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What Happened to Trumpcare?

Terry H. Schwadron

Oct. 15, 2019

For a moment, let’s step away from all the White House impeachment talk, underhandedness with Ukrainian leaders, and the lies about “perfect” conversations with foreign autocrats.

Instead, let’s focus on Donald Trump’s fascination with claiming on the one hand to be delivering better health care to Americans while actually undercutting any reliability in getting health bills paid.

Though not subject of any impeachment high crimes and misdemeanors, it is bad policy-making that is among the real crimes of the Trump administration — and only worsened by the hypocrisy of claiming that things are better rather than worse. You’d think that Team Trump would actually take credit for undercutting various social services if that’s what they set out to do, but it seems even crueler to claim the opposite.

We see it in many areas: Trump has eviscerated water and air cleanliness rules, as part of his attacks on environmental regulations, only to insist that he has improved them (Tell it to Flint, MI!); Trump has evicted Science advisers in favor of industry representatives, only for him to turn around and say the opposite; his administration has opposed moves to ease tuition loans, make procedures easier on campus assaulters, made public housing less effective — all while claiming the opposite on each matter.

So, the question turns to health care access, the singular issue that has outlasted all other financial and social issues for both political parties to emerge as the most important of election issues.

As Axios summed up in a recent report, “President Trump may be telling voters everything that they want to hear when it comes to health care, but much of it isn’t true.”

There it is — pretty stark.

“Trump is claiming victories he hasn’t achieved and making promises he’s not prepared to live up to, all on an immensely personal subject that that voters consistently rank as one of the most important issues of 2020,” Axios, which has no particular ax to grind, concluded.

After a series of attacks on specific financial supports for the Affordable Care Act, Trump ordered the Justice Department to join a court case in Texas that seeks, again, to throw out the entirety of Obamacare. The legal reasoning is not about health, of course, it concerns the legality of basing the health care law on a provision that had been ruled a “tax” by the Supreme Court that the Trump administration subsequently set at zero. The legal case says if there is no tax, there is no validity to the law itself.

As those efforts have worked their administrative pathways, an additional 20 million Americans have lost access to health insurance. So, that is where we should start.

Of course, there is no Trump plan for health care, and his attempts to educe one from congressional Republicans all start and end with much-reduced benefits or the same higher-priced premiums that have dogged U.S. health care policy-making for decades.

Were there to be an actual Trumpcare, it would pit the promise that “we will always protect patients with pre-existing conditions” against the reality of any Trump partial proposals that have emerged that vow bare-bones catastrophic health insurance with absolutely no protections for pre-existing conditions. If the court case is successful in striking down Obamacare, that action will eliminate its protections for pre-existing conditions.

Indeed, the other big emphasis in Trumpcare is moving all costs and difficult questions to the states, so that, as with abortion and women’s health clinics, we would have a checkered health provisions map across the country. Some states would insist on stronger protections, some states would ignore calls for coverage.

The other biggest public complaint reflects high prices for prescription drugs. Trump has made several changes through the agency administering Medicare and Medicaid, but the effects are at the edges and relatively minor. They have focused on outlying costs for specific prescriptive practices, but not addressed the great bulk of drug pricing.

Still, Trump claims that he has lowered drug prices for the first time in 51 years. Axios rated that statement “murky at best,” including the timeframe. Prices for generics continue to fall, bringing down the average cost of drugs overall, but that average masks steady increases in the price of drugs that treat rarer diseases. Brand-name drug prices increased by only 0.3% in 2018, although per-capita spending on specialty drugs increased by 5.8%.

Clearly, the Trump virulent campaign about abortion and women’s clinics are at odds with calls to expand health services — even if the administration is successful at making more of abortion illegal.

Democrats, of course, increasingly are promoting some version of Medicare for All ideas as a basis for government-paid health care, an approach that Trump attacks as socialist and wrong. But there has been no substantial alternative from Republicans.

In its place, the Centers for Medicare/Medicaid Services are issuing periodic small-scale rules that deal much more with price issues than with access to health care.

Despite impeachment efforts, Speaker Nancy Pelosi has insisted for her part that there are possibilities out there for a deal on capping prescription drug prices in a bipartisan agreement. Frankly, I doubt it.

In the meantime, it would be helpful if Trump stopped giving himself credit for improving Americans’ health when he is doing the oppoisite.


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