Donald Trump on Healthcare

President Trump promised to reduce the cost of prescription drugs and abolish Obamacare. Although he did not successfully abolish the Affordable Care Act, he has greatly weakened the bill.

Lower drug prices

On May 4, 2018, Trump announced the "American Patient First" program. He blamed the rise in drug prices on everyone from the company to the consumer. He wants to reform the rebates that pharmaceutical companies pay for the pharmacy welfare manager. They negotiate prices between drug manufacturers, pharmacies and health insurance companies. These rebates provide incentives for PBM to recommend high-cost drugs. PBM also allows insurance companies to charge more than pharmacies. As a result, everyone pays different prices for medicines. Trump partially fulfilled a campaign promise to require health care providers to announce the price of their services. He suggested that drug makers announce prices in advertising. This will enable people to shop at the best value. Competition will drive down prices. The PBM rebate arrangement has evolved due to no regulations.

Another campaign promise is to allow consumers to buy medicines overseas. Competition will drive down the price of medicines. So far, this is not in Trump's plan. But he does hope to link the price of drugs in the United States to the international level.

Abolition of ACA authorization

On December 22, 2017, President Trump signed the Tax Reduction and Employment Act. In 2019, it abolished the Obamacare tax imposed on those without health insurance. It eliminates the motivation for healthy people to get insurance. The Congressional Budget Office estimates that 13 million people will lose coverage. Health care costs will rise as the number of healthy people paying premiums will decrease. Health insurance companies only have people who are more seriously ill.

Cancellation of this task means that fewer people will receive preventive care or treatment for chronic conditions. This will exacerbate health care inequalities. Uninsured people use expensive emergency rooms instead of primary care. This increases the cost per person. A study predicts that premiums will rise by 35% to 94% in three years. Some parts of the South and Midwest will bear the brunt of price increases.

Weakening Obama's medical reform

The Trump administration has taken many steps to weaken the ACA, even if it has not been abolished and replaced. But it didn't work. As of the first quarter of 2018, insurers reported financial performance better than at any time since the ACA was enacted. They only require a modest increase in premiums. The number of students enrolled remained stable.

On October 12, 2017, President Trump stopped paying compensation to insurance companies that gave up 6 million low-income customers deductibles and co-payments. He accused Congress of no funds to pay for these ACA subsidies. A study shows that subsidies enable insurance companies to cover 3.2 million people. In turn, they will provide enough income to reduce everyone's premiums by 20% to 40%.

Once Trump stopped paying back, the insurance company said they had to increase their premiums by 20%. In order to keep them on the exchange, the states have to approve a rate hike. For example, Kentucky, Mississippi, and Virginia have approved a 25% rate hike. ACA subsidies will cover these growth for many people. But this increases the deficit.

On February 20, 2018, the government proposed a plan to relax short-term insurance supervision. As Trump said in his October 2017 executive order, he hopes that the short-term policy will last for a year. The Obama administration has limited their tenure to 90 days. Short-term planning costs are lower, but the benefits are not much. Since these programs are attractive to young and healthy people, this change may lead to higher premiums for the integrated program.

On January 11, 2018, the Trump administration allowed states to enforce work requirements for Medicaid beneficiaries. At least 10 states require this license. They will cut off the welfare of beneficiaries of “physical health” unless they have a job, are a caregiver, or are at school.

This requirement does not affect 95% of Medicaid recipients. 60% of people are not under 18 or over 65. Another 25% have already started working. At least 10% of people are disabled, caregivers or students. This requirement is for a small number of single adults without children, and ACA provides them with more benefits.

The government encourages states to submit exemptions to make other Medicaid changes. For example, states require premiums to be paid to Medicaid recipients. Some people want to limit the time when beneficiaries receive benefits. Others want to force a drug test.