By Brian Blase
President Trump will face off with former Vice President Joe Biden in the first presidential debate this week, where health care is bound to come up. While Democrats often attack Trump for a lack of a health-care plan, the truth is, his administration has significantly increased Americans’ choice of health coverage and improved access to care. In fact, Trump should be proud to campaign on his health-care record.
When Trump took office, Obamacare was wreaking havoc with the individual health-insurance market — premiums and deductibles were escalating, and choices of coverage were dwindling. The Trump administration took steps to shore up these markets and premiums have held flat since 2018, with more insurers now offering plans.
At the same time, his administration also increased options for families and small businesses. A 2018 Trump rule expanded renewable and flexible plans not subject to Obamacare’s laundry list of expensive requirements. This rule expanded consumer protections for these more affordable plans by allowing people to keep them for up to three years instead of just three months.
Another 2018 rule expanded Association Health Plans, permitting employers to band together and offer their workers more affordable coverage. This showed initial promise. Unfortunately, a dozen Democratic attorneys general have sued to take away this option and a sympathetic judge has so far blocked the rule. The Trump administration has appealed. The White House Council of Economic Advisers finds that Americans receive a yearly net benefit of $45 billion from these expanded coverage options, along with the elimination of Obamacare’s regressive individual mandate penalty that mainly hit families earning less than $50,000 per year.
Of all the administration’s actions, the most groundbreaking rule allows employers to provide contributions using pre-tax dollars so workers can select a plan in the individual health-insurance market that’s best for them. These “health reimbursement arrangements” (HRAs) hold the potential to revolutionize employer-sponsored health insurance and dramatically expand worker choice and control, as most employers now only offer their workers a single option for coverage.
The HRA rule demonstrates how Trump’s policies are an improvement over Obamacare for the individual market. Obamacare priced everyone but the lowest income, who qualify for giant subsidies, out of the individual health-insurance market. In fact, $50 billion a year in premium subsidies has only boosted individual market enrollment by about 2 million people — a staggering $25,000 per newly insured. Trump’s HRA rule will lead to four times as many people purchasing coverage in the individual market with no new federal spending.
While increasing Americans’ coverage options and shoring up the individual market was mission number one, the Trump administration did much more to improve our health-care system. Because of its rules requiring hospitals and insurers to provide price information, Americans will finally have access to real prices before they access health-care services. Employers will be able to use these prices to negotiate better deals for their workers.
The administration has reformed Medicare so that seniors can more easily receive care in the comfort of their own home over the phone or through video. Through the coronavirus public-health emergency, doctors can now be paid for providing virtual care, which can be safer and faster.
Another Trump policy helps the chronically ill save tax-free for their health care. For example, diabetics can make deposits to their health savings accounts for the first time even if they have a plan that covers insulin before meeting their deductible. The president has also taken action to increase kidney donations and dialysis provided in patients’ homes rather than predominantly in hospitals and clinics.
And on pharmaceuticals, the president should tout tangible successes. Overall, drug price inflation was just 1.5 percent from 2017 to 2019, in part from a surge of competition introduced after a historic number of generic drugs were approved by the Food and Drug Administration. And the president signed the Right to Try Act, permitting very sick patients to access experimental, but potentially life-saving, treatments.
While the president certainly needs to articulate his vision for future health reform, he has a good health-care record that he can run on now — and he should use the forthcoming debates to make this case.