Trump and health care: What the president’s address tells us

Last night, Trump made his first address to a joint session of Congress. He covered a lot of ground, from immigration to national security to spending. But one thing that everyone was listening carefully for, from Congress to the American people, was a definitive plan for health care reform.

While there was no specific plan announced, Trump did outline his top priorities for reform—some that align with his party’s intentions, others that do not. His five main health care goals include:

  1. Ensuring Americans with pre-existing health conditions have access to health insurance, and that we have a stable transition for Americans currently enrolled in the health-care exchanges. Whether access to health care is enough has been a sticking point for Democrats in moving forward with any kind of change to the ACA. They argue that access doesn’t mean people can reasonably and affordably purchase plans that are actually beneficial. Republicans, however, seem to think simple access is key—they want to make health care available, but not mandatory. This is why they dislike the individual mandate, and have made getting rid of it one of their top priorities. However, covering those with pre-existing conditions and stability for those in the current marketplace are likely to be popular on both sides of the aisle. It’s finding the “how” that will continue to divide.
  2. Offering tax credits and expanded health savings accounts to help people buy their own health coverage, as well as flexibility about the design of their plans. Overall, tax credits and subsidies would probably be similar in many ways. But Republicans prefer tax credits, and they prefer that they be based on age rather than income. Trump didn’t specify whether he agreed with this practice, but his indication that everyone who buys their own health insurance should get one means it’s more likely. Health savings accounts (HSAs) are another idea that Trump has been particularly vocal on, and one that Republicans are certainly in favor of. HSAs were one of the main topics of a leaked Republican health care proposal last week.
  3. Giving states the resources and flexibility in their Medicaid programs to make sure no one is left out. Medicaid has been a touchy subject with Republicans. Many governors fully endorse the Medicaid expansion that they were able to opt into under the ACA, and are fighting to keep it around. Many Republicans in Congress hope to trim Medicaid as a way to lower government spending. GOP lawmakers have knocked heads with Trump on this point before, but it seems that Trump is determined to keep Medicaid around— and may side with the governors over those on Capitol Hill when it comes to Medicaid expansion.
  4. Legal reforms to protect doctors and patients from unnecessary costs that drive up insurance costs, and to bring down the price of high-cost drugs. Driving down unnecessary costs for doctors and patients will most likely come in the form of less regulation and requirements for health care providers. This is very much in line with Republican values, so Trump probably won’t see much in-party pushback on this one. As for lowering drug costs, both sides of the aisle have been after drug pricing reform for years, so it’s reasonable to say this may be one of the easiest goals for Trump to get bipartisan support on.
  5. Creating a national insurance marketplace that allows insurers to sell health plans across state lines. This has been one of Trump’s priorities since he began discussing health care on the campaign trail. The idea is that allowing insurance providers to sell their plans across state lines would create more competition with less regulation, thus driving down prices. It’s a popular Republican idea, and one that will probably have the support of those in Congress. But it’s difficult to implement based upon the specific state regulations around insurance.

Overall, Trump’s speech reiterated and highlighted many of the ideas that he’s been pushing over the course of the last year. By prioritizing these factors, however, we can see what he’s willing to fight his party on, and what kind of language may make it into the final version of the bill.

Reforming health care isn’t a one-man job. Trump, as the President, certainly has a large say, but it will ultimately come down to the lawmakers to decide how to proceed. Expect to see a lot of back-and-forth over the next few weeks (or months) before a fully formed plan surfaces.