In a joint address to Congress, President Donald Trump reiterated his call to repeal and replace the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) with reforms that expand choice, increase access, lower costs, and, at the same time, provide better health care. Offering more detail on his vision than previously, President Trump stressed that lowering the cost of health insurance would make health insurance available to everyone.
Citing numbers from the governors of Arizona and Kentucky, Trump noted that health insurance premiums on the marketplace have increased by double and triple digits. In Arizona, Trump stated that premiums went up 116 percent in 2016 and that the governor of Kentucky had stated that the law was unsustainable and collapsing. In addition to those concerns from Republican governors, Trump stated that one-third of all counties in the U.S. only had one insurer available under the ACA.
Most notably, in five key points, Trump called for members of both parties in Congress to support his ideas to repeal and replace the ACA: (1) allow people with pre-existing conditions to maintain coverage; (2) give individuals ability to buy their own plans with tax credits and expanded health savings accounts; (3) provide states with the flexibility and resources to address Medicaid issues; (4) implement legal reforms from unnecessary costs that drive up the price of insurance, including drug pricing; and (5) allow individuals to purchase insurance plans across state lines.
HHS Secretary Price, House Energy and Commerce Co-Chairman Walden (R-Ore), House Small Business Committee Chairman Chabot (R-Ohio), House Ways and Means Chairman Brady (R-Texas), and Sen. Lamar Alexander (R-Tenn) issued statements commending the President’s address and his point of repealing and replacing the ACA.
On the other side, policy experts are concerned with Trump’s ideas, especially the greater emphasis of using health savings accounts (HSAs) instead of premium subsidies. The Center for American Progress, in a statement following the speech, noted that HSAs fail to benefit low-income people who might not have extra cash to store away for health care. Instead, HSAs are generally tied to high-deductible health plans, meaning that individuals might be responsible for higher out-of-pocket costs
Even some Republicans have voiced concerns that Trump’s tax credits and HSA proposal is "Obamacare lite." Other proposals to repeal and replace the ACA, whether "Obamacare lite" or not, include House Speaker Paul Ryan’s (R-Wis) A Better Way plan; the Empowering Patients First Act, proposed by HHS Secretary Price during his tenure as a Republican representative from the state of Georgia; Sen. Bill Cassidy’s (R-La) Patient Freedom Act; and Sen. Rand Paul’s (R-Ky) Obamacare Replacement Act (see How will Congress replace the ACA? KFF compares plans, February 21, 2017).
Additionally, even though Trump did not mention food safety in his first speech Congress, his appointment earlier of a special assistant for agriculture, trade, and food assistance that would be part of the National Economic Council provides some insight as to how the President will rely on councils to advise him on various matters. In 2016, during the campaign for the White House, then-candidate Trump posted comments indicating he had less than a favorable opinion of the FDA’s role and staff, which he referred to as food police. During the joint speech, he only referenced the FDA in the context of speeding medical treatment approvals.
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