Overview of the Trump Administration’s 'America First Healthcare Vision'

Brownstein Hyatt Farber Schreck

On Thursday, Sept. 24, President Trump announced his long-awaited health care plan, the “America First Healthcare Vision,” aimed at replacing the Affordable Care Act (ACA) and reshaping our nation’s health care system. The plan includes three overarching pillars: 1) more choice for Americans, 2) lower costs for families and seniors, and 3) better care for American patients. President Trump also announced two key elements within his executive order(EO),one aimed at protecting patients with preexisting conditions and a second aimed at ending surprise billing. The executive order does the following:

Pre-existing conditions:

  • The president’s order directs the Department of Health and Human Services (HHS) to provide protections for patients with preexisting conditions, and if necessary, to propose legislation to ensure Americans remain protected even if the ACA is struck down and existing protections are invalidated. 

Surprise billing:

  • This order directs HHS to work with Congress to reach a legislative solution to end surprise billing by Dec. 31, 2020.
  • In the event a legislative solution is not reached by Dec. 31, the order directs the Secretary of HHS to take administrative action to prevent patients from receiving bills for out-of-pocket costs they could not have been reasonably foreseen. 

The newly released EO primarily highlights President Trump’s health care priorities ahead of the November election. As currently drafted, the EO lacks the authority to have a substantial impact on provider, physician and insurer groups, unless the individual elements are followed by regulations.

Following the president’s signing ceremony, the White House Office of Intergovernmental Affairs, Office of Public Liaison and Office of Legislative Affairs hosted a briefing call with senior administration officials including Doug Hoelscher, director of the White House Office of Intergovernmental Affairs; Brooke Rollins, acting director of the Domestic Policy Council; Jim Parker, senior advisor to the Secretary for Health Reform and director of the Office of Health Reform at HHS; and Nick Uehlecke, advisor at HHS. An overview of the briefing can be found below.

Jim Parker (senior advisor to the Secretary for Health Reform and director of the Office of Health Reform at HHS)discussed the two key elements of the administration’s new EO around preexisting conditions and surprise billing. He also announced several other major steps the administration has taken to lower the cost of drugs following the president’s August drug pricing EOs. 

Parker noted that President Trump’s plan is comprehensive and already delivering results, whereas the ACA was only focused on the individual marketplace. He also mentioned the administration’s hospital price transparency rule, interoperability rule and value-based payment rule, as well as the president’s July 2019 EO and subsequent rulemakings around kidney health. 

Brooke Rollins (acting director, Domestic Policy Council)outlined the president’s health care platform, highlighting that it puts patients first, in contrast with the Democratic proposal, which puts the government, spending and bureaucracy in the middle. She stressed that patients and doctors should be running the system, not the government.

More choice:

  • The president has given patients more control over their health care dollars by repealing the ACA individual mandate.
  • He has provided waivers to the states to manage their own individual markets.
  • He has implemented and expanded telehealth waivers, and plans to expand them permanently for Medicare patients.
  • He is expanding the availability of health reimbursement accounts (HRAs).

Lower costs:

  • The president lowered the price of prescription drugs through his historic approvals of generics, by allowing limited drug importation from Canada and by prohibiting surprise medical billing during the pandemic.
  • He announced today he will permanently end surprise billing.
  • The administration will be sending out prescription drug discount cards of $200 each to over 33 million Medicare beneficiaries.

Better care:

  • President Trump signed an EO to declare it is the policy of the federal government to protect individuals with preexisting conditions and ensure they have access to care they can afford.
  • The administration will also continue to invest in critical areas, including pediatric cancer, Sickle cell disease and Alzheimer’s research.

Nick Uehlecke (advisor at HHS)discussed several prescription drug pricing proposalsthe administration has recently announced.

  • The administration is opening up pathways for states to submit drug importation proposals to the Food and Drug Administration (FDA) for review and authorization. The programs will be managed by the states and facilitated by FDA and HHS.
  • The administration will facilitate private sector proposals, which will be approved by FDA, so patients can get lower-cost insulin via reimportation.
  • The administration will allow patients to self-import prescription drugs at lower costs. Pharmacies and others will be invited to submit plans to allow patients to apply for waivers from HHS to import drugs.
  • The administration recently finalized a rule to allow low-income Americans living below 350% of the federal poverty line to purchase affordable insulin and EpiPens.
  • Thirty-three million Americans on Medicare will receive discount cards for prescription drugs—more on this will be announced over the next couple of weeks.

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