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Trump's Health Care Executive Order Short on Details, Experts Say

President Donald Trump waves before boarding Air Force One for a trip to Charlotte, NC, to deliver remarks on health care, Sept. 24, 2020, in Andrews Air Force Base, Md.
President Donald Trump waves before boarding Air Force One for a trip to Charlotte, NC, to deliver remarks on health care, Sept. 24, 2020, in Andrews Air Force Base, Md.

President Donald Trump issued an executive order Thursday targeting a number of health care issues important to American voters that so far have played to the advantage of his Democratic rival, Joe Biden, in the polls.

Trump’s “America First” health care plan “delivers better care, more choice and lower costs for all Americans,” said Health and Human Services Secretary Alex Azar.

Trump’s executive order, which does not have the force of law, targets three major issues: preventing unexpected medical bills, reducing prescription drug prices and protecting patients with preexisting medical conditions.

“The historic action I’m taking today includes the first-ever executive order to affirm it is the official policy of the United States government to protect patients with preexisting conditions,” Trump said.

But some experts say the president essentially is aiming to give with one hand while trying to take away with the other.

Preexisting conditions are health problems a patient has before signing up for insurance coverage.

Before the Affordable Care Act was signed in 2010 by then-President Barack Obama, insurance companies could charge higher premiums or refuse to pay for expensive treatment if patients had preexisting conditions, including cancer, diabetes, depression and pregnancy. The ban on preexisting condition restrictions is one of the most popular provisions of the ACA.

GOP opposition

Republicans have strenuously opposed the law in large part because of its requirement that all Americans buy health insurance. Trump came into office promising to repeal and replace the entire law. While key parts have been repealed, Republicans could not agree on a replacement when they controlled both chambers of Congress.

The issue has languished until now, with just weeks to go before the election. Polls show health care is one of the most important issues for voters, though its ranking has slipped as racial justice and police violence protests have scrambled priorities.

A case that could decide the fate of the ACA comes before the Supreme Court shortly after the November 3 election. The court’s composition and ideological center of gravity is in flux after the death of liberal Justice Ruth Bader Ginsburg last week. Trump nominated conservative Amy Coney Barrett to replace her, and she could be confirmed before the court hears the case. That new justice could tip the balance in favor of repealing the law.

Trump appears to want to assure voters that protection for preexisting conditions will remain even if the ACA is repealed, according to Doug Badger, a health policy adviser to former Republican President George W. Bush and a visiting fellow at the Heritage Foundation, a conservative policy analysis institute.

"I think the executive order is his way of saying that 'I really mean this,' " he said.

But the executive order does not have the force of law, said Howard Koh, Obama's former U.S. assistant secretary for health and a professor at the Harvard T.H. Chan School of Public Health.

"The president simply reaffirmed [the protection] in his executive order without explaining in greater detail about how to keep it all going forward if the law got dismantled," Koh said.

Surprise medical bills

The executive order also seeks to protect patients from expensive, unexpected medical bills. These bills can arise, for example, when patients get care at a hospital that is part of their health insurance network, but one specialist involved in their care is not part of that network. These bills can run into the thousands of dollars.

Both parties agree it's a problem.

"For everything else they disagree on, they all agree we have to end this practice," Badger said. But they haven't come up with a solution.

Trump's executive order "handles that a little bit vaguely," Badger said. It essentially gives Congress until the end of the year to come up with a solution. After that, it instructs the secretary of health and human services to "take administrative action" to stop the practice.

The order does not spell out what actions to take. Badger said some have suggested banning the practice as a condition for hospitals to receive federal payments, but, he added, "I don't know about its legality or whether the president has that authority."

"There are so many specifics that have not been ironed out," Koh said. "It was a pledge and it was a promise, but far from a policy or a plan."

Drug prices

The order also allows the importation of prescription drugs from Canada, where prices tend to be cheaper than in the United States.

"No one's happy with [high] prescription drug costs" in the United States, Koh acknowledged.

However, "the problem is you need the Canadians to buy into this," Badger added. The Canadian government has negotiated with manufacturers to supply their own population, he said, not their people plus the United States. Canada’s population is roughly 12% that of the United States.

Trump also said the government would be mailing $200 cards to 33 million senior citizens to pay for prescription drugs.

He "didn't say, first of all, where that money was coming from," Koh said. Congress, not the president, has the authority to appropriate funding.

House Speaker Nancy Pelosi called the executive order "bogus" and said it "isn't worth the paper it's signed on."