What is TrumpCare?

TrumpCare” is Donald Trump’s healthcare reform platform, below we explain TrumpCare and how it is different than ObamaCare.

TIP: The GOP forever altered the lexicon when they called the Patient Protection and Affordable Care Act “ObamaCare.” With this in mind, Trump’s healthcare plan has been unofficially dubbed “TrumpCare.” This is true even though no formal plan is on the table yet.

TIP: You can see Trump’s healthcare reform to make America great again here. See Vox’s TrumpCare article for a different take. We discuss all things TrumpCare below, including a line-by-line review of his original plan and all the updates since the election. There is a lot of ground to cover, so read carefully.

UPDATE: Trump and Republicans in Congress had long stated that they would seek to repeal ObamaCare within Trump’s first hundred days in office (and true to their word the process of repeal has begun and Trump has signed an executive order on ObamaCare). Then, after a meeting with President Obama, President-elect Trump suggested he would either amend ObamaCare or repeal and replace it (not just repeal) and would keep key provisions like guaranteed coverage for preexisting conditions and allowing kids to stay on their plans until 26. More recently, Trump promised “simultaneous repeal and replace“, “insurance for everybody“, and doubled down on a longstanding promise of “negotiating with drug companies“. Then, after a meeting with drug companies Trump backed away from allowing for negotiating. What does this all mean? It means Trump’s order, plan on his site, and spoken words all signal his intentions, but that he is obviously willing to change stances when he is swayed by evidence. A fair position, and one that bodes well for the countless “repair” plans being put on the table (including ours). With that said, while we explain what we do know below, no official plan is on the table yet. So for today, those who support the ACA should be speaking out against the Republican “repeal and delay” plan, pushing for “repair and reform” instead, and focusing on holding Trump to his word and presenting plans that will sway him.

UPDATE: With Tom Price selected to be health secretary, and him favoring the GOP solution for preexisting conditions, it is likely we will get a “Continuous Coverage Exclusion” for pre-existing conditions” (it’s not the same as the ACA version, for example it has very long exclusion periods, so make sure you understand the implications!). See our review of the GOP ObamaCare alternative plan and our review of the Burr, Hatch, and Upton plan for an idea of what Republicans have suggested for ACA replacements in the past. It is very likely TrumpCare will draw elements from past GOP plans, as ultimately it is Congress who makes the laws.

Overview of TrumpCare

On his website, the TrumpCare plan listed is part a rehash of the Republican playbook, “insurance across state lines, HSAs, get the sick out of the healthcare system to keep costs down,” and part, an “oddly socially liberal market-based healthcare reform and cracking down on big pharma.”

Despite some of the expected Republican views being included in his written plan, some parts of the plan and the words that Trump says paint a very different picture.

Below we’ll look at what Trump’s written position and past statements could mean for the future of healthcare reform, and how TrumpCare is different (or not ) from ObamaCare.

First, let us get a glimpse a Trump speaking his mind so we can set the stage.

“The Government’s Gonna Pay For It” – Wildcard Donald Trump on Single-ish Payer.

TIP: See how past healthcare proposals from the GOP differ and relate to each other. Past healthcare reform proposals compared.

The Cost of TrumpCare

The Committee for a Responsible Federal Budget did a review of Trump’s healthcare plan. The following article shows a breakdown of costs: MEASURING TRUMP’S HEALTHCARE PLAN. The result is a cost of roughly $550 billion over ten years under conventional scoring and about $330 billion with dynamic scoring (see breakdown below).

trump-health-analysis

Note that this analysis does not include Mr. Trump’s call to negotiate aggressively for Medicare drugs, a policy that is not listed on his website. He has previously claimed that $300 billion a year could be saved through negotiation, a claim we rated as false because Medicare will only spend an average of $111 billion each year on prescription drugs. Based on previous estimates by CBO, actual savings would likely be small or negligible.

NOTE: The plan assumes a full repeal of ObamaCare before replacing it. While this is possible given Trump’s statements, it isn’t necessarily what we would get from the future President Trump.

NOTE: Like him or hate him, Trump has mentioned some really important health policies like expanding Medicaid and debating drug costs for Medicare. These didn’t make it into the Trump plan as written, but it would be a mistake to overlook the benefits of strategies like debating drug prices for Medicare.

10-Year Estimates of “Healthcare Reform to Make America Great Again”
Policy Costs (+) / Savings (-)
Repealing Obamacare Coverage Provisions  -$1,120 billion
Repeal Obamacare Tax Increases  $660 billion
Repeal Obamacare Medicare Savings  $940 billion
Dynamic Effects from Growth (excluded from conventional scores)
 -$220 billion
Subtotal, Repeal Obamacare $260 billion
Allow insurance to be purchased across state lines -$10 billion
Create deduction for individual insurance premiums $100 billion
Allow importation of prescription drugs -$20 billion
Require price transparency and promote health savings accounts (HSAs) *
Subtotal, Replace Obamacare $70 billion
Total under Dynamic Scoring (including growth from repealing Obamacare)
$330 billion
Subtract Dynamic Effects from Growth (excluded from conventional scores)
-$220 billion
Total under Conventional Scoring
$550 billion

* Less than $10 billion of net costs or savings.
Source: CRFB calculations based entirely on various CBO estimates for the independent pieces. All estimates are very rough and rounded to the nearest $10 billion. Interactions or interest costs not included.

TrumpCare As Written on DonaldTrump.com

Below is an annotated version of TrumpCare. I explain what each measure means for America and the current ObamaCare system.

1) Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

COMMENT: No Republican is likely to repeal ObamaCare in full. Saying “repeal ObamaCare” is a way of saying, “get rid of key provisions like the mandates, subsidies, coverage for preexisting conditions, insurance on parents’ plans for those under 26, and specifically, regulations on key businesses favored by the GOP.” This doesn’t mean Trump plans to do all of this, it just means he could (certainly past GOP replacement or repeal plans have gone after the aforementioned provisions before). Trump simply says we must eliminate the individual mandate to obtain and maintain coverage, so that part seems likely. From there, we can speculate that this could, by extension, mean getting rid of subsidies and a few other key regulations, such as bans on annual and lifetime limits or rules against discrimination based on gender or health status. Of course, Trump hasn’t explicitly stated what he plans to do, so nothing is certain. The thing I want to stress here is that “repeal the mandate” almost certainly means eliminating the clause requiring insurance companies to cover people with preexisting conditions (although President-elect Trump has suggested he will keep preexisting conditions protections, it will take some real skill to get rid of the mandate but not the protections, as that and open enrollment is what protects insurers from people waiting until they are sick to sign up and thus keeps costs down). As in pre-ACA times, we could see that only a health issue that occurs while a person is covered by an insurance policy would be covered, or we may see that people can only keep their plans if they elected to maintain their coverage. Again though, we want to avoid reading into a single website statement or offhanded comment made before or since the election too deeply, but instead only want to make clear that repealing the mandate could by extension mean repealing key provisions which many Americans rely on to ensure access to affordable coverage. See why Republicans can’t just repeal ObamaCare.

2) Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs are expected to go down, and consumer satisfaction is expected to go up.

COMMENT: Republicans have always wanted to sell insurance across state lines. The conversation as to why or why not is nuanced. It’s not a bad idea and would make his constituents happy. See The Problem With G.O.P. Plans to Sell Health Insurance Across State Lines.

3) Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want health care coverage can have it.

COMMENT: Deducting health insurance premiums makes a lot of sense. People are getting taken to the cleaners with rate increases. Trump says he will expand Medicaid here too, or eluded to a variation of this. That is potentially a big deal, and very opposite of what the Cruz’s and Rubio’s of the world want (which means Trump could face opposition on this from his own party). See why Medicaid expansion is so important.

4) Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.

COMMENT: The Republican view part two. Expanding HSAs sounds great, but the actual policy is typically code for, “benefit upper-middle class who can afford to fund HSAs.” The GOP would like to give people a free 1,000 to fund an HSA, but as much as I love HSAs, you can’t fund $3,000 to $6,000 for the tax benefits if you don’t have the income to do it. Learn more about HSAs.

5) Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

COMMENT: If Trump didn’t just suggest expanding Medicaid-like programs, I would be shocked to realize that Trump just called for war on the price setters of the healthcare industry. I’m pretty sure he is implying he will let Medicare negotiate drug prices. See why Drug costs are crippling the American taxpayer.

6) Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better than the federal government. States will have the incentives to seek out and eliminate fraud, waste, and abuse to preserve precious resources.

COMMENT: The Republican view part three. It’s not a bad move, but block-grants sound better on paper. See why block grants are worse than they look on paper.

7) Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

COMMENT: Trump just suggested measures that would result in big Pharma losing a great deal of money; once you pay non-US prices you’ll never go back. See why the US pays more than other countries for drugs.

TrumpCare as Spoken By Donald Trump

Trump’s health policy is largely unknown; that much is clear. All we can do is listen to what he is saying and judge it for what it is.

Single Payer – Trump Style

Trump has essentially insinuated that he plans to implement a market-driven version of single payer insurance. He made this very clear in a debate where his dialogue with Cruz focused on the Medicaid side:

CRUZ: So does the government pay for everyone’s health care?

TRUMP: … I’m not fine with it. We are going to take those people…

CRUZ: Yes or no. Just answer the question.

TRUMP: Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We’re going to make great deals on it, but we’re not going to let them die in the streets.

CRUZ: Who pays for it?

COMMENT: Go to about 8 minutes into the video blow and see Trump win a debate against Republicans by pushing moral healthcare policies.

Learn more about Donald Trump on HealthCare from ontheissues.org.

How is TrumpCare Different From ObamaCare?

TrumpCare, as written on Trump’s site, is like Republican health care reform meets BernieCare. TrumpCare as it is unfolding is still anyone’s guess.

On the site, the plan has little in common with ObamaCare outside of Medicaid expansion. So far in real life, it is looking like the GOP will push to block grant Medicaid, which could have a number of implications. Block-grant could mean expansion, or it could mean provide loopholes to decrease federal funding (the fear of liberals). Like on many of these issues, it really is still too early to tell.

On the site, Trump sounds as though he wants a complete repeal of the ACA, but actually language since the election hints that this won’t be the case. It makes little sense to try to get rid of every part of the Affordable Care Act, especially the parts about that aren’t drawing criticism.

Trump seems to be dropping the mandates and some subsidies, pushing Medicaid expansion (rhetorically, actually pushing Medicaid block-grant in practice it seems), deregulating a little, regulating a little, and… maybe… just maybe… initiating some version of a free-market single payer / public option like we saw in Upton, Burr, and Hatch’s CARE plan or Pence’s HIP.

Trump’s stance on healthcare, as far as we know, contains a lot of room for bipartisan reform. It is still too early to know what a Trump will do as a President under the GOP controlled congress, but if it is a moderate version of what he has said, Americans should be just fine.

In many ways, the real issue all comes back to Trump’s pronouncements that, “we aren’t going to let them die on the street” and “the goal is insurance for everybody”.  Were those empty promises, or real ones?

NOTE FROM THE PRIMARIES: I’ll add more to this page as we move forward. If Trump makes it to the primary then naturally his policies will become clearer and we will have more to dive into. Politicians almost always put out a rough outline, the PPACA is 1,000 pages of legislation, so we can’t make a completely fair comparison just yet. Stay tuned.

UPDATE POST TRUMP ELECTION: Now that Trump has been elected, we will what policies he attempts to implement. We will keep this page updated has Trump begins to shape his repeal or replace plan. For now, the ACA is still the law of the land. Everything from ObamaCare’s cost assistance to ObamaCare’s fee applies despite the recent order and suggested replacement plans.