Trump Administration Health Care Plan
Nicole Hefner
Politics of Health
Professor Callahan-Kapoor
April 2, 2017
Definition and Background:
During his campaign for the presidency, Donald Trump promised to make a number of changes for the United States if elected. Along with building a wall to secure our borders with Mexico and banning Muslims and refugees from the United States, Trump’s plan to completely revamp the current health care system, the Affordable Care Act, was among his top priorities for reform. For months he claimed that as soon as he took office, he would simultaneously repeal and replace the Affordable Care Act, enacted in 2010 under President Obama, with a new and improved plan. Republicans have tried to repeal the Affordable Care Act since its enactment, but now that the House, Senate, and presidency are controlled by Republicans, many, including Trump, thought a repeal would have a good chance at passing. If the ACA were repealed, healthcare for 22 million Americans would have been taken away, so a new program would need to be instituted right away (Shyrock, 2016).
Donald Trump, image from News, CBS. “Turning the page: Donald Trump’s first day in office.” CBS News. January 22, 2018=7. Accessed April 02, 2017. http://www.cbsnews.com/news/turning-the-page-donald-trumps-first-day-in-office/.
On his first day in office, Trump signed an executive order which was the first step in his original plan to repeal and replace the ACA. The order gave federal agencies authority “to defer or delay any part of the Affordable Care Act that costs anybody money” (Carroll, 2017). In terms of what he planned to replace the ACA with, Trump initially had no formally submitted program nor did he provide many concrete details on what his program would entail (Carroll, 2017). He claimed his plan was “formulated down to the final strokes” but that he was waiting for his secretary of health and human services, Tom Price, to be confirmed before he submitted the plan (Costa and Goldstein, 2017). Price was confirmed on February 10, 2017, but the plan still was not submitted as of this date (Costa and Goldstein, 2017).
On an archive of Trump’s website, he stated that the damage done by the Affordable Care Act “will be difficult to repair unless the next President and a Republican Congress lead the effort to bring much-needed free reforms to the healthcare industry” (Trump 2017, 1). He at first told the Washington Post that his plan had insurance for everybody as the goal, but his transition team rescinded that statement days later (Raju, Lubhy, and LoBianco, 2017). Trump claimed his health insurance plan would follow market principles and allow providers to sell health insurance across state lines in order to create more competition among providers and drive down the cost of coverage. Additionally, he called for the removal of barriers to entry into free markets for drug providers that offer reliable but cheaper products. On a website page that has since been taken down, Trump made further demands of the House and Senate, including the elimination of the individual mandate in the Affordable Care Act so that no one would be forced into buying health insurance unless they choose to. He also proposed that individuals should be allowed to deduct their premium payments for health insurance from their tax returns and that health care providers be required to show price transparency so that patients may act like consumers and “shop around” for the best prices. Although he did not propose to stop providing health care to illegal immigrants, Trump noted that if we did stop our provisions to them, mostly in the form of emergency care which amounts to $11 billion annually, we could relieve the pressures of healthcare costs on state and local governments (Trump, 2017).
All of Trump’s plans were conditional on the repeal of the Affordable Care Act; unfortunately for Trump and the Republican party, legislation to repeal the ACA was withdrawn from consideration on the house floor on March 24, 2017. Once House speaker Paul Ryan was informed that there were not enough votes to pass a repeal bill, he and Trump quickly decided to withdraw the bill rather than let it be defeated. Trump initially played off the loss as a blessing in disguise, saying that “the best thing that could happen is exactly what happened” because “Obamacare unfortunately will explode” and “democrats will come to [the Republican party]” ready to negotiate a better health care plan for the nation (Pear, Kaplan, Haberman, 2017). However, comments from other Republican representatives included “You can’t pretend this is a win for us” and “This bill’s done” (Pear, Kaplan, Haberman, 2017). Had the bill been more encompassing of the sentiments of the moderate Republicans and the far right, it would have had a better chance of passing (Pear, Kaplan, Haberman, 2017). Despite all the recent obstacles, Tom Price announced in a speech on March 29th that although his party is unable to rewrite the ACA, they are still determined to dismantle parts of it. In particular, he said his party is still looking to make insurance plans cheaper by scaling back on federal mandates including some essential benefits in coverage (Eilperin and DeBonis, 2017). It remains to be seen whether the Trump administration will make another attempt to repeal the Affordable Care Act, and, if they choose not to, how they will move forward in trying to amend it.
Tom Price, image from “Tom Price (U.S. politician). “Wikipedia. March 31, 2017. Accessed April 02, 2017. https://wikipedia.org/wiki/Tom_Price_(U.S._politician).
Controversy / Perspectives
Trump’s proposal to repeal the ACA and replace it with a new program has been and continues to be a contentious political issue. The groups most supportive of Trump’s “repeal and replace” plan are doctors and Republicans. Some – but not all – doctors have been upset by the administrative and regulatory burdens placed on them by Obama’s Affordable Care Act and hope that if it is repealed, there will be fewer regulations. This will give them more time to focus on treating patients rather than figuring out administrative procedures. Other doctors, however, are against Trump’s plan because they realize that many of their patients currently covered by the ACA will now be forced to pay for their care. If the patients cannot pay, they will forego treatment, and their doctors will lose business (Shyrock, 2016). Furthermore, people will wait until they are sicker before seeking help and will end up in the emergency room where they may need more complicated, urgent procedures that are more expensive.
The Republican party has been, for the most part, supportive of at least a partial repeal of the ACA. As of January, they had already taken steps to repeal the law through budget reconciliation, requiring a simple majority in the Senate, that would allow them to overturn parts of the ACA involving federal spending (Costa and Goldstein, 2017). Still, they question Trump because the Republican party has always opposed further expansion of government involvement in the healthcare system. The moderates worry about the Congressional Budget Office’s predictions that Trump’s new bill would leave millions more without insurance while the extreme conservatives feel that Trump’s bill doesn’t dismantle the ACA enough (Pear, Kaplan, Haberman, 2017).
On the opposite side, the groups least supportive of Trump’s plan are women’s rights activists and Democrats, who supported the Affordable Care Act and don’t wish to see it repealed and replaced with conservative policies. After the withdrawal of the repeal bill, Representative Mark Walker commented that the Democrats would be celebrating the Republican failure to dismantle the ACA as well as the obvious disunity within the Republican party (Pear, Kaplan, Haberman, 2017). Trump also angered many women’s groups and supporters of Planned Parenthood by claiming that his bill to repeal the ACA would also defund Planned Parenthood as long as they continue to perform abortions (Dias, 2017). Whether this will be one of the amendments Trump continues to pursue after the repeal bill’s withdrawal is unclear. In general, Trump can continue to expect significant controversy as he attempts to amend the ACA to broaden access to insurance and lower health care costs by scaling back federal mandates and benefits in coverage (Costa and Goldstein, 2017).
Historical / Topical context
Europe preceded America in its creation of government-sponsored health insurance, starting with Germany enacting sickness insurance in 1883. Britain soon followed by adopting national insurance in 1911, but even before this, European unions and employers would insure their workers through sickness funds to cover lost wages and payment for medical care. During the Progressive era, around the years 1915-1919, health insurance became a public issue in the United States. Health insurance was first proposed as a state-level program, with the goal of supporting workers during times of illness. But by 1935, a more expansionary, national health insurance plan was called for in hopes of financing medical care for all Americans. This time period during the New Deal was very favorable for passing a universal health program because the recent Great Depression opened pathways for nationally-scaled social legislation. Ultimately, health insurance did not make it into the New Deal, and calls for national health insurance lasted until Medicare and Medicaid, insurance programs for the elderly and the poor, were established in 1965 by Lyndon B. Johnson. Medicare and Medicaid did not, and still do not, cover the entire American population, but they do cover those in great need, the retired and elderly populations who don’t qualify for health benefits from their work and some of those who can’t afford it from their salaries. Throughout the 1960s, the costs of public and private insurance soared, and instead of a purely expansionary outlook, reformers changed their platforms to include changes in organization of the current systems and improving already existing services (Starr 2011). In the 1970s, legislation provided more federal endorsement and assistance to health maintenance organizations, but prices continued to rise due to high Medicare expenditures and economic inflation (Silverman and Epstein, 2000). Nixon, a Republican, was the first president to send a near-universal health coverage plan to Congress in 1971. The plan aimed to fill in the gaps in the insurance system by requiring employers to pay three-fourths of their workers’ premiums for health insurance and have the federal government eliminate the premiums paid by the elderly for Medicare (Starr, 2011). A significant shift toward privatization and corporation of health care occurred in the 1980s as the hospital system was centralized and private insurance plans became more popular (Silverman and Epstein 2000). Medicaid, but not Medicare, was expanded under Reagan, and his administration gained stronger authority to control the prices that Medicaid paid hospitals (Starr 2011). Throughout the 1990s and into the 2000s, health care costs continued to rise dramatically, and the numbers of uninsured Americans skyrocketed (Silverman and Epstein, 2000). Part of the Republican party’s platform in 1992 was that health care choices should be left in the hands of the people, not with the government. George H.W. Bush’s health care plan expanded access to care by requiring insurers to cover preexisting conditions and making health insurance premiums fully deductible for self-employed workers (The Republican Party, 1992). In their 2000 platform, the Republican party continued to believe that individuals should be managing their own health care needs (The Republican Party 2000). When President Obama proposed the Affordable Care Act and signed it into law in 2010, the Republican party had reason to be unhappy. Among other changes, the Affordable Care Act allowed dependents to stay on their parents’ healthcare plan until age 26, forced states to contribute to employee premiums, and required many people to be insured or face a fine. As a result of this legislation, those who can afford to buy insurance from a provider are charged higher premiums. Since the enactment of the ACA, government has been more directly involved in the health care decisions of the American people. This environment is what Trump, a Republican who prefers the government to be much less involved in health care, is responding to as he creates his plan.
How it relates to politics of health
The Trump administration health care plan relates to the politics of health through the concepts of sympathy and exclusion and biological citizenship. An attempt to cut back federal mandates and benefits specifically targets the groups of people who do not have the means to pay for private insurance and who rely on federal benefits for their care. The amendments that Trump claims will improve the country’s health care – the elimination of the individual mandate, the creation of more competition among providers, and the reduction of costs through the removal of emergency care for illegal immigrants – exclude disadvantaged groups, like immigrants and the poor, while conferring sympathy and benefits on other more mainstream American groups. Many groups’ biological citizenship will be threatened by these amendments, and it is likely that if emergency care for illegal immigrants is cut back, they will be forced to draw more on their biological identity as a sick person (Petryna, 2003). By lessening their humanity and increasing the impression that they are extremely ill and in need of care, they will play on the sympathies of government health workers in hopes of receiving proper health care.
Trump’s health care plan, which would have primary effects on access and delivery of healthcare and the way that hospitals and medical practices are run, is extremely divisive politically. Although it was not implemented, we are already seeing this outcome. Groups that are afraid of losing their health insurance under the Trump administration have fought back, as seen in the Philadelphia march against Trump and the repeal of Obamacare on January 26, 2017 (Knight, 2017). The groups involved in the protests overwhelmingly include the middle to lower classes, minorities, and immigrants. These groups have developed a renewed sense of mistrust in the American government, as they worry that patterns of the past will repeat. They have heard of countless illegal immigrants to the United States who have sought medical care, been discovered as illegal, and were deported back to their home country. Trump has made his anti-immigrant beliefs well-known with his plans to build a wall along the Mexican-American border to keep out immigrants and his executive order to keep refugees from seven middle eastern countries from entering the country for 120 days. For the present time, the Affordable Care Act will not be repealed, but it is still possible that amendments will be made that cause poor minorities who benefitted from the ACA’s provision of health care subsidies to no longer receive the same quality of care (McGirt, 2017).
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