Trump stands apart from party on some proposals.
He releases outline, parts of which split from GOP stands
Washington — Donald Trump’s evolving ideas on health care do not amount to a full plan, and some proposals could mean new political and policy dilemmas for the Republican presidential front-runner and his party.
One Trump idea — allowing Medicare to negotiate prescription drug prices — puts him at odds with Republican congressional leaders who favor the current system of private benefit managers bargaining with drug-makers. It aligns Trump with Democrat Hillary Clinton, who also favors direct negotiation by Medicare.
The Trump campaign late Wednesday released a sevenpoint outline for replacing President Barack Obama’s health care law and said it was based on “free-market principles.” It included standard GOP ideas such as health savings accounts and no health insurance mandates, along with a proposal not usually floated by Republicans — permitting the importation of lower-cost prescription drugs from abroad.
“As far as substance is concerned, it is a very, very long way from a plan you could actually put in place,” said economist Joe Antos of the business-oriented American Enterprise Institute. “It is still something of a mystery.”
Antos is part of a group of conservative policy experts who recently produced a blueprint for replacing Obama’s health overhaul.
Trump’s plan “is not strictly a replacement for Obamacare,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. “There’s no question Trump’s plan would cost less than Obamacare, but it would also cover fewer people.”
The Trump campaign says its candidate is only getting started and that more is coming.
“Frankly, right now nobody has a comprehensive plan,” said Sam Clovis, the campaign’s national cochairman.
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.
That “feels like he is just winging it and making it up,” said Douglas Holtz-Eakin, a former Congressional Budget Office director and now president of the American Action Forum, a center-right think tank.
Clovis clarified that the $300-billion figure would include savings from other actions, such as cracking down on waste, fraud and abuse.
But after reading the latest proposals from Trump, HoltzEakin said: “It looks to me like this is the staff putting the genie back in the bottle.”
If Trump’s plan is a work in progress, his own statements provide a rough guide to his views.
A standard refrain is that as president he will not have people “dying in the street” just because they are unable to afford treatment. He has said he would do a deal with hospitals, but it’s not clear how the hospitals would be paid.
In the past, Trump indicated that he was open to looking at a government-run health care system like Canada’s — what Vermont Sen. Bernie Sanders is proposing in the Democratic presidential primary. That’s “not at all” the case anymore, said campaign official Clovis.
Unlike many Republicans, Trump says he adamantly opposes cuts to social programs for the elderly, the disabled and the poor.
His stance on Medicare and Medicaid seems to put him in conflict with House Speaker Paul Ryan (R-Wis.). Ryan has advocated overhauling both programs, channeling future retirees into a privatized Medicare and limiting federal costs for Medicaid.
On the health law — a molehill compared with Medicare and Medicaid — there’s no apparent difference between Trump and other Republicans. Calling the program a disaster, Trump has embraced the GOP’s “repeal and replace” mantra. But he doesn’t favor going back to the days when insurers could turn down people with medical conditions.
That raises another potential problem: If Trump has no requirement for healthy people to get coverage, and those in poor health can still get a policy, premiums would only shoot up.