photo illustration of Ben Franklin wearing a health care mask and bonnet on a one hundred dollar bill

Trump’s second term healthcare agenda

The health care vision of the two political parties in America could not be more different. Democrats and those on the left want to see government play a much larger role than it already does. Many on the left support a single-payer system in which the government is the sole purchaser of health care, and all Americans would be enrolled in one large plan. Those on the right want a much more decentralized system but, typically can’t come to any consensus among each other about what the future of health care should look like. This was most prominently on display during the repeal and replace debacle of 2017.

While the Trump administration’s top health care priority, repealing and replacing Obamacare, failed, other pieces of policy enacted through executive order and agency rulemaking have been enacted that brought about meaningful reform. These include the expansion of association health plans, short-term limited-duration insurance, and health reimbursement accounts. Enhanced price transparency measures have also been enacted and an expansion of the waiver concepts for Section 1332 of Obamacare.

While it seems Obamacare is here to stay for the foreseeable future, the Trump administration needs to communicate its healthcare agenda to the American people for a potential second term. A clear policy agenda on healthcare is needed because it is one of the most important issues for voters.

Brian Blase, former special assistant to President Trump and Lanhee Chen of Standford University discussed a list of policies in the Washington Times that should drive the Trump healthcare agenda in his second term. Here is what they recommend:

  • Universal health savings accounts
  • Confront the consolidation in healthcare
  • Improved access to care through telehealth, licensure reform, and scope of practice reform
  • Return state’s flexibility to regulate insurance markets
  • Improve the financial state of Medicare and Medicaid

I have written about several of these issues and their impact on North Carolinians.

First, health savings accounts (HSA) should be more widely adopted. Patients would enjoy the ability to set aside tax-free dollars for health expenditures to use as they wish. By law, the only individuals who can use an HSA are those enrolled in a high deductible health plan. As employer-sponsored health insurance becomes more expensive, employers are shifting more costs to the employee in the form of higher deductibles. This means that more out of pocket expenses will be paid for through HSA’s, and this arrangement pairs nicely with some of the more recent Trump administration policies on price transparency. 

Second, consolidation in health care. There’s no denying the rate of consolidation among providers and insurers is alarming. Increased market power for some and dwindling negotiation space for others in the health care purchasing process harm patients as they are usually the ones left on the hook for all of the higher costs that usually come after large hospital consolidations. Policies that encourage consolidation need to be reexamined.

Third, increased access to care. Telehealth was one solution to the COVID-19 pandemic as individuals sheltered in place began to seek care virtually at exponentially higher rates than before the pandemic. Health care providers traveled out of state and practice at the top of their license to aid the country’s response. Most of this activity was allowed by the removal of restrictive regulations. The administration should work with Congress and the states to make these permanent.

Fourth, returning state flexibility in the insurance markets. One of Obamacare’s most problematic parts was the usurpation of the individual healthcare markets in states. States are better equipped and have better information on how to structure their insurance markets that bureaucrats in Washington. The administration could work with Congress to bolster state control of regulation and subsidies to improve health insurance markets and lower premiums.

To stave off single-payer proposals, the President and Republicans in Congress need to work to reform the country’s healthcare system further. Decentralization, choice, competition, and patient-centered health care should be the guiding principles.

Jordan Roberts / Health Policy Analyst

Jordan joined the Locke Foundation in the summer of 2018 as Health Care Policy Analyst. He analyzes state and national health policy issues with an eye toward removing governm...

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