White House Weighs September Rollout of Health Plan

The Trump administration is considering releasing its long-promised health-care plan in the fall as part of a campaign strategy to offer an alternative to Democratic candidates who back Medicare for All, according to people familiar with the discussions.

White House officials are discussing unveiling the proposal during a September speech in which President Trump would seek to draw a contrast with Democrats while reassuring voters the administration is prepared if the courts abolish the Affordable Care Act. The timing of the speech could shift, officials said.

Elements of the plan could include providing coverage for people with pre-existing conditions, the people said, and spurring the sale of insurance across state lines. Other provisions being discussed include giving states more flexibility, expanding health savings accounts, linking price transparency to quality metrics, and more insurance options for consumers, they said. The plan would include a number of new elements that haven’t yet been released, one person familiar with the work said.

White House officials stressed that the plans haven’t been completed, and some close to the president have privately expressed skepticism. One former White House official raised the possibility that the plan may not materialize this fall if Mr. Trump second-guesses the effort. The administration is also still weighing how specific the plan should be, the people familiar with the plan said, and the ideas have yet to get Mr. Trump’s sign off.

“President Trump has said we will protect people with pre-existing conditions, lower drug prices, end surprise medical bills, and make sure Americans get the highest quality of care they deserve,” White House spokesman Judd Deere said in a statement.

Kellyanne Conway, a senior adviser to the president who is involved in the discussions, met recently with House Republicans to brief them on the progress of the administration’s efforts, two people present said. She stressed that the administration’s plan would protect pre-existing conditions and she reviewed possible legal outcomes in the lawsuit to strike down the ACA. She is planning to brief Senate Republicans after they return from their August recess.

The push to put out a plan, which has already involved months of behind-the-scenes work, underscores growing concern on Mr. Trump’s team that the president could be vulnerable on health care. A recent Fox News poll of registered voters found Democrats had a 14-point advantage over Republicans on which party would do a better job handling the issue.

The administration is backing a lawsuit from GOP-led states to strike down the ACA, a stance that leaves Mr. Trump open to attacks from Democratic presidential candidates who say he is a threat to coverage.

“We are the Democrats. We are not about trying to take away health care from anyone,” Sen. Elizabeth Warren of Massachusetts said in the second Democratic debate in Detroit this week. “That’s what the Republicans are trying to do.”

The case may not be fully resolved until next year, placing health care at the center of the 2020 presidential campaign. An estimated 20 million people have gained coverage because of the ACA, and more than 100 million people with existing medical conditions could see their coverage lost or become more expensive if the law is struck down.

The White House has already released initiatives or been working on regulations that would accomplish some of the goals that could be in the president’s plan. But his fall proposal, if released, could go further—for example, calling for state or state and federal high-risk pools, which aim to provide coverage to people who can’t get insurance because of expensive pre-existing health conditions, according to one person familiar with the planning.

“They definitely want to show they’re protecting pre-existing conditions,” said one GOP Hill staffer familiar with the discussions.

Parts of the plan would probably require congressional action, which is unlikely because the House and Senate remain divided.

The plan could call for grants to states to establish high-risk pools or programs that pay a portion of high-cost claims to buffer insurers and help drive down premiums. High-risk pools were used by more than 30 states and covered more than 200,000 people before the ACA, but some people had trouble getting coverage as states capped enrollment amid funding pressures.

The return of high-risk pools has been a longtime Republican goal; House Republicans pushed for the creation of a $15 billion federal high-risk pool in their proposals to replace the ACA. Critics say they cost too much money and have a long history of problems.

Mr. Trump may also lay out new strategies to jump start the sale of insurance across state lines, an idea he included in his 2016 campaign platform. The Centers for Medicare and Medicaid Service in March sought public input on how to eliminate barriers to such sales, which are already permitted, but have had few takers. Mr. Trump has also said he wants to let people on Medicare contribute to health savings accounts.

The proposal could also call for more action to link price information in health care to quality. Actions to provide more alternative forms of insurance that don’t comply with ACA regulations and consumer protections are also being discussed, one person familiar with the planning said.

The tentative release of a more complete plan in September is part of a broader strategy ahead of the 2020 election. The White House is planning to ramp up Mr. Trump’s speeches and actions on health care this fall because polls show it is a top issue for voters. The administration has already unveiled new efforts on a range of health-related issues, from improving kidney health to making it easier to import prescription drugs from other countries.

But skepticism abounds because Mr. Trump has repeatedly promised a health plan without delivering one. During the GOP push to repeal the ACA in 2017, he said he was close to finishing a plan that aimed to provide “insurance for everybody.”

Fault lines have emerged within the White House over how to accomplish aspects of the plan and how specific to be largely because of concerns it could open Mr. Trump up to attacks from Democratic presidential candidates, according to two people familiar with the discussions.

Yet allies of Mr. Trump believe it would give a boost to the president even though Congress is unlikely to take action on any of the ideas that require legislation.
At the White House, regular meetings on broad health-care strategy are being led by Domestic Policy Council Director Joe Grogan, with participation from Centers for Medicare and Medicaid Services head Seema Verma, Health and Human Services Department officials, and senior aides from the National Economic Council, Council of Economic Advisers and other White House offices, according to people involved in the talks.

 

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