Trump’s only health policy is to undo everything that Obama did


In the latest effort to undermine ObamaCare, President Trump took two major steps towards destabilizing the Affordable Care Act (ACA) last week. The first was an executive order expanding the use of weaker, less protected, health plans known as short-term and association plans.

The second eliminated the subsidies that make many insurance plans affordable to regular Americans. These efforts are a big step towards clarifying what TrumpCare is beginning to take to take shape as: wanton health policy unhinged from any real human outcomes.

{mosads}TrumpCare, is becoming clear, is has no grand policy objective other than the breakdown and implosion of ACA. Without any ultimate regard for its effect on patients, hospitals, or taxpayers, it is nothing more than health policy written for policy’s sake.


In the wild push to vilify and repeal ObamaCare, the GOP, it seems, has lost the trees for the forest and forgotten the very point of having any sort of insurance system to begin with. If we take a step back and appreciate that the purpose of health policy is to protect and optimize the health of Americans at the most economically feasible cost, it becomes painfully clear that these latest moves do nothing towards that end.

By simultaneously pushing people away from plans with guaranteed protections and towards barebones plans that lack them, the Trump administration argues that it is taking steps towards making health care more affordable by making cheaper insurance plans more widely available.

While it is true that some insurance plans will be cheaper, these discount plans lack the protections that the ACA worked hard to guarantee. Short-term plans promoted by these actions, for example, do not guarantee coverage for preexisting conditions, while association plans, also given a boost by yesterday’s order, lack basic protections like the one that forbids women from being charged more than men for the same services.

Republicans have previously argued that offering cheaper plans that cover less medical services is the definition of freedom. And it is indeed true that such a strategy increases the diversity of options for consumers. But this approach is a little like trying to increase the affordability of cars by eliminating the requirement for them to have seatbelts, airbags, and brakes. Would more cars be available on the market? Certainly. Would these new cars be anything that anyone wants to drive? Highly doubtful.

The push towards discount health plans that don’t cover basic health services can’t reasonably be called freedom in health care any more than a push towards licensing soapbox cars for use on the expressway could be called freedom to commute. It is recklessness masquerading as freedom.

The reason such a strategy is especially dangerous, however, is that unlike a car missing its seatbelt, it is not so obvious when a health plan lacks basic protections. It is often unclear what a particular insurance plan will or will not cover until it is too late. According to one survey, a meager 4 percent of Americans have a solid understanding of their health insurance plans and what they cover. In other words, patients often think they are getting a good deal, but only when they are speeding downhill into a busy intersection slamming on brakes that were never installed, do they learn why their car was so cheap.

I have seen this situation play out repeatedly in my emergency room. Tearful patients often realize only too late that their high-deductible health plan means they are on the hook for thousands of dollars of unexpected medical costs. Worse, they make poor health decisions out of fear of these costs. Whether purchased because they thought they would never get sick or because they simply couldn’t afford the plan that they needed, these patients all end up suffering in the end.

After yesterday’s orders, this problem will only get worse.

This race to the bottom should be concerning to people from all political stripes. Our health care debate has devolved from reasonable policy discussions to pure ideology completely united to real people and their needs. Ultimately, we need to ask ourselves: if all we are doing to expand health coverage is offering more plans with less services, what real value are we adding to the market?

At the end of the day, making things cheaper by simply making them worse is a sad excuse for policy. Calling that freedom is just cruel. We need forget about dilapidated health coverage and refocus on what it is we want from health policy to begin with.

A good starting point would be what President Trump himself declared in January, “Insurance for everybody… much less expensive, and much better.” Nothing addressed by our president thus far has advanced us a single step towards that ultimate goal.

Farzon A. Nahvi is an emergency medicine physician and clinical instructor of emergency medicine in New York City.

Tags ACA TrumpCare

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