‘Absolutely no detail’: experts alarmed as Trump unveils healthcare plan

Donald Trump has finally unveiled his long-awaited framework for healthcare affordability, almost a year and a half after announcing during a pre-election presidential debate that he had the “concepts of a plan” for healthcare reform.

The short document, titled the Great Healthcare Plan, provides four headline objectives, but few specific details as to how they will be achieved.

The Trump administration says it intends to lower prescription prices and healthcare premiums; hold big insurance companies accountable by requiring them to publish their claim costs, overheads and profits; and push insurers and medical providers to provide greater transparency over pricing.

“Instead of putting the needs of big corporations and special interests first, our plan finally puts you first and puts more money in your pocket,” Trump said in a video released by the White House to accompany the plan’s publication.

“I’m calling on Congress to pass this framework into law without delay. Have to do it right now so that we can get immediate relief to the American people.”

The policy framework had been expected to be released in November, but was delayed by wrangling over certain elements of it, according to Politico.

The issue of rising healthcare premiums has become a millstone for Republicans in recent weeks after the failure to reach agreement on the extension of Affordable Care Act (ACA) subsidies saw sharp increases for at least 22 million Americans. Last week, 17 members of the Republican House majority broke with the White House to advance legislation restoring credits established during the Biden administration that expired at the end of last year.

Trump has hinted he might veto the bill, which extends the premiums for three years, if it passes the Senate.

The framework makes no mention of any further attempt by the administration to weaken or scrap the ACA, also known as Obamacare, which Trump has frequently railed against during his two terms of office.

But it contains policy elements that lawmakers in Congress might oppose, including a call for billions of dollars in taxpayer subsidies to be sent to Americans’ personal health savings accounts, instead of directly to insurance companies, to allow them to buy health insurance of their choice; and requiring pharmaceutical companies to match or better “the same low prices for prescription drugs that people in other countries pay”.

Both elements of the Trump plan would require the approval of Congress before they could go into effect, an outcome far from guaranteed despite Republicans holding a majority in both chambers.

“The plan clearly opposes extension of the expiring ACA marketplace subsidies, without which roughly 4 million people will end up uninsured and many millions more will see their marketplace premiums double or increase by even more. Instead, the plan criticizes the enhanced subsidies and talks about sending money to individuals directly to purchase coverage on their own,” said Edwin Park, a research professor at the McCourt School of Public Policy at Georgetown University.

Park said the plan also “appropriates the ‘cost-sharing reductions’ under the Affordable Care Act”, which would “have the effect of reducing premium tax credit amounts for those eligible for subsidies (while lowering unsubsidized premiums). The result would actually be more uninsured as low-income people see smaller subsidies and higher premiums they cannot afford.”

Park added: “The ‘plan’ includes absolutely no detail even though the president and the administration have been promising a credible health plan within two weeks for many, many years. Instead, as in the past, this plan is more about increasing the number of uninsured, on top of the 10 million who will already lose coverage under HR1, the budget reconciliation law from last summer.”

That sentiment was echoed by Cynthia Cox, senior vice-president at KFF, a health policy non-profit, who oversees research into the ACA and health costs.

“When it comes to health reform, the devil is in the details, and this lacks detail. Some provisions look very similar to ones that are already in the Affordable Care Act: for example, price transparency, public data on claims denials and insurer overhead, and ‘plain-English’ insurance coverage summaries,” she told the Guardian.

“Other provisions, in particular the idea of sending money directly to the people, sound like radical departures from the Affordable Care Act. It’s not clear from the summary exactly what is meant by that, but it has the potential to severely impact the stability of the ACA marketplaces.

“This provision has the potential to lead to a ‘death spiral’, leaving many people with pre-existing conditions who don’t get coverage through their jobs without an option for comprehensive coverage.”

Asked about her thoughts on Trump’s plan, Miranda Yaver, an assistant professor at the University of Pittsburgh who teaches courses on health policy and health politics, said in a statement that “it isn’t clear that the plans the Trump administration wants to help people to purchase would be ACA-compliant, which would mean that while healthy patients may enjoy cost savings, there won’t be remotely sufficient protection for the millions of Americans with pre-existing medical conditions.

“The result would be inequity (and likely worse health outcomes) and further sabotage of the progress of the ACA.”

Beyond Trump’s plan, in a sign of growing frustration with the White House over healthcare, and fears that a public backlash over soaring premiums could hurt them in November’s midterm elections, several Republicans signed a discharge petition overriding Speaker Mike Johnson’s refusal to bring the ACA bill for a vote.

One, the New York congressman Mike Lawler, said he hoped sending the bill to the Senate would allow the chamber “to put forth a reform package that can pass Congress and become law”.

Republicans’ resistance to the extension of subsidies became the main reason for the Democratic party’s holdout during the record-breaking 42-day government shutdown last year, which ended when a splinter group of Democratic senators accepted an assurance from the Senate majority leader, John Thune, that he would hold a vote on the issue by December.

It is not clear if the Trump plan for changes to ACA funding, particularly allowing payments directly to individuals not insurance companies, would mean other current parts of the law would survive, including guaranteed coverage for pre-existing conditions, and allowing younger adults to remain on their parents plan until they are 26.