President Trump said last month, ‘We’re signing a health-care plan within two weeks, a full and complete health-care plan.’
Photo: Andrew Harnik/Associated PressWASHINGTON—President Trump has missed a self-imposed deadline to release a comprehensive health-care plan and has said he would issue an executive order on pre-existing conditions that public-health specialists believe would be difficult to execute because of legal and economic hurdles.
Mr. Trump said Friday that over the next two weeks he would be “pursuing a major executive order requiring health insurance companies to cover all pre-existing conditions for all customers.” The Obama-era Affordable Care Act already requires that, but the administration is supporting a Republican-led lawsuit that could invalidate the health law.
In a July 19 interview on “Fox News Sunday,” Mr. Trump said: “We’re signing a health-care plan within two weeks, a full and complete health-care plan.” The two-week mark passed in early August with no action by the president.
The recent pledges have drawn attention to a challenge facing Mr. Trump: Neither he nor his campaign have identified a second-term health-care agenda, and his administration lacks a clear plan if the Supreme Court strikes down the ACA. The Supreme Court appears unlikely to hear the case before Election Day.
White House spokesman Judd Deere said that Mr. Trump has already accomplished a lot on the health front. “While Democrats have continued to propose radical plans that would destroy the health insurance of millions of Americans, President Trump continues to work to improve health care more broadly and stabilize the market, including creating a system that protects the vulnerable, lowers prescription drug costs, increases transparency and delivers the affordability Americans need, the choice and control they want, and the quality they deserve,” Mr. Deere said.
He added that “there will be more action in the coming weeks to build on his longstanding commitment to protect those with pre-existing conditions.”
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Democrats have stepped up criticisms of Mr. Trump on health care, and presumptive Democratic presidential nominee Joe Biden’s campaign launched ads in Iowa emphasizing his own focus on health care, while accusing Mr. Trump of destroying the ACA, which expanded health coverage to tens of millions of uninsured Americans.
The Democratic strategy played well in the 2018 midterms when Democrats regained the House and took nine governorships by portraying Republicans as a threat to health coverage and protections for people with pre-existing conditions.
A Gallup survey released in January found that 81% of Americans said candidates’ views on health care were either extremely important or very important in influencing their votes for president—higher than any other issue.
“Donald Trump promising to protect people with pre-existing conditions is like Hannibal Lecter promising to protect vegetarianism,” said Jesse Ferguson, who served as a spokesman for Hillary Clinton’s 2016 presidential campaign.
At a press briefing Monday, Mr. Trump said the order wouldn’t change the law but was “just a double safety-net.”
“Just to let people know that Republicans are totally and strongly in favor of pre-existing conditions—taking care of people with pre-existing conditions,” Mr. Trump said. “It’s a signal to people. It’s a second platform. We have pre-existing conditions, will be taken care of, 100%, by Republicans and the Republican Party. I actually think it’s a very important statement.”
If the ACA is invalidated, any new requirement for covering pre-existing health conditions would cause premiums to soar unless such a mandate also included subsidies to offset the costs of health insurance, health-care experts said. The ACA currently provides subsidies to millions of people that offset premium costs.
The ACA also bans insurers from charging higher rates to people with pre-existing conditions. Requiring that insurers provide coverage without also restricting the ability to impose higher premiums on those customers would make the coverage unaffordable, health-care experts said.
“To make coverage of pre-existing conditions sustainable, you also need subsidies to make sure coverage is affordable and healthy people enroll as well as those who are sick. Otherwise, premiums would skyrocket,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, which provides information and data on health policy issues.
Some experts also said a blanket requirement for covering pre-existing conditions wouldn’t be legal, since insurers are regulated by states.
Kristine Grow, a spokeswoman with America’s Health Insurance Plans, a trade group for the industry, declined to comment until any executive order is public.
One option for Mr. Trump would be to push 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. 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. Mark Meadows, the White House chief of staff, has been a supporter. Critics say they cost too much money and have a long history of problems.
From the Archives
Mr. Trump has repeatedly promised to produce a health plan, but a public proposal has yet to materialize. During the failed GOP push to repeal the ACA in 2017, he said he was close to finishing a plan that aimed to provide “insurance for everybody.” In 2019, White House advisers discussed unveiling the proposal during a September speech. While work was done on a plan, the advisers ultimately scrapped it because it relied too heavily on subsidies, according to one person familiar with the discussions.
So far, Mr. Trump’s health-care agenda has largely focused on price transparency in billing and curbing drug prices, with the president on July 24 signing executive orders aimed at furthering those initiatives. One of the orders focused on pegging the cost of drugs in the U.S. to lower drug prices overseas, and another concerned speeding imports of drugs from Canada.
The pharmaceutical industry and some Republicans have criticized the first order, saying it amounts to price controls, while opponents of the second initiative say it raises questions about product safety.
The orders are unlikely to result in immediate changes. The White House said they represent the administration’s policy and begin a rule-making process. That process can be arduous and face legal challenges.
Mr. Biden, the vice president when the ACA was enacted, has championed a platform that would shore up and expand the health law, a $775 billion investment in caregiving programs and a public option that provides a Medicare-like alternative to traditional health insurance plans. Republicans say his plan is too expensive and creates an intrusive government role in health care.
Write to Stephanie Armour at stephanie.armour@wsj.com
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