Now, with the two weeks expiring Sunday, there is no evidence that the administration has designed a replacement for the 2010 health-care law. Instead, there is a sense of familiarity.
Trump promised great health care policy in 2016. The Republicans have been promising something on and off since the Clinton health care proposal crashed and burned in 1993. What their best minds put together turned into the blueprint for the Affordable Care Act, but since a Democratic president took ownership of that idea, the GOP disowned it. Since then Republican legislators have occasionally hauled stacks of paper in front of cameras that they claimed was their new health care policy proposal, but it never goes anywhere. See, for example, old posts from 2009 and 2014. The 2014 post asks whether such a beast as a Republican health care plan can exist, since there is no way to address our health care issues without the kind of tax-supported “big government” programs that are the root of all evil, they think.
This is from a 2013 Jonathan Chait article that’s worth reviewing.
Conservative health-care-policy ideas reside in an uncertain state of quasi-existence. You can describe the policies in the abstract, sometimes even in detail, but any attempt to reproduce them in physical form will cause such proposals to disappear instantly. It’s not so much an issue of “hypocrisy,” as Klein frames it, as a deeper metaphysical question of whether conservative health-care policies actually exist.
The question should be posed to better-trained philosophical minds than my own. I would posit that conservative health-care policies do not exist in any real form. Call it the “Heritage Uncertainty Principle.”
When pressed, Republicans trot out the same old tweaks to the system — high-risk pools, “tort reform,” allowing insurers to price gouge older and sicker folks — that no one who knows anything about how health care works thinks wouldn’t just make things worse.
It’s safe to say that there is no Trump health care plan and there cannot be a Trump health care plan. No one in Congress is working on a Trump health care plan. It’s possible Trump has Mr. Ivanka working on a health care plan, which means that one of these days we may be treated to the sight of another stack of paper filled with nonsense that won’t address the problems and will never be enacted.
Instead, it appears Trump has his staff — including Mr. Ivanka — working on a whiz bang executive order he can sign so he can pretend he’s done something.
Sen. Lindsey O. Graham (R-S.C.), who regularly meets and golfs with the president, said the health-care plan that Trump has referred to would come in the form of an executive order that Graham called “fairly comprehensive.” However broad, an executive order would fall short of a full legislative overhaul.
Graham said what Trump has in mind now would ensure that consumers do not risk losing their health plans if they get sick, but he did not give details.
“He’s pretty excited about it,” Graham said of the president. The ACA’s consumer protections for people with preexisting medical conditions is one its most popular facets with the public, and it is the one part of the law Trump consistently says he would preserve if he could get rid of the rest. How he could do that while containing costs after he and congressional Republicans remove the law’s requirement that everyone has to purchase health insurance remains the question.
The insurance companies aren’t going to agree to insure the preexisting condition folks unless they get something substantial in return. The mandate was the deal Obama offered. Short of substantial tax subsidies to underwrite the policies, which is way not Republican, I don’t see a deal getting made. More likely, Trump will demand that insurers offer policies to everybody, but at premiums nobody can afford.
Trump’s latest promise comes amid the outbreak of the novel coronavirus, which has infected millions, caused more than 150,000 deaths and cost Americans their work and the health benefits that often come with jobs. His vow comes three months before the presidential election and at a time when Trump’s Republican allies in Congress may least want to revisit an issue that was a political loser for the party in the 2018 midterm elections.
Yet Trump has returned to the theme in recent days.
“We’re going to be doing a health-care plan. We’re going to be doing a very inclusive health-care plan. I’ll be signing it sometime very soon,” Trump said during an exchange with reporters at an event in Belleair, Fla., on Friday. When a reporter noted that he told Fox’s Wallace that he would sign it in two weeks, Trump added: “Might be Sunday. But it’s going to be very soon.”
Steve Benen provides another detail:
Two weeks ago today, Donald Trump sat down with Fox News’ Chris Wallace in the White House Rose Garden, and the host asked about the president’s ongoing efforts to destroy the Affordable Care Act, which would strip benefits from tens of millions of families. The president replied that he still intends to “replace” the ACA.
The host reminded Trump, “But you’ve been in office three and a half years, you don’t have a plan.” It was at this point that the president responded with an unexpected vow:
“Well, we haven’t had. Excuse me. You heard me yesterday. We’re signing a health care plan within two weeks, a full and complete health care plan that the Supreme Court decision on DACA gave me the right to do…. [T]he decision by the Supreme Court on DACA allows me to do things on immigration, on health care, on other things that we’ve never done before. And you’re going to find it to be a very exciting two weeks.”
The Supreme Court decision on DACA? I missed that one. Apparently Trump believes this decision gives him the right to step in and enact policy by executive order if Congress hasn’t done it. Remember John Yoo? Trump has been listening to John Yoo.
Trump signed a bunch of executive orders on prescription drugs a few days ago that, among other things, called for price controls.
Commenting on how he had the authority to control those prices unilaterally, without Congress passing a law or an agency completing a formal rulemaking process, Trump said, “I was given that right because of the DACA decision. The DACA decision allowed me to do things that some people thought the president didn’t have the right to do. I was given that right. Drug prices will be coming down very, very substantially. No other president has been allowed to do that. No other president has been able to do that.”
Yeah, no. Trump has tried to snatch victory out of the jaws of the court’s DACA ruling, but he’s dreaming. Granted, it’s a dream shared by some influential conservative thinkers, but there’s no basis for it in the ruling.
The court found that DACA was more than just an administrative decision not to enforce immigration law against a group of people brought into this country as children by their parents. It also offered these “Dreamers” benefits, such as the ability to obtain work permits. Ending DACA, therefore, required reversing a substantive policy that had been in place and relied upon by hundreds of thousands of Americans for years. That sort of policy change is governed by the Administrative Procedures Act, which bars actions that are arbitrary, capricious and procedurally deficient. Because the Trump administration did not follow the APA in rescinding DACA, as in so many of its actions, its decision was invalid.
Trump turns the court’s reasoning on its head. Because the court focused on the legality of Trump’s reversal of DACA instead of President Obama’s adoption of the program, he seems to believe he can issue whatever orders he wants, and any future president attempting to undo what he’s done will have to jump through months or years of procedural hoops under the APA.
That’s hogwash. As Harry Litman ably explained in The Times, executive orders that launch substantive new programs have to comply with the APA, and anyone damaged by a Trump order can sue to stop it under that law.
Like I said, this is just weird. But price controls are something like original sin to the free market people. That we haven’t heard screaming from here to eternity tells us something. I’m not sure what.
