After the bombast of this primary cycle, the release of a policy plan by Donald Trump seems at once both mundane and remarkable. His rivals have hit at the frontrunner for lacking substance and detail in his campaign, and of late Ted Cruz and Marco Rubio have hammered Trump on his past support of single-payer systems and praise for parts of ObamaCare. The Trump campaign released its health-care reform plan last night, titled — natch — “Healthcare Reform to Make America Great Again.”
Here are the seven steps Trump and his team envision to reach that goal:
- Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
- Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
- Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
- Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
- Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
- Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
- Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
For conservatives, this is a mixed bag, but mostly positive. Trump commits in substance to a repeal of ObamaCare and the exit of the federal government from management of the health-care markets. It returns oversight over plan coverage to the states, where it was before ObamaCare got imposed, and would allow for greater competition through interstate sales. It also returns HSAs to the center of policy regarding insurance management for individuals and price transparency as a way to blunt utilization, hinting — not explicitly stated, though — that an emphasis will fall on tailored coverage rather than demanding expensive comprehensive coverage for those who don’t need it and won’t ever use it. Block-granting Medicaid will be especially popular with budget hawks, even if the “waste, fraud, and abuse” slogan will have some of those rolling their eyes. The problems in entitlement spending are structural, not just behavioral.
That’s not to say this will please all conservatives entirely. The drug-importation issues will likely set up some red flags on the Right, as The Hill notes:
The area of prescription drugs is where Trump breaks from most Republicans. His plan calls for allowing drugs to be imported from overseas to increase competition and drive down prices, an idea strongly opposed by pharmaceutical companies and favored by Hillary Clinton. Sen. John McCain (R-Ariz.) is also a rare Republican who supports the idea.
Trump has also previously called for allowing Medicare to negotiate drug prices, another common Democratic idea opposed by the industry.
Finally, Trump pointed to the need for mental health reform, without providing details. “There are promising reforms being developed in Congress that should receive bi-partisan support,” his plan states.
It is unclear what exactly he is referring to, though both the House and Senate are working on mental health reform bills.
How “unclear” is that? The Hill seems to have figured it out. It’s worth noting that while Trump has called in the past to have Medicare negotiate drug prices (a bad idea, as discussed before here), this plan does not include that demand. The drug-importation plank of the plan is designed to appeal to populists who see pharmaceuticals as part of a medical establishment that may be taking advantage of them. If it comes to trading an end to ObamaCare and the embrace of free-market reforms otherwise for drug importation, though, conservatives will take that deal.
All in all, it’s not a bad plan. The timing of its release suggests that the Trump campaign has seen the increased momentum from Cruz and Rubio as a signal that they may not be winning the insult war any longer, and that some of the “con man” and other arguments painting Trump as either a dilettante or crypto-Clintonista may be sticking. A fresh dose of substance might undercut those messages, as well as clearing up the ambiguity on health-care policy that Trump has created for months.