Trump’s healthcare plans trouble GOP

Donald Trump’s inconsistencies on health policy are baffling experts and deepening the doubts that conservatives have about his candidacy.

The presumptive Republican presidential nominee has put forward a healthcare plan on his campaign website that leaves out many of the bolder promises he has made during debates and speeches.

{mosads}Trump has repeatedly promised to “take care of everybody,” but his health plan includes no major expansion of coverage; one analysis asserted the proposal would actually end coverage for 21 million people. 

Similarly, he has vowed to keep protections for people with pre-existing conditions, but his plan includes no such provision.

The celebrity businessman strayed from GOP orthodoxy in January by endorsing the idea of Medicare negotiating drug prices, something that Democrats have pushed for years. But he then included a different drug pricing idea in his plan that allows for the importation of drugs from abroad. 

Then, on Feb. 18, Trump said, “I like the mandate,” referring to ObamaCare’s requirement that everyone have coverage. A day later, he clarified that he wants to repeal the mandate along with the rest of the healthcare reform law.

Republican healthcare experts say the contradictions in Trump’s array of statements and positions about the issue have made it nearly impossible to discern what he really wants to do.

“I’d say it’s still pretty uncertain,” said Doug Holtz-Eakin, a longtime Republican health policy adviser. “What he has said in the debates isn’t what’s on his website, which makes you wonder which version you should pay attention to.”

One of Trump’s most prominent refrains on healthcare is that he “will not let people die on the streets,” adding, “We gotta take care of people that can’t take care of themselves.”

James Capretta, a healthcare expert at the conservative American Enterprise Institute, said Trump has not backed up those slogans with policy. 

“I think it’s wrong for Trump to suggest that somehow he’s got some idea to try to take care of people on healthcare in a way that other Republicans have been negligent on,” Capretta said. “Beyond asserting that he wants to do this, the explicit plan to try to do something about it has been really inadequate to the task.”

In a departure from Trump’s rhetoric, the healthcare plan on his website does not include any major expansion of coverage. The main ideas it contains that could make a difference on coverage are allowing insurance to be sold across state lines and making health insurance premiums tax-deductible. 

But the Committee for a Responsible Federal Budget, using a previous analysis from the nonpartisan Congressional Budget Office, found that these two ideas together would provide coverage for just 1.1 million people. By repealing ObamaCare, the analysis found, 22 million people would lose coverage.

The end result of Trump’s plan, therefore, would be that about 21 million people would lose coverage, the analysis found. 

Trump has also said that he wants to keep protections so that people with pre-existing conditions cannot be denied health insurance. 

“I want to keep pre-existing conditions,” he said in a debate on Feb. 25. 

But by repealing ObamaCare, the real estate mogul’s plan would remove those protections, and he has not put forward an alternative idea. 

“He’s offered nothing yet that would guarantee anybody who’s got a pre-existing condition that they would be given [coverage],” Capretta said. 

Sometimes, Trump has tacked back and forth in his views on healthcare within days. 

He said on CNN in February that he wants to “take care of” poor people “through maybe concepts of Medicare,” indicating a government-run health insurance system. Then, the next day, he tweeted that his proposal would use “private plans,” which would not be like Medicare. 

Despite the inconsistencies, liberals say they are convinced that Trump’s ideas for the healthcare system would be damaging, mainly because he is adamant about repealing ObamaCare. 

Ron Pollack, executive director of Families USA, the liberal healthcare advocacy group, noted that Trump has not proposed any solutions for people with pre-existing conditions and said a tax deduction, as Trump has proposed, would offer far less help to low-income people than ObamaCare’s tax credits. 

“If you take all the things combined, what it clearly shows is working families, those with modest incomes, would be the ones who are most hurt,” Pollack said. 

He did add that on drug pricing, where Trump has offered proposals usually associated with Democrats, “some of that stuff could be fairly interesting, and depending on the details, could even be helpful.”

Republican experts, meanwhile, are hoping that Trump will propose more ideas to address the underlying costs in the healthcare system. 

Holtz-Eakin said that he would like to see more of Trump’s plan on ways to bend the cost curve of healthcare spending. 

Robert Graboyes, a healthcare scholar at the conservative Mercatus Center, said Trump’s main idea on cost containment so far, allowing insurance to be sold across state lines, “would do practically nothing to change anything.”

Capretta said he does not have high hopes that more details will be forthcoming. 

“He seems like he’s going to try to go through the general election without having spelled out much of anything,” he said.