Super Tuesday propelled businessman and reality TV star Donald Trump into a strong position to capture the Republican nomination for the White House.
Throughout the campaign, Trump has left many scratching their heads over his healthcare positions. He defied GOP orthodoxy by saying the federal government should negotiate with pharmaceutical companies to bring down drug prices. He suggested at one point that he supported the Affordable Care Act's individual insurance mandate, but later clarified he meant only that insurance companies should not be able to deny coverage because of pre-existing conditions.
Trump has now posted a seven-point plan for healthcare. The first action is to repeal the ACA, and much of the rest likewise mirrors ideas circulated by conservative policy experts and lawmakers.
Tom Miller, a fellow with conservative think tank the American Enterprise Institute, said Trump's plan looks like a poorly outlined version of House GOP 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.”
The plan calls for making Medicaid a block grant program, offering an individual tax deduction to buy coverage and allowing insurers to sell plans across state lines. The plan also calls for allowing individuals to use health savings accounts, which are already used by 19.7 million Americans, according to America's Health Insurance Plans.
Trump also said he would allow foreign prescription drugs to be imported and require price transparency, a provision already in the ACA. He did not mention allowing Medicare to negotiate prices with pharmaceutical companies.
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 for 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 work are difficult to determine without more detail. The plan has pieces that would cut costs, but it would also probably reduce coverage by about 20 million people annually. Proposing Medicaid block grants without stating how much states would get creates a big question mark, he said.
The Trump campaign said their candidate is only getting started and more is coming. “Frankly, right now nobody has a comprehensive plan,” Sam Clovis, the campaign's national co-chairman, told the Associated Press. “Nobody has a bill that they put together, and it serves no useful purpose to do that.”
Trump previously claimed that his plan for allowing Medicare to negotiate prescription prices would save $300 billion a year, which fact-checkers pointed out is roughly equivalent to all U.S. drug spending in 2014.
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 keep 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.”
Miller said the vagueness of the healthcare plan isn't likely to matter much for voters considering Trump. “He'll say, 'I have as detailed a plan as the rest of you (candidates),' and he'll be pretty close to right.”
