© 2023 WFAE
90.7 Charlotte 93.7 Southern Pines 90.3 Hickory 106.1 Laurinburg
Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations
Follow the latest news and information about voting and the 2020 election, including essential information about how to vote during a pandemic and more.

Is Donald Trump's Election Year Health Care Plan Substantive Or Symbolic?

franchise opportunities/Flickr

The number of North Carolinians without health insurance grew to 1.2 million last year. That number is expected to grow again this year as an estimated 238,000 state residents lost their coverage – and their jobs -- just in the early months of the pandemic.

On Thursday, WFAE looked at Joe Biden’s health care plan. Friday, Lisa Worf speaks with WFAE’s Dana Miller Ervin about Donald Trump’s plans for health care if he’s elected to a second term.

Lisa Worf: Good Morning, Dana.

Dana Miller Ervin: Good Morning, Lisa.

Worf: President Trump has promised to repeal and replace the Affordable Care Act since running for office four years ago. His administration is suing to overturn the law, and last week he came to Charlotte to announce his plan.

Moderator Chris Wallace challenged him about that plan during Tuesday night’s debate with Democratic nominee Joe Biden.

Chris Wallace: "Over the last four years you have promised to repeal and replace Obamacare, but you have never in these four years come up with a plan …"

Donald Trump: "Yes, I have."

Chris Wallace: "... to replace Obamacare."

Donald Trump: "Of course I have."

Worf: So, is there a plan or isn’t there?

Ervin: The president has made some substantive changes to health care, but a lot of what he’s done is issue executive orders. Last week, he signed a new order saying he’d guarantee coverage for preexisting conditions and end surprise medical bills.

The problem with executive orders is that they aren’t full proposals.

And they aren’t laws. They don’t change the law.

They tell a cabinet secretary to do something under current law. And so they can be challenged in court because someone can say “the president doesn’t have the legal authority to do that.”

That’s what’s happening with many of Trump’s executive orders. For example, the American Hospital Association is challenging an order which requires hospitals to post prices, and the president’s effort to create some plans with limited coverage is also stalled in court. So the executive orders aren’t a done deal.

So when the president announced the executive order to protect preexisting conditions and end surprise medical bills … that in itself doesn’t have any immediate effect.

And of course, the Affordable Care Act – which is the law, already protects people with preexisting conditions, which may be why Chris Wallace said the new executive order is “symbolic.”

Worf: So if the Supreme Court decides to overturn the Affordable Care Act, will people with preexisting conditions be protected?

Ervin: Not under the president’s executive order, no. But some health policy experts say that if the Supreme Court overturns the entire ACA, as the president is arguing it should, then Congress will end up passing a law reinstating protections for preexisting conditions, because no one wants to go back to the situation where people can’t get coverage.

But,, of course, there are no guarantees.

Worf: OK, you said the executive order also addresses surprise medical bills -- the bills people couldn’t have forseen, like hospital bills they thought their insurance would cover.

Ervin: Yes. Basically the executive order says “Secretary of Health and Human Services, work with Congress and figure out a way to stop surprise medical bills. And if you can’t do that by the end of the year, then find another way to do it next year.” 

Worf: OK, the president has talked a lot about lowering health care costs. What’s he done on that front?

Ervin: The president backed a bill which repealed the penalty for not having the individual mandate in Obamacare that’s been a target of critics of the law.

And he’s trying to create some less expensive -- but also less inclusive -- insurance options. So he’s allowed for the creation of short-term health insurance policies, and 188,000 North Carolinians have signed up for these plans.

They don’t have to cover preexisting conditions and they offer limited coverage, so healthy people can find them attractive. But they’re also controversial. An investigation by the U.S. House Committee on Energy and Commerce found many people covered by these plans end up getting saddled with large medical bills their insurance won’t cover.

Worf: The president has also talked a lot about price transparency -- requiring hospitals and insurance companies to post all their prices online so people can compare them and have an idea how much they’re going to pay.

Ervin: Yes. The president signed executive orders on these, but they haven’t gone into effect yet in part because of lawsuits. I spoke with Georgetown University health law professor Katie Keith about this:

Katie Keith: "So, trying to get hospitals and insurance companies to disclose their negotiated prices has been really kind of like a bedrock policy key priority on the Trump health policy agenda. And so they’ve done kind of two rules: one that applies to hospitals and one that applies to insurance companies. And both of these rely on a legal authority granted to the administration under the ACA. So there is this irony that if something happens to the ACA, those rules would be invalidated and it would really undercut one of their priorities."

Ervin: The same issue affects one of the president’s most high-profile executive orders to lower prescription drug prices -- what he’s called the Most Favored Nation policy. That would tie the cost here to the lowest price offered by a comparable European country. But the authority for doing that is also based on a provision of Obamacare.

Worf: What about the president’s promise to send $200 Medicare Part D cards to send seniors before election day?

Ervin: Trump said he was going to pay for those, at an estimated $6.6 billion, from savings from his Most Favored Nation executive order. So that relies on Obamacare too, and obviously it hasn’t gone into effect yet -- so we don’t know if it will ever be implemented.

At this point it’s really not clear how they’ll be paid for and, earlier this week, the administration appeared to be backtracking, saying not all the cards will go out before the election.

Many health policy analysts suspect it’s just a stunt announced by a president whose been more focused on repealing Obamacare than on replacing it – until he started to worry about reelection.

Sign up here for The Frequency, WFAE’s daily email newsletter.

What questions do you have about the 2020 election, absentee voting or how to vote safely in person? Share your questions below.


Lisa Worf traded the Midwest for Charlotte in 2006 to take a job at WFAE. She worked with public TV in Detroit and taught English in Austria before making her way to radio. Lisa graduated from University of Chicago with a bachelor’s degree in English.
Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.