Republican presidential front-runner Donald Trump released a long-awaited healthcare plan Wednesday evening that includes ideas that have been popular with Republicans for years and doesn't do much to distinguish himself from his rivals in the area of health policy.
Trump posted his plan the day after a strong showing on Super Tuesday, where he won seven states. He had taken direct attacks from opponents for not releasing any details beyond wanting to repeal and replace the Affordable Care Act. He has also had statements favorable of the individual mandate and government-provided coverage thrown back at him.
Tom Miller, a fellow with the American Enterprise Institute, a conservative think tank, said Trump's plan looks like a poorly outlined version of previous House Republican proposals.
“It's sort of singing karaoke to the songs others have written,” he said.
Trump's website introduces the plan with a tirade against the ACA, saying "Obamacare has raised the economic uncertainty of every single person residing in this country."
He pledges to immediately repeal the ACA. He says that his plan is based on free-market principles.
The seven-point plan calls for making Medicaid a block grant to the states, offering an individual tax deduction to buy coverage and allowing insurance companies to sell plans across state lines. The plan also calls for "allowing individual health savings accounts," which are already in use by 19.7 million Americans, according to America's Health Insurance Plans.
Trump also says he would allow the importation of foreign prescription drugs and require price transparency, a provision already in the ACA. He does not mention allowing Medicare to negotiate prices with pharmaceutical companies, which he has previously endorsed.
He shares some basic ideas with his remaining primary opponents. Florida Sen. Marco Rubio has also proposed Medicaid block grants and calls for an individual tax credit to buy insurance. Texas Sen. Ted Cruz has pushed allowing insurance to be sold across state lines and health savings accounts. He has also said health insurance should be delinked from employers.
Marc Goldwein, senior vice president of the bipartisan Committee for a Responsible Federal Budget, said even rough estimates of how Trump's plan would play out are difficult to determine without more details.
"There's still not a lot of 'there' there," he said.
The plan has pieces that would reduce costs, but it would probably also reduce coverage by about 20 million people annually. Proposing the block grants without stating how much states would receive creates a big question mark as well, he said.
The Trump campaign says their candidate is only getting started, and that more is coming.
"Frankly, right now nobody has a comprehensive plan," Sam Clovis, the campaign's national co-chairman, said in an interview with the Associated Press.
"Nobody has a bill that they put together, and it serves no useful purpose to do that," Clovis added. It would only allow critics to "nitpick you to death."
Trump has claimed that his plan for Medicare to negotiate prescription prices would save $300 billion, which is about what the whole country spends on such medications in a year.
Edwin Park, vice president for health policy at the progressive Center for Budget and Policy Priorities, said Trump's plan would do away with years of progress in decreasing the rate of uninsured and making healthcare more available and affordable.
“You actually move the U.S. backward from before the Affordable Care Act,” he said.
Financing Medicaid with a fixed block grant would force states—which are not known for healthy budgets—to cut benefits, tighten eligibility requirements and lower provider payments. States that go through particular economic struggles would have trouble absorbing the costs of a likely landslide of new beneficiaries, Park said.
Chris Jennings, a Democratic healthcare strategist who was a senior adviser to the Clinton and Obama administrations, said he would expect a major change to Medicaid if Republicans win the White House and maintain control of Congress.
“They don't believe (Medicaid beneficiaries) are their voting bloc,” he said. “They will cap expenditures. What they'll do is say 'it's still up to the states to expand Medicaid.' But the states will conclude that they can't afford to do that. Then there will be more uninsured people.”
Park said Trump's tax deduction plan would take away an incentive for employers to offer health coverage and would do little to help the uninsured, who are almost exclusively in lower tax brackets and wouldn't receive a substantial deduction.
“And we know that affordability is the primary reason people aren't able to obtain coverage,” he said.
The proposal to allow interstate selling of health insurance plans would likely create an unlevel playing field with out-of-state insurers cherry-picking the healthier beneficiaries. Republicans particularly pushed the idea in the George W. Bush administration, but some experts believe it would lead to adverse selection, he said.
“The concern has always been that insurers would then go get licensed in states with the least regulation,” Park said.
Miller said the vagueness of the plan isn't likely to matter much for voters considering Trump. Healthcare hasn't been a top concern for primary voters so far and has been an infrequent debate topic.
“He'll say I have as detailed a plan as the rest of you (candidates), and he'll be pretty close to right," he said.
The Associated Press contributed to this report.
