Trump said.
This will be shocking news to Biden, who won the Democratic primary by opposing the kinds of health care reforms, like “Medicare for All,” that his progressive opponents favored and that also wouldn’t do what Trump says they would. Instead, Biden is running on a potentially consequential but also kind of boring plan to make Obamacare coverage cheaper.
Election Day is 40 days away, and Trump knows he’s on the wrong side of public opinion on health care. He’s going to keep repeating falsehoods and misrepresentations about his health care record and agenda. But the totality of his actions as president makes very clear that his promises of better, cheaper health care are extremely hard to believe.