Trump’s 5 Health Care Principles, Explained

Melissa Quinn / March 01, 2017

President Donald Trump didn’t shy away from asking Congress to unwind Obamacare during Tuesday night’s joint address, and he presented lawmakers with a list of five policies to consider as Republicans craft their replacement for the health care law.

During his speech, Trump called on lawmakers to repeal and replace Obamacare, and reform the health care system to “expand choice, increase access, lower costs, and at the same time, provide better health care.”

“Mandating every American to buy government-approved health insurance was never the right solution for our country,” Trump said. “The way to make health insurance available to everyone is to lower the cost of health insurance, and that’s what we are going to do.”

The president offered few specifics on what reforms he would like to see Congress pursue as they work toward a replacement for Obamacare.

But Trump did outline five policies he supports in a proposal that will dismantle the health care law.

Many of the policies are in line with those backed by House Speaker Paul Ryan and Health and Human Services Secretary Tom Price. But some have been met with resistance from the House and Senate’s most conservative members.

The GOP conference hasn’t yet united around a plan to repeal and replace the law, and Trump’s comments seemed to tip the scales in favor of leadership’s suggested reforms.

But, conservatives have said they’ll oppose any legislation that doesn’t fully repeal Obamacare, and their hard line sent Republican leaders back to the drawing board.

Here are the policies Trump said he would like to see in an Obamacare replacement plan, and where they stand in the context of the current debate.

1. “We should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health care exchanges.”

Obamacare’s pre-existing conditions provision has become one of the health care law’s more popular measures. Under the Affordable Care Act, insurance companies were prohibited from discriminating against consumers with pre-existing conditions.

Trump, Price, and congressional Republicans have repeatedly said they want to make sure Americans with pre-existing conditions have access to health insurance.

Most replacement plans include a provision barring insurers from discriminating against customers with pre-existing conditions if the person maintained coverage continuously, and a draft proposal—viewed as the leading plan—leaked to the press last week penalized individuals who let their coverage lapse by raising their premiums 30 percent for a year.

2. “We should help Americans purchase their own coverage through the use of tax credits and expanded health savings accounts—but it must be the plan they want, not the plan forced on them by our government.”

Republicans across the board agree on expanding health savings accounts, or medical savings accounts.

In fact, GOP leaders want to see the expansion of health savings accounts included in the bill that will repeal Obamacare.

But where Republican leadership and conservative lawmakers are at odds is in the financial assistance available to customers buying individual market coverage.

Tax credits were a staple of Obamacare replacement plans rolled out by Price and Ryan, and the leaked repeal document created refundable tax credits based on age—ranging from $2,000 for consumers under 30 to $4,000 for consumers over 60.

But conservatives object to the idea of refundable tax credits and say they’re a form of “Obamacare lite.”

They’re not ruling out all forms of financial assistance for consumers, though. Last month, the House Freedom Caucus, a group of approximately 40 conservatives, backed an Obamacare replacement plan from Sen. Rand Paul, R-Ky., and Rep. Mark Sanford, R-S.C., that created a $5,000 tax credit for those who contribute to their HSAs.

By referencing tax credits explicitly, Trump seemed to side with Ryan and Republican leadership.

However, conservatives after the speech suggested that Trump didn’t explicitly endorse “refundable tax credits,” which leadership’s plan calls for, and which they object to.

3. “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.”

Trump hasn’t offered specifics on which changes to Medicaid he would prefer. However, he seemed swayed by Ohio Gov. John Kasich, a Republican, after a meeting at the White House on Friday—Trump suggested Kasich meet further with Price and chief of staff Reince Priebus to discuss Obamacare’s future more.

Kasich is opposed to repealing the Medicaid expansion, but favors making changes to the Affordable Care Act.

Governors who decided to expand the program, as well as Republican senators representing those states, have opposed a rollback of the Medicaid expansion, which expanded eligibility.

Still, Republican governors are working with congressional leaders to discuss potential changes and come up with a plan for the future of the Medicaid program.

Trump’s call for giving governors “resources and flexibility” with Medicaid seems to go along with Republican plans to block grant the program.

Some Obamacare replacement plans call for Medicaid to be turned into a block grant, or a lump sum of money allocated to the states. Others, though, favor a per-capita allotment.

Like the tax credits, the future of the Medicaid expansion is a point of contention for conservative lawmakers.

House and Senate conservatives are urging Republican leaders to bring a bill from 2015 rolling back key provisions of Obamacare, including Medicaid expansion, before members vote again.

Any proposal that falls short of that legislation won’t earn their support, and Medicaid expansion, specifically, is a sticking point for the conservatives.

4. “We should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance, and work to bring down the artificially high price of drugs, and bring them down immediately.”

Trump’s fourth policy calls for medical malpractice reform.

The issue hasn’t been prominent in debates over Obamacare’s future, though, Price and Ryan did say in the past they wanted to make tort reform part of their replacement plan.

On drug pricing, though, Trump has criticized the “artificially high price of drugs” before. During the campaign, the president said he was in favor of letting Medicare negotiate prescription drug prices.

Last month, White House press secretary Sean Spicer confirmed Trump hadn’t changed his stance. But the high cost of prescription drugs has largely been left out of discussions surrounding Obamacare’s replacement.

5. “The time has come to give Americans the freedom to purchase health insurance across state lines—which will create a truly competitive national marketplace that will bring costs way down and provide far better care.”

The ability to purchase health insurance across state lines has been the one health care reform Trump has consistently advocated.

And on this policy, in particular, Republicans are in agreement.

Some Obamacare replacement plans floated by GOP lawmakers over the years would allow consumers to buy coverage across state lines, including Ryan’s “Better Way” plan, Price’s proposal, and the Paul-Sanford replacement bill.

Trump and his fellow Republicans believe allowing insurers to sell across state lines will increase consumers’ access to coverage.

This proposal is beneficial for insurers based in states with strict regulations that can drive up the cost of plans, since they would be able to sell coverage in others with less stringent mandates.

However, it’s not the only thing that needs to be done to lower costs and boost competition, according to Sabrina Corlette, a research professor at Georgetown University.