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President Donald Trump has long pledged a “phenomenal” replacement for the Affordable Care Act. On Friday, he signed several executive orders on health care and announced at a North Carolina rally that he was unveiling a historic plan, the American First Healthcare Plan.
What he announced wasn’t historic, or even much of a plan. Instead, his orders were simply statements of intent to lower health care costs and to protect pre-existing conditions without any policy details.
Likewise, the administration’s plan to send $200 drug discount cards to 33 million American seniors — some of them before the Nov. 3 election — is short on specifics. The proposal, which would cost $6.6 billion, doesn’t have a clear funding source.
As such, this feels much more like a campaign ploy than a serious effort to lower costs and to ensure that Americans have access to needed medical care and medications.
So on Friday, the president was in the odd position of touting the patient protections in the Affordable Care Act, while also telling the cheering audience that his administration was actively working to overturn the entirety of the ACA, including those provisions that he praised
“We were able to terminate the individual mandate, but kept the provision protecting patients with preexisting conditions,” Trump said in Charlotte.
This isn’t entirely true.
As part of a Republican tax cut bill, a penalty for not having health insurance under the ACA — the individual mandate — was removed from the law. A group of Republican attorneys general and governor sued the federal government, arguing that if the penalty was gone, the individual mandate was essentially eliminated and the whole law should be declared invalid. The Trump administration has backed the lawsuit.
The U.S. Supreme Court will hear arguments in the case a week after Election Day.
If the law is deemed unconstitutional, millions of Americans will lose their health insurance, because Republicans have failed to put an alternative into place. In addition, even those with insurance that is provided by their employer will likely lose some coverage and benefits that were mandated by the ACA or pay higher costs. Maine lawmakers passed a law last year to include many of the ACA’s protections in state law.
“Simultaneously with all of this, we are joining in a lawsuit to end this ill-conceived plan. I’m in court to terminate this really, really terrible situation,” Trump said in North Carolina.
“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 — the original version of Obamacare, by far. Much better. Much better. Again, we will always protect patients with preexisting conditions.”
The problem is that there is no “better and less expensive plan” and no actual protections for pre-existing conditions.
Despite being in office for nearly four years — all of them spent criticizing the Affordable Care Act — the president has never offered an alternative plan. He has chipped away at the ACA through administrative orders, but he and his Republican colleagues in Congress have not presented a viable, comprehensive alternative to the ACA.
So, if the Supreme Court strikes down the ACA, there currently is no alternate comprehensive health care plan for millions of Americans or a specific plan to protect those with pre-existing conditions.
The more prudent path has long been to improve the ACA rather than repeatedly threatening to repeal, overturn and invalidate it without a genuine replacement.