The Trump campaign has released a health-care plan. Like the campaign’s immigration plan and tax plan before it, it contradicts much of what he has been saying on the stump. Trump has frequently suggested that other Republicans would leave people to “die in the streets” and that he would make sure that government would take care of everyone. The plan on his website, on the other hand, would do much less to expand access to health coverage than most Republican plans. At the last debate, he said that he would protect people with pre-existing conditions; there’s nothing in the plan about how, or even if, he would do that. He has spoken about driving hard bargains with health-care providers to lower prices. Again, there’s nothing about that in the plan. The plan describes itself as “a place to start,” but it does not even begin to show how to make good on the candidate’s pledges.
The plan is, however, consistent with Trump’s rhetoric on health care in that it betrays little familiarity with health policy. He proposes allowing Americans to have Health Savings Accounts with tax-free contributions: a fine idea that has already been in law since 2003. If Trump wants to do anything to change this existing law, or is aware of it, his plan doesn’t let on.
During World War II, Congress passed a law allowing state governments to regulate individual insurance policies sold in their states. It has led the individual insurance market to be divided into fifty regulatory fiefdoms. Many Republicans have suggested that individuals should be able to buy insurance from out-of-state companies: If New Jersey raises premiums too much with its regulations, its residents would be able to buy cheaper policies that follow Pennsylvania’s lighter regulations. Trump seemed to be referring to this idea in the last debate when he talked about “lines around states.” But the plan says that people should be allowed to buy insurance out of state only “as long as the plan purchased complies with state requirements.” That defeats the whole purpose of the reform, and means either that Trump is coming out for the status quo or that whoever wrote his plan garbled it.
Trump also comes out for making individual premium payments deductible. It’s a small step in the wrong direction. We already do too much to encourage people to pay for health care through insurance rather than out of pocket. This policy would reinforce that trend, especially for the high earners for whom the deduction would be valuable.
The plan includes some good ideas, like block-granting Medicaid. But it seems mostly cribbed from dated Republican talking points, and it is not clear whether it is going to have much effect on what Trump says on the campaign trail, let alone what he would do if he were president.