Analysis Based on factual reporting, although it incorporates the expertise of the author/producer and may offer interpretations and conclusions.
Why Trump’s Health Care Move Is an Empty Promise
The battle over the replacement of Justice Ruth Bader Ginsburg has refocused American attention on the future of the Affordable Care Act. The Supreme Court is that brought insurance coverage to .
Meanwhile, Trump recently released his “.” In it, the president claims significant achievements. He also outlines broad principles of his vision for the future of health care in America.
Over the past three years, the Trump administration has taken a number of steps to dismantle pieces of the ACA. And his recently introduced executive order and the .
The two factors leave me—a who —skeptical about the emergence of a to the ACA that would expand insurance access should the Supreme Court invalidate the Obama administration’s signature achievement.
Trump’s Moves on Health Care
President Trump campaigned and entered office with the pledge to “” the ACA. In his own words, there would be a “” right after the election.
Since 2016, Congress has made little headway besides eliminating the ACA’s penalty for not carrying insurance. This is the basis for the to be heard before the Supreme Court in November. The argument is that because Congress did away with the penalty, the individual mandate can no longer be constitutionally justified as a tax. As a result, the entire law should fall.
While Republicans have been unable to repeal the law, the Trump administration has taken a number of . In combination, these efforts have contributed to bringing the uninsured rate to . This leaves millions of Americans without coverage and exposed to medical bills should they fall ill.
A major target of the Trump administration has been reducing enrollment through the . Here, the administration and drastically reduced funding for individuals who help consumers enroll in coverage as well as advertising. It also to support low-income individuals with out-of-pocket costs, which also caused problems to insurers offering plans to those people.
The administration has also worked to expand alternative insurance plans such as so-called , and . While these plans have lower premiums, they do not carry the consumer protections of the ACA such as preexisting condition coverage. They also do not pay for prescription drugs or hospital stays. And unlike the ACA, they also require consumers to undergo a medical assessment before enrollment. Consumers may be charged higher premiums or rejected entirely based on their medical condition and age.
Regulations issued by the Trump administration have reduced access to reproductive care for women. The administration has also pushed states to implement and in Medicaid for fear of being denied permanent residency. As a result, .
Even on one of the president’s favorite topics, reducing the cost of prescription drugs, numerous initiatives regarding for Medicare beneficiaries .
On one of the president’s other priorities, eliminating for medical services that patients unexpectedly receive for care that they reasonably thought would be covered by their insurance, the administration’s actions have yet to have a meaningful effect.
An Executive Order Can’t Replace a Law
When it comes to Trump’s executive order, the topic that received the most public attention—the guarantee that “Americans with preexisting conditions can obtain the insurance of their choice at affordable rates”—carries no legal weight nor clear explanation of how it would be achieved or funded.
Ƶ generally, , the focuses primarily on past actions. It also spends just 491 words on laying out a set of objectives—lower costs, better care and more choice—yet does not provide a mechanism or road map for how to implement them.
All this leads me to believe that if the ACA is overturned before the Supreme Court, the prospect of substantive replacement that seeks to expand care to more Americans is unlikely.
This article originally appeared in . It has been edited for YES! Magazine.
Simon F. Haeder
is Assistant Professor of Public Policy at Pennsylvania State University. His most recent work has focused on such issues as the implementation of the Affordable Care Act, provider networks, and regulatory policymaking at the Office of Management and Budget.
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