The health care legacy of President Trump
Let’s take a look back at President Trump's 2016 health care objectives and his measure of success in achieving them.
With each passing day, it becomes more definite that President Trump’s time in office has come to an end. The health care legacy he laid claim to upon taking office in 2016 eluded him. But as he leaves office, he leaves behind a legacy nonetheless. Let’s take a look at his 2016 health care objectives and his measure of success in achieving them.
1. Dismantle Obamacare
President Trump stormed into the White House promising to dismantle Obamacare and all that it stood for. He vowed to replace it with a national health insurance plan that offered coverage to more Americans for less money, one that would also ensure that insurance companies and health care systems would be more viable than ever.
He achieved key components, such as eliminating the penalty for failing to buy insurance on the exchange and took credit for dumping the Cadillac tax, which in truth neither party endorsed. He fought for and won the right for no-frills short-term policyholders to extend their coverage.
But Republicans were unable to cobble together an alternative to it, and it remains the law of the land. Biden has vowed to undo many of his revisions. If the goal was to eliminate Obamacare, he failed.
2. Prescription drug pricing and sourcing
On the surface, at least, Trump has championed major reforms in pricing and sourcing. His odd mix of “Buy American” and “contain drug price escalation” sought to bring more production back to the states–where costs tend to be higher than in offshore fabs. But if you back out the significant caveats on foreign dug sourcing, Trump has consistently sought to bring drug prices under control.
3. Transparency
Directly related to his determination to address drug costs: his consistent attack on the lack of transparency around prices in prescription drugs, insurance and health systems.
His major accomplishments here won’t kick in till after the new year. But his championing of new rules that will require health insurers, self-insured health plans, employer-sponsored health plans and health care systems to share details around pricing truly moved the dial on transparency in health care.
4. Medicaid reform
Here the president carved out a mixed record that revealed his knack for appealing to multiple special interests. Apart from being philosophically opposed to Medicaid, Trump applied the same “death of a thousand small cuts” approach that he was forced to use on Obamacare. Are people on Medicaid lazy? Force them to work! Is abortion morally wrong? Bar Medicaid funds from going to qualified providers that separately provide abortions, such as Planned Parenthood! Medicaid expansion raising your blood pressure? Let’s stop it!
But for the most part, Trump failed to seriously undermine Medicaid.
5. LGBTQ+, and reproductive rights protections
Playing shamelessly to the Christian Right and other ultra-conservatives, Trump build a legacy of attacks against anyone whose sex life or approach to reproduction was not based upon “The Waltons.”
LGBTQ+: In 2020, his administration jammed through a new rule that would have ended nondiscrimination protections for LGBTQ people seeking health care. That one was shot down by the U.S. Supreme Court.
Reproductive rights: But the same court upheld his administration’s rule allowing health plan sponsors who oppose abortion to withhold coverage of birth control for plan members. Trump pushed through a rule barring federally funded health care providers in the Title X family planning program from referring patients for abortions. He leveled several blasts at Planned Parenthood. His campaign against choice was relentless and multifaceted. But the new administration is likely to undo most of this misogynous masterpiece.
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