Trump Turns to Congress If Pre-Existing Conditions Overturned
Trump Preps Health Orders as Opponents Demand Obamacare Plan
(Bloomberg) -- President Donald Trump plans to announce in North Carolina on Thursday that he’ll sign an executive order intended to pressure Republican lawmakers who have long been unable to forge an Obamacare alternative to come up with a plan to protect people with pre-existing conditions.
Trump has often promised he would produce a replacement for the Affordable Care Act, which guarantees insurers can’t deny coverage to sick people or charge them more. Just last week, the president said his plan is “ready.” But the order he plans to sign essentially abandons the issue to Congress, suggesting he won’t offer his own plan before the election.
A second order to be signed Thursday will direct U.S. Health and Human Services Secretary Alex Azar to work with Congress in addressing “surprise” hospital billings, Azar said in a briefing. The orders come as Trump faces Democratic criticism he’s failed to offer a replacement for the Affordable Care Act now facing a U.S. Supreme Court challenge.
While Azar said the president’s order would make it U.S. “policy” that people with pre-existing conditions can’t be denied insurance or made to pay more, he didn’t address what the administration could do about this without a law being passed.
The Thursday speech and accompanying orders are expected to lay out Trump’s broader vision for U.S. health care in a second term, two White House officials said. He will emphasize improving consumer choice, affordability, and quality of care for vulnerable groups. And the president will portray previous actions he’s taken to reduce drug costs, expand tele-medicine, and assist vulnerable groups like people with kidney disease as indicative of his approach toward a more ambitious health care overhaul in a second term.
What’s not expected: The president’s long-promised comprehensive replacement plan for Obamacare, which his administration is trying to persuade the Supreme Court to strike down. And experts say that Trump’s order on pre-existing conditions won’t provide meaningful protections to sick people who seek health insurance.
“An executive order by itself can’t accomplish anything,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, a health research group. “It has to be followed by regulations, and there’s nothing in an executive order that can give the executive branch authority it doesn’t have.”
Democratic Pressure
Trump and vulnerable Republican senators have been under increasing pressure from Democrats to explain how they would preserve popular elements of the Affordable Care Act, including its legal protections for people with pre-existing conditions. That scrutiny has intensified since the death of Justice Ruth Bader Ginsburg last Friday.
The president has promised to replace the liberal icon, who twice voted to uphold core parts of his predecessor’s landmark health law, with a conservative justice.
Democrats – including presidential nominee Joe Biden – have warned that a more conservative court could strike down Obamacare, jeopardizing insurance coverage for millions of people. Senate Democratic leader Chuck Schumer has mocked Trump in recent weeks, saying in a tweet that the president “keeps promising his magic healthcare plan is right around the corner.”
An NBC News/Wall Street Journal poll released Sunday found that by 20 points -- 51%-31% -- voters say Biden would better handle health care.
Trump said Sept. 15 in a town hall event hosted by ABC News that his Obamacare replacement is “all ready,” but there’s been no sign of it. Instead, the administration has been preparing a flurry of executive actions.
In addition to the orders Trump will announce Thursday, the president said Wednesday he’d sign an order purporting to protect babies born prematurely, or who survive abortions, and increasing federal funding for neonatal research. The White House has also been working on an initiative to address mental health, Politico reported Tuesday.
Overblown Concerns
White House officials say some of the fears voiced by Democrats are overblown. The Supreme Court isn’t likely to immediately invalidate the Affordable Care Act or void existing contracts and subsidies, leaving millions of Americans uninsured or facing higher costs overnight, they say.
And Trump has said he would use a wind-down period as leverage to negotiate a better, less expensive restructuring of the health care system, though he has not described in any detail how he would improve on Obamacare or reduce the costs of its insurance policies.
Though he was elected on a promise to repeal and replace Obamacare, he failed in the effort in the first two of years of his presidency, when Republicans controlled both the House and Senate. Allied lawmakers largely blamed the White House for refusing to support viable alternatives and the requisite trade-offs they would require.
A broad judgment by the courts overturning much or all of the Affordable Care Act could jeopardize a slew of measures including subsidies for private insurance plans and expansions of Medicaid, the health program for low-income people, that benefit millions of people.
The White House believes that enduring problems with the nation’s health care system – coupled with the president’s first-term efforts to curb prescription drug prices, assist those with severe kidney disease, and approve cheaper health care plans -- allow him to argue he’s fighting to lower health-care costs.
But in 2018, Republicans were shown to be vulnerable to arguments that they would once again allow insurers to deny coverage to people with pre-existing conditions when Democrats used the issue to help win control of the House.
Experts warn that it would be difficult to replace Obamacare’s protections for sick people buying insurance coverage by executive order. That’s because the executive branch’s authority to enforce those protections comes from the ACA.
Beyond guaranteeing coverage for people with pre-existing conditions, the ACA put in place other policies needed for stable insurance markets, said JoAnn Volk, research professor at the Georgetown University Center on Health Insurance Reforms.
Feeling Heat
“There is a whole suite of protections that ensure that people with pre-existing conditions can buy coverage, that the coverage they buy is adequate, that they aren’t charged more, and by the way, there’s subsidies,” she said.
Even if the administration could order insurance protections for people with a history of health conditions, it wouldn’t be sufficient to ensure stable insurance markets, she said. Before the ACA, states that tried to guarantee coverage without offering subsidies saw premiums increase and private insurers leave their markets.
The administration may have more latitude to address surprise billing, a concern for many Americans that Congress has failed to resolve. For example, Levitt said, Trump could attach strings to pandemic relief money the government has provided hospitals, prohibiting them from billing patients for disputed charges -- though such a policy might face legal challenges.
Trump’s efforts are a “sign that the president is feeling some political heat” on the issue, Levitt added.
The president has a history of health-related executive orders that failed to gain traction. An October 2017 order aimed at improving options in health insurance markets expanded the use of so-called association health plans, short-term insurance plans and health reimbursement arrangements.
Neither association health plans, in which groups of small businesses to band together to provide coverage employees, nor short-term plans are required to cover people with pre-existing conditions. Participation in the plans led to a decrease in enrollment in more robust coverage sold through Obamacare markets.
The expansions of both types of plans were quickly challenged in courts. Association health plans were struck down by a U.S. district court in March 2019 and an appeal by the administration is pending. Short-term plans were upheld by a U.S. circuit court in July; an appeal is also pending.
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