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Donald Trump Reveals Details of His Health Care Plan

By Ali Vitali, NBC News, March 3, 2016

Donald Trump released his health care plan Wednesday evening, finally detailing the way in which he would fulfill his campaign trail promise to repeal and replace Obamacare. In a seven-point plan posted to his website and publicized by a tweet, Trump says he will do away with the individual health insurance mandate, as well as allow competition over state lines for health care plans, and “block grant” Medicaid to the states, allowing them to follow through on his prescription to “eliminate fraud, waste and abuse to preserve our precious resources.”

The decision to go against the idea of an individual mandate is new for Trump, who told CNN during a February town hall before the South Carolina primary that he “likes the mandate” and that makes him “a little bit different” than other conservatives. But Wednesday’s plan outlines as the first point on the list: “Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.” He counters that, however, by saying individuals should be allowed to “fully deduct health insurance premium payments from their tax returns.”

The third bullet point goes on to say that “we must make sure no one slips through the cracks simply because they cannot afford insurance” and that “we must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.”

Further, Trump ties illegal immigration to his healthcare plan, writing “providing healthcare to illegal immigrants costs us some $11 billion annually… If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.”

Trump, who after almost every mass shooting has responded to questions on gun control with an answer about mental health, also noted the need for mental health institution reform. His plan states that “[f]amilies, without the ability to get the information needed to help those who are ailing, are too often not given the tool to help their loved ones.” Beyond this statement, however, Trump gives no solution. Instead, writing that “there are promising reforms being developed in Congress that should receive bi-partisan support.”

Another recent talking point that has made its way into the healthcare plan is pharmaceutical drugs, special interest control of prices, and the need to be able to negotiate. Though this talking point seemed to stem from former Bush finance chairman Woody Johnson’s attendance to a GOP debate, Trump has since included the need to negotiate prices and unleash Washington from its special interest hold.

The final point in his plan states the need to “[R]emove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.” Trump says that “Congress will need the courage to step away from the special interests and do what is right for America” and that despite pharmaceuticals being private companies, they “provide a public service.” Trump instead is advocating for international competition and the importing of drugs from overseas to “bring more options to consumers.”

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GENERAL REMARKS ABOUT THE RECORDING

This year’s presidential primary election has been eventful, particularly on the Republican side, with the unexpected and by now seemingly irresistible rise of the real-estate tycoon and reality-television star Donald Trump. The latter’s success has defied the odds and pundits’ predictions of his ineluctable implosion, regardless of the oftentimes outrageous things that he has been saying and his rivals’ increasingly aggressive attacks against him – none of them appearing to “stick” – but also, as may be seen in the text at hand, in spite of the vagueness and fluctuations of his program, even on crucial matters of social policy like health care reform. Indeed, this report published by NBC News on the campaign trail on March 3 (i.e., the night after Super Tuesday) and entitled “Donald Trump Reveals Details of His Health Care Plan,” delineates Trump’s proposals for health care, after months of obfuscation, if not doublespeak, most strikingly on the future of President Obama’s Patient Protection and Affordable Care Act.

Published the very day when they were released, the NBC News report emphasizes that Donald Trump’s health care proposals purport to abrogate what they refer to as “Obamacare,” by repealing its most significant measure, the “individual mandate,” i.e., the requirement for every American to buy insurance for themselves and their family or pay a fine. As the reporter immediately points out in something of an understatement, merely noting that this is something “new,” the proposal is in fact a huge turnaround for the Republican candidate since less than a month before, he was still praising the mandate, even somewhat boasting that this made him an unconventional conservative.

Besides the scrapping of the individual mandate, Donald Trump’s proposals are altogether straightforward market-based, fiscally conservative ones:

– stimulating competition for insurance across state lines (in the hope of driving premium prices down)

– allowing Americans to deduct insurance premiums from their tax returns (which, incidentally, would benefit only the 55% richer Americans actually paying federal income tax…)

– liberalizing the pharmaceutical drug market, both liberating it from government control and opening it to foreign competition, in order to bring prices down too.

The NBC reporter adds three more measures:

– the somewhat cryptic proposal that government might support if not fund programs in favour of the mentally ill

– returning to a hobbyhorse or pet peeve of Donald Trump’s in this campaign, i.e. the fight against illegal immigration, his plan claims that cracking down on the latter and curbing immigration itself might lead to savings of up to $11 billion annually in health spending (a somewhat surprising claim given that legal immigrants have to wait five years to be eligible for programs like Medicaid, and illegal immigrants are denied coverage entirely anyway)

– last but not least: perhaps because he is primarily concerned with Donald Trump’s apparent change of heart regarding Obamacare, the journalist mentions only in passing a momentous reform of Medicaid, which would consist in turning the federal program into a block grant scheme, i.e. a scheme similar to the one applied to welfare since 1996 (and the passing of TANF).

Commentary

As I pointed out in my introduction, Donald Trump’s shifting position on health care – specifically on the Affordable Care Act – is an interesting example of the ambiguities of his populist candidacy within the Republican Party, but also of the G.O.P.’s ideological stance regarding government and social policy, and, beyond, the very place of social protection in American culture itself. Indeed, as  shall be seen first, the text emphasizes a rare retreat on Donald Trump’s part, which, more than a tactical choice, reveals what a litmus test opposition to “Obamacare” remains among Republicans today. In a second part, I shall attempt to offer explanations as to why it is so – why, in other words the signature legislation of President Obama’s administration immediately became and remains so controversial among conservative Republicans (and other Americans too), before addressing the peculiar situation of health and health care in the American conception of social protection and the Welfare State.

Since he entered the Republican campaign last year, Donald Trump’s successful populist strategy has consisted in him being “his own man” and flaunt his indifference not only to good taste but to any sense of “ideological purity”, going farther to the right than any major Republican candidate in recent history (perhaps even more so than Pat Buchanan in 1992), whilst also challenging mainstream conservative dogma (for instance his opposition to free trade, his attacks against the financial industry or his quasi-Rooseveltian advocacy of public investment in infrastructure).

Yet, such is not the case of his “Health Care Reform to make America great again,” which, has been seen, contradicts some of Donald Trump’s previous, though admittedly vague statements, during the campaign, and constitutes a  straightforward conservative agenda, and even a fairly radical one when it comes to reforming Medicaid, by turning the federal program into a block grant scheme, i.e. a scheme similar to the one applied to welfare by TANF in 1996. [1]

Even more striking, however, is Trump’s turnaround on the Affordable Care Act. After months of appearing to actually endorse it as a whole, especially the individual mandate – in some interviews earlier in the campaign, even suggesting he might favor universal government-sponsored health care coverage – Donald Trump thus finds himself somewhat backpedalling, returning to the “fold,” realigning himself with most GOP  leaders and candidates, from moderates like John Kasich (the Governor of Ohio who  accepted the money allocated by the Affordable Care Act’s expansion of Medicaid, though he otherwise rejected the rest of the law) to extremists like Ted Cruz, the US Senator from Texas who, over his past mandate, has repeatedly proven that he is ready to have the federal government shut down or even have his country default in order to block Obamacare.

Perhaps Donald Trump’s realignment has to do with the circumstances. Published the day after his Super Tuesday triumph, when he won seven out the eleven states that were in play, these proposals might be the sign that he already perceived himself as the likely Republican presidential candidate and, seeing beyond his party’s primary and Convention, set out to position himself against his future Democratic opponent, either Hillary Clinton or Bernie Sanders. His apparent retreat on the question of the individual mandate also shows what a volatile subject Obacamare remains even six year after it was passed: that President Obama’s signature legislation remains not just a « political football » for Republican politicians, but something of a litmus test among conservative voters themselves. [2]

–> Nature of the Affordable Care Act / Circumstances of the passing of the vote / Fierce opposition among Republican politicians and conservative voters (a lot of it crystallizing their hostility to if not their hatred of President Obama himself) <–

Finally, what this controversy illustrates yet again, is the peculiar position of health, and health care in the U.S.’s history of social reform, and within its Welfare State. Indeed, while, contrary to common knowledge, the US does have a fairly generous Welfare State, health care for the majority of Americans (who are not old, disabled or poor) has long been a weak link. Unlike the universal (or quasi-universal) solidaristic, public, taxpayer-funded systems in comparable Western countries like the UK (with the NHS), France or even  its Canadian neighbor, the US has a predominantly individualistic, market-oriented and privatized system (with the exception of the federal programs of Medicare and Medicaid).

In this light, and as we saw in previous work (i.e., Recording n°5), there is a striking difference between the American society’s conception of health care within the framework of its social policies and, say, a society like the British one that conceived health care reform as the cornerstone of its Welfare State – disease being perhaps the greatest of the five giant evils which William Beveridge had targeted in his 1942 report (along with idleness, ignorance, squalor and want) and the 1946 National Health Service Act (which created the NHS and effectively nationalised medicine in the country) being by far the most important social measure passed by the Attlee government after the war, together with the 1946 National Insurance Act (which enforced social security for the aged, widows, orphans, the unemployed and maternity).

Conversely, healthcare coverage did not prove to be a priority, even to some of the most progressive, most liberal administrations in the 20^th century:

– during the New Deal, no significant program for health care was launched by the FDR administration (as opposed to the momentous social reforms it enforced on employment, labour relations, social security, pensions, welfare, or even education).

– LBJ’s administration did enact Medicare and Medicaid, but though many of its advocates expected the former program to cover more and more Americans if not all of them, and though a majority of Americans have consistently favoured expanding it more and more,  at least to people between the ages of 55 and 64, it never happened…

– reforming the health care system was one of the Clinton administration’s memorable failures, with the demise of the “HillaryCare” program promoted by the former First Lady (in 1992-1994).

– even President Obama was forced to give up on his most ambitious idea of a « public option » to have the ACA enacted…

Given the rather mediocre numbers regarding health in such a highly developed country, this reluctance or inability to effectively overhaul the health system remains something of a mystery…

[1] The purpose of the measure seems to be to force savings on states. Currently, the federal government picks up between 51% (in the case of states like Massachusetts, New Hampshire and Wyoming) and 76% (in Kentucky) of the « Medicaid tab, » no matter how large. With block grants, the states would be encouraged, if not forced to curb spending, and would also be granted a high degree of discretion in the way they spend these funds (though states are already relatively free to establish their own eligibility criteria: in some states, only extremely poor parents qualify for coverage, and childless adults are excluded entirely). All of which, of course, is anathema to defenders of the integrity of the program as it was initially created, liberals and progressives in particular.

[2] Incidentally, one must notice that Donald Trump appears to have  nothing to say about other crucial features of the law, such as the protection of patients with pre-existing conditions.