Former President Donald Trump is the latest to weigh in, recently unveiling a new approach to making healthcare more affordable — the appropriately named Great Healthcare Plan. He first claimed in a pre-election presidential debate that he had the “nuts and bolts of a plan” for healthcare reform. Indeed, just over a year and a half later, he just announced this today. Reactions have been mixed to the release of the policy framework, especially with its glaring omission of any specific language surrounding implementation.
The Great Healthcare Plan is full of lofty goals but leaves out the details of how we’re actually getting there to make sure that they do happen in reality. One of the most exciting proposals would be to allow payments directly to individuals instead of forcing people to first through insurance companies. This approach introduces significant questions about the legality of this approach, especially in terms of its interactions with existing healthcare law, especially the Affordable Care Act (ACA).
Environmental experts are horrified by all aspects of Trump’s plan, and for good reason. They’re particularly concerned about how it might impact people with pre-existing conditions. Whether any changes to ACA funding would continue the same protections for this at-risk population is still unknown. Yet the plan still would need approval from Congress before it could be fully realized, adding some serious question marks to its road to fruition.
Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy, flagged these alarming issues. He expressed great concern about the potential impact the proposal might have on ACA subsidies. He noted that Trump’s framework “appropriates the ‘cost-sharing reductions’ under the Affordable Care Act,” which may lead to reduced premium tax credit amounts for those eligible for subsidies, while lowering unsubsidized premiums.
Cynthia Cox, KFF’s senior vice-president, noted that the plan seems to be against expanding current ACA marketplace subsidies. She stated, “The plan clearly opposes extension of the expiring ACA marketplace subsidies, without which roughly 4 million people will end up uninsured and many millions more will see their marketplace premiums double or increase by even more.”
Miranda Yaver, an assistant professor at the University of Pittsburgh, emphasized the uncertainty surrounding the compliance of Trump’s proposed healthcare plans with ACA regulations. She remarked, “It isn’t clear that the plans the Trump administration wants to help people to purchase would be ACA-compliant, which would mean that while healthy patients may enjoy cost savings, there won’t be remotely sufficient protection for the millions of Americans with pre-existing medical conditions.”
The process leading to the eventual announcement of the Great Healthcare Plan was pushed back by infighting among ministries over what should be included. Initially scheduled for release in November, its release date was moved back. Several Republican lawmakers signed a discharge petition to override Speaker Mike Johnson’s refusal to bring an ACA-related bill to a vote in Congress. Trump has already signaled that he’ll veto this bill when it passes the Senate. This announcement injects even more chaos into an already-delicate legislative equation.
Critics have pointed out that while some provisions in Trump’s framework resemble existing ACA measures, such as price transparency and public data on claims denials, the overall proposal lacks essential details. Cox noted, “When it comes to health reform, the devil is in the details, and this lacks detail.”
Trump has framed his plan as a departure from traditional healthcare approaches, stating, “Instead of putting the needs of big corporations and special interests first, our plan finally puts you first and puts more money in your pocket.” We have concerns that these claims will not be converted into real, tangible benefits to the American people, experts caution.
Fear of negative downstream effects quickly emerged among the healthcare community as well. One expert suggested that aspects of Trump’s plan could lead to “inequity (and likely worse health outcomes) and further sabotage of the progress of the ACA.” One prominent economist warned that sending money directly to people would set off a “death spiral.” This would end up leaving most people with pre-existing conditions with severely limited coverage options.