Understand how we got here — and how to move forward.


September 25, 2020

What you need to know about Trump's 'America First Healthcare Plan'

Daily Briefing

    President Trump on Thursday announced his "America First Healthcare Plan" and signed executive orders stating that his administration will protect Americans with pre-existing medical conditions and eliminate so-called "surprise" medical bills.

    Register for our new weekly webinar series, 'Up to Date'

    Trump unveiled his health care plan during a speech in North Carolina. According to Reuters, the plan comes as Trump seeks to boost public opinion of his health care stances ahead of the upcoming presidential election. National polls have shown that Trump consistently lags behind former Vice President Joe Biden, who is the Democratic Party's presidential nominee, when it comes to public opinion on which candidate would better handle health care issues, Reuters reports.

    Details on the executive orders

    The first executive order states that the Trump administration is committed "to always protecting individuals with pre-existing conditions." During a conference call with reporters, HHS Secretary Alex Azar said the executive order will ensure that Americans with pre-existing conditions will have access to health coverage "regardless of whether the Affordable Care Act [ACA] is and its protections for pre-existing conditions invalidated." The order did not, however, implement any specific measures that would protect patients with pre-existing conditions if the ACA is overturned.

    The executive order comes as the Supreme Court on Nov. 10 is set to hear oral arguments in a case seeking to strike down the entire ACA as unconstitutional. The Trump administration has supported the lawsuit and urged the Supreme Court to invalidate the ACA, which established the United States' current insurance protections for individuals with pre-existing conditions. If the Court strikes down the entire ACA (a possibility that has become more likely with Supreme Court Justice Ruth Bader Ginsburg's death), those protections also would be eliminated.

    The second executive order that Trump signed on Tuesday is aimed at protecting Americans from receiving surprise medical bills. Azar explained that the order directs HHS to work alongside Congress to pass legislation to protect patients from such bills. The order states that, if such legislation is not passed by Jan. 1, 2021, HHS must investigate potential executive and regulatory actions that can be implemented without congressional approval to ensure patients are protected from the bills.

    "He's telling [Congress] get your act together, get something passed or we'll be coming at it and you'll get what you get from us," Azar said.

    Experts and others say the executive orders don't carry legal weight

    Some legal experts were quick to point out that the executive orders are mostly a symbolic gesture.

    Nicholas Bagley, a law professor at the University of Michigan, in a series of tweets explained, "Traditionally, executive orders are instructions to agency officials about how to exercise their congressionally delegated powers. … Those executive orders … don't have legal effect."

    Separately, Bagley elaborated, "Unless there's a law that prohibits the conduct in question, or unless the president is exercising a power that's been delegated to him by Congress, his statements have no more legal weight than a tweet."

    House Speaker Nancy Pelosi (D-Calif.) called the orders "bogus" and added, "If President Trump cared at all about people with pre-existing conditions, he would drop his lawsuit to overturn the [ACA] in the middle of a pandemic."

    Trump announces Medicare drug discount cards

    Also as part of his new health care plan, Trump on Thursday announced that his administration plans to send 33 million Medicare beneficiaries $200 discount cards that would help the beneficiaries pay their Medicare copayments for prescription drugs.

    "Nobody's seen this before, these cards are incredible, the cards will be mailed out in coming weeks," Trump said.

    A White House spokesperson said the federal government will launch the initiative under a Medicare demonstration program, so it does not need congressional approval. The spokesperson said the administration will get the $6.6 billion needed to fund the drug discount cards from savings generated under Trump's "most favored nations" drug pricing proposal. The proposal aims to lower the costs of prescription drugs in the United States by tying Medicare payments for certain drugs to the lowest prices offered in other developed nations.

    However, observers noted that the Trump administration hasn't yet implemented the so-called "favored nations" proposal, so it hasn't yet generated any savings. A White House official who spoke to the Washington Post on the condition of anonymity said the drug discount cards are a "last-minute thing that" originated from the office of White House Chief of Staff Mark Meadows and "is still being worked out."

    Some observers and industry stakeholders criticized the effort, saying it is politically motivated and will not help to fix the broader issue of costly U.S. drug prices, STAT News reports.

    For instance, Public Citizen dismissed the move as an "attempt to bribe [seniors] for their votes." Robert Weissman, president of Public Citizen, in a statement said, "The solution to outlandishly high pharmaceutical prices is not to give people money to offset extortionate drug prices; the solution is to end price gouging altogether."

    A spokesperson for the Pharmaceutical Researchers and Manufacturers of America in a statement said that "one-time savings cards will neither provide lasting help, nor advance the fundamental reforms necessary to help seniors better afford their medicines" (Alper et. al., Reuters, 9/24; Owens, "Vitals," Axios, 9/25; Luthi/Roubein, Politico, 9/24; Lovelace/Breuninger, CNBC, 9/24; Sullivan, The Hill, 9/24; Facher/Florko, STAT News, 9/24; Roubein/Luthi, Politico, 9/24; Goldstein et. al., Washington Post, 9/24).

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.