Trump’s Health Care Policy, Does It Align With the GOP?

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All eyes are on the man of the hour, hundreds, thousands — no, millions — of them, if you count the cameras (which of course he does). With each pugnacious point, Donald J. Trump raises a hand like a conductor and then lowers it. An accompanying verbal jab falls like a tomahawk. His now all-too-familiar chorus — “we,” “us,” “them” — plays again and again, entrancing crowds, whether they’re cramped in a tiny town hall in Londonderry, New Hampshire, or filled in a football stadium with tens of thousands in Mobile, Alabama.

As we chase the Republican front-runner across New England, America’s heartland and through the South on the eve of Super Tuesday, we’ve seen the many facets of Trump: raw, demagogic, blustery and, to put it mildly, irreverent. Meanwhile, we’ve watched him grab the political mirror and swing it back on the Republican Party, casting its deficits into sharp relief and revealing a new path forward. Trump’s GOP focuses on deals over ideals, on the candidate himself over any dogma. His platform, such as it is, is flexible enough to allow independents and disgruntled Democrats, too. “We’re building a much bigger, much stronger Republican party,” he said at the GOP debate in Houston last week, citing his support among non-GOP voters.

Indeed, despite howls from the Republican establishment, the 69-year-old billionaire has over the past eight months done much more than disable a party that was already split from the inside and seemingly behind the times: Arguably, Trump has begun to reassemble a party made in his own image. “He’s beloved by tens of millions of people who, no matter what he says, still love him,” says Surya Yalamanchili, a politician and marketing expert who spent months with Trump on the set of The Apprentice and is the author of Decoding the Donald: Trump’s Apprenticeship in Politics.

Of course those loyal adherents are causing the rest of the Republican Party a fit, as it seems to get reshaped from the inside out. Often lower class, white and disillusioned — and “poorly educated,” as the Donald himself has said — this under-served population sees itself in Trump, who, despite being an opulent billionaire, has won them over. Even more crucially, he’s shown a willingness to confront the challenges blue-collar America faces in a global economy that has all but left them behind. It’s a demographic that tends to care less about cultural issues, which have long dominated modern conservatism. “I don’t give a shit if he’s Christian or not,” says 22-year-old Aaron McBryer, a Scottsboro, Alabama, native. “For people like me, I’m angry that I don’t have a job — and Trump believes in putting your own people first. It’s like a family.”

The result, experts say, is a coalition of new voters: Election Day turnout in Republican primaries is at an all-time high — not only upending traditional politics, but derailing the party and setting it on a different course. And that’s fallen in line with past, sweeping moments, such as the Reagan revolution. “Historically speaking, the Republican Party has reinvented itself at moments where it is at a crossroads of ideology and constituency,” says Brandon Rottinghaus, a political scientist at the University of Houston. “Trump,” he adds, “is effectively remaking the ideology and constituency of the Republican Party

Trump has been vague about his plan for healthcare and declined to provide details despite direct prodding from Rubio in the most recent debate. Trump said Tuesday only that he would implement something “much, much better’ than the Affordable Care Act.

In a lengthy news conference Tuesday night, also in Florida, Trump said that although there is “always some negotiation,” he stands by his comments that Planned Parenthood has helped millions of women. He said he still supports banning funds to the organization because of its stance on abortion.

“I’m going to be really good for women. I’m going to be good for women’s health issues,” he said. “It’s something I care about.”

Cruz, who was in Texas, took aim squarely at Trump in his remarks, saying he was the only person able to beat Trump. He said Trump had pledged to expand Obamacare into socialized medicine with government control and rationing.” Trump has denied this but has not given details on any healthcare program of his own. Cruz said he would repeal the ACA.

So, I thought that I would look at the Seven-Point Healthcare Plan of the Donald. Is it any different than the GOP party line or Hillary?

After months of promising to repeal ObamaCare, but failing to spell out how — and what would replace it — Republican presidential candidate Donald Trump finally revealed some specifics Wednesday night, including doing away with the individual mandate that requires everyone to have health insurance, an apparent reversal of his previous support for the provision.

Trump also proposes that states take over management of Medicaid and provide incentives to eliminate fraud and waste.

The seven-point plan, posted on the GOP frontrunner’s website, slammed the Affordable Care Act, saying it has “tragically but predictably resulted in runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and few choices.”

In explaining his plan to abolish the individual mandate, Trump said no one should be required to buy health insurance if they don’t want to. The current law requires everyone to have health insurance, or pay a penalty. That’s an apparent reversal from his “I like the mandate” comment last month during a CNN town hall.

In that forum, Trump said he’s a “little bit different” in that he doesn’t want “people dying on the streets.”

His Republican rivals have accused him of advocating “socialized” medicine, but his latest plan pushes back on that — and could help rebut charges that his health care platform lacked details.

Trump also wants to expand the sale of health insurance across state lines. Doing that, he says, will allow full competition in the market and “consumer satisfaction will go up.” He proposes, “price transparency from all healthcare providers,” saying individuals should be able to shop around for the best prices for any sort of procedures, exams or checkups.

The New York businessman also wants to allow a tax deduction for insurance premium payments, and expand the Health Savings Account program.

“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,” Trump wrote.

Trump also touches on illegal immigration, claiming that providing healthcare to illegal immigrants costs taxpayers $11 billion a year. He said if the immigration laws were enforced, “we could relieve healthcare cost pressures on state and local governments.”

Dr. Marc Siegel, a practicing internist has studied and been victimized by the damaging effects of ObamaCare, he and I were glad to see Trump define his position. I am on the lookout for any plan that aims to undo the worst of ObamaCare: spiraling premiums, limited access to providers, high deductibles that hamstring poor and middle-class patients and heavy federal subsidies and related tax hikes.

Complex candidate position papers are standard fare, but the fact is that little or none of their detail will be utilized when the election is over. So I’m more interested in broad brush strokes at this point, and the American public should be too. With this in mind, let’s examine the essential bones of Trump’s health care plan, even if it lacks the flesh of the other candidates’. Let’s break them down. He released seven key points:

1: Repeal and replace. Trump has said this repeatedly, and it carries more weight now than previous threats thrown at President Obama’s veto pen. The Health Care Choices Act, authored by Cruz and co-sponsored by Rubio last year, included central aspects of both senators’ positions: the ability to buy health insurance across state lines and eliminating the mandate to buy insurance, the insurance marketplaces and federal subsidies. But it had zero chance of becoming law. “Repeal and replace” can become a reality only if a Republican wins the presidency.

2: Modify the law that inhibits the sale of health insurance across state lines. “The lines, the lines,” Trump says on the stump, referring to removing the ban, not to the growing waiting lines in doctors’ offices. Like Rubio and Cruz, Trump favors portability of health insurance from state to state. As a mega businessman, he knows this will introduce more competition into the system and drive premiums down. If, for example, Nevada offers a cheaper yet equally effective insurance product as New York, my patients could buy it there and use it here.

3: Allow individuals to fully deduct health insurance premiums on their tax returns. Businesses take these deductions, so why shouldn’t individuals? This will help people who previously couldn’t afford insurance to buy it. Rubio, too, has backed the idea of tax incentives to buy health insurance.

4: Health Savings Accounts. Trump proposes to expand this program. Contributions should be tax-free and be allowed to accumulate and become part of the patient’s estate. Health savings accounts work well in the doctor’s office, as a patients are more aware of what services they’re getting and what they’re actually paying for them.

5. All prices should be transparent. Patients should be able to shop for the best prices for procedures, examinations, etc. This will help drive prices down to a more affordable range. Right now, something like an echocardiogram is far more expensive at one hospital than another.

6: Block-grant Medicaid to the states. States know their people the best, Trump says, “and can manage the administration of Medicaid without federal overhead.” Rubio, too, recommends block grants. But Trump refused to denounce Medicaid expansion in New Hampshire when he was campaigning there. He has said repeatedly, “I will not let people die on the streets.” His plan doesn’t take into account that Medicaid is an expensive and inefficient state-administered insurance plan that has a narrow network of doctors and badly needs an overhaul. Simply expanding it, the way ObamaCare does, or handing over full responsibility to the states is not the best solution. Perhaps a more informed Trump will come to see this.

7: Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Trump believes special interests are driving up prices, and he wants consumers to be able to import drugs, which will drive prices down. He has also said that Medicare should be able to negotiate prices, a controversial change. Since Medicare frequently sets the standard for prices in the industry, this makes sense – especially when it comes to the overinflated prices of new cancer and heart drugs. Rubio proposes reforming Medicare by transitioning to a privately funded premium support program intended to control costs while maintaining services, though prior efforts to privatize Medicare have failed. Cruz would raise the Medicare eligibility age, which I believe is a good idea.

In a Feb. 18 interview with CNN, Trump indicated he would keep ObamaCare’s individual mandate, which makes you pay a fine if you don’t have health insurance. But the next day he tweeted that he would remove the mandate (a central piece of ObamaCare) and install a “backstop for pre-existing conditions.” His positions on health care seem to be evolving as he learns more.  In this week’s position paper, it is clear that he intends to get rid of the individual mandate. During last week’s debate, he flatly denied Cruz’s accusation that he wants the government to pay for everyone’s health care. Perhaps Trump would have agreed with President Richard Nixon, who in 1974 proposed a comprehensive health reform plan that included cost-sharing health coverage, subsidized by the federal government, for poor Americans. This plan probably would have passed, if not for Watergate.

Trump’s position paper on health care goes on to say that enforcing immigration laws will relieve economic pressures. His wall would theoretically help out hospitals in the South and Southwest that are overburdened by the costs of services they provide to illegal immigrants who can’t pay for them. Meanwhile, the heroin trade is burgeoning, with 300,000 more users than a decade ago and over 10,000 overdose deaths per year. Decreasing these numbers would decrease U.S. health care costs substantially.

So Donald Trump has a health care plan. It needs more flesh on its bones, but at first glance it is not as reckless as his main opponents (both huge ObamaCare critics) say it is. Trump promises to reverse at least some of the damage ObamaCare has done to my patients and me. I believe that if he’s elected, he’ll try, but what will we really get?

Heavens only knows, it seems that Trump changes his mind depending what direction the voter or better media winds blow. Stay tuned!

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