President Donald Trump on Thursday signed an executive order on the topics of protecting people with preexisting conditions and surprise billing that will have little practical consequence as he works to bolster his healthcare record.
Trump has faced criticism from Democrats for advocating that the entire Affordable Care Act be struck down in court, including the law's protections for people with preexisting conditions. Trump timed the orders with a speech to outline his healthcare vision, which highlighted existing policy priorities and did not offer a plan to replace the Affordable Care Act.
A Supreme Court vacancy created by the late Justice Ruth Bader Ginsburg has cast new urgency on the possibility that the ACA will be struck down, as the Supreme Court will hear a case on the issue a week after Election Day.
"If we win, we will have a better and less expensive plan that will always protect individuals with preexisting conditions. If we lose, what we have now is better than the original version of Obamacare," Trump said, though he did not outline a replacement plan on Thursday.
HHS Secretary Alex Azar said the president would sign an executive order clarifying that it is the policy of the United States to protect people from insurance discrimination based on preexisting conditions. The protections are existing law under the ACA. Trump said the order is intended to signal he will not sign healthcare reform legislation without protections for people with preexisting conditions.
"The Democrats like to constantly talk about it. And yet preexisting conditions are much safer with us than they are with them. And now, we have it affirmed, signed and done so we can put that to rest," Trump said.
Azar said some individual market plans have high deductibles and are unaffordable and the order is intended to signal that Trump would preserve the protections if the ACA is struck down, though that action may have to go through Congress.
During his speech Trump touted the expansion of short-term, limited-duration insurance plans, which do not have to adhere to the ACA's requirements to protect patients with preexisting conditions.
The second executive order would instruct HHS to work with Congress to achieve reform on surprise medical bills, as the agency has been doing for months. The order does not detail a strategy to resolve the standstill lawmakers have reached over how insurers should be required to pay for out-of-network care.
If no balance billing reform is achieved by Jan. 1, the order would ask HHS to "investigate regulatory actions" that could be taken on the issue.
Sen. Bill Cassidy (R-La.), who was present at Trump's speech, released a statement calling for legislative progress on banning balance billing.
"I have worked with Chairman [Lamar]Alexander to reach a legislative agreement that is supported by a robust bipartisan, bicameral coalition. Congress should swiftly pass this bill to protect Americans from outrageous surprise medical bills," Cassidy said. Other health policy issues that Trump addressed included lowering prescription drug prices, promoting hospital price transparency, making telehealth expansions permanent, domestic manufacturing, electronic health records and HSA expansions.
Trump announced a new plan for Medicare beneficiaries to receive a discount card in the mail with $200 to help pay for prescription drug copays, but his administration has not detailed any related policy. A White House spokesman said that the program would be paid for in part using supposed future savings from an international reference pricing plan that has not yet begun to be implemented.
Democratic presidential nominee Joe Biden has proposed building on the ACA by offering a public insurance option on insurance exchanges and increasing subsidies and banning surprise billing.