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 released a seven-point 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.
'Attitudes and aspirations'
Trump’s positions are “based on attitudes and aspirations, not plans,” said former Health and Human Services Secretary Michael Leavitt, who served under Republican President George W. Bush.
“It is clear he underestimates the complexity and has not contemplated many of the dilemmas he would face,” added Leavitt, now heading a health care consulting firm.
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.”
“It is still something of a mystery,” said economist Joe Antos of the business-oriented American Enterprise Institute.
The Trump campaign says its 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, 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.
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, Holtz-Eakin 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.
People need access
Trump’s bottom line seems to be that people need access to health care.
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.
“Every Republican wants to do a big number on Social Security, they want to do it on Medicare, and they want to do it on Medicaid. And we can’t do that,” Trump said last year at a Republican forum in New Hampshire. That would not be fair to people who have paid in for years.
Trump’s 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.
If Trump wins the nomination, “we are going to be in a position where our nominee would not agree with the Republican House and Senate caucuses,” said GOP pollster Bill McInturff, who follows health care closely.
Clovis said Trump believes the economy comes first. “It’s not the right thing to be talking about how to fix our entitlement programs until we have an economy that is fixed,” he explained.
But the consensus among experts is that overextended benefit programs could eventually damage the economy, and it’s less painful to address problems now than in a full-blown crisis.
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 shoot up.
Associated Press researcher Monika Mathur contributed to this report.