- - Wednesday, July 22, 2020

Joe Biden and Democrats have released their 2020 health care agenda, and President Trump has promised to release his own within two weeks. The Democrats will expand the role of the federal government, spend more on Obamacare and further empower bureaucracies. 

As a reminder, Mr. Trump’s team released a health plan in a 120-page report issued 20 months ago. He now needs to fill in the details for a second-term health policy agenda. Given the importance Americans place on health care issues for their vote, Mr. Trump probably can’t win reelection without doing so.

In a second term, Mr. Trump and his administration should work to make permanent the executive action they took to empower patients and create a more competitive and transparent health care marketplace. They expanded access to Association Health Plans and short-term health plans, which help those hurt most by Obamacare: small businesses and their employees and middle-income families without workplace coverage. Mr. Trump also expanded 401(k)-like accounts known as health reimbursement arrangements to enable workers to purchase coverage that’s best for them. These actions expand choices and control for patients and employers, and lower costs.

The Trump administration has also taken bold action to provide patients with better information about the care they’re buying by requiring hospitals and insurers to provide real, up-front price information. Here, too, Mr. Trump should work with Congress to codify these reforms, which will lead providers to offer higher-quality services at lower prices.

In addition to solidifying his executive actions, Mr. Trump should use his second term to make progress in five areas to increase health care choice and competition, and lower costs.

First, Mr. Trump should ensure that every American has a health savings account (HSA). Currently, only people with certain types of health insurance can benefit from HSAs. But these restrictions prevent most families from saving and investing tax-free for their health care, giving them the freedom to better control their health care spending. Broader access to HSAs is crucial to better engage consumers to seek value and increase competitive forces on providers to lower prices and improve quality. 

Second, Mr. Trump should tackle high costs head-on. He must confront the growing consolidation among hospitals and providers that has driven prices and spending higher. Mr. Trump should instruct his appointees to make battling anticompetitive mergers and growing consolidation a top priority, and seek additional funds for the Federal Trade Commission and the Department of Justice to accomplish this goal.

Third, people need improved ways to access care. The pandemic has demonstrated the value of telehealth, particularly for seniors. Over the last several months, strong executive action has enabled more patients to connect with their doctors by video, phone or email. Mr. Trump should go a step further and work with Congress to ensure Americans have access to telehealth and other emerging technologies. In addition, his administration should work with states to eliminate rules that prevent doctors and nurses from moving to where they are most needed and from taking care of patients to the top of their ability.

Fourth, Obamacare’s failings must be addressed. While the law has helped some Americans, it has hurt middle-income families who are forced to deal with skyrocketing premiums and deductibles without the benefit of subsidies. The Democrats’ approach is to further restrict choices outside of Obamacare and throw more subsidies at the existing structure. Real reform would return significant regulatory flexibility to states. With this control and with reformed subsidies, states can take the lead on making coverage more affordable, while targeting financial assistance to those who need it.

Finally, Mr. Trump should improve federal health programs. Medicaid and Medicare are on unsustainable fiscal trajectories and program outcomes too often disappoint. Medicaid reform starts with giving states more flexibility to innovate and improve the program, and address widespread waste and abuse. He should also work with Congress to end the immorality of the federal government paying a substantially greater share of health care costs for able-bodied, working-age Medicaid enrollees than for the traditional program beneficiaries, such as low-income pregnant women and the disabled.

The Trump administration has already strengthened Medicare by giving seniors unprecedented choice of Medicare Advantage plans with declining premiums. In a second term, the administration can further improve Medicare by ending the wasteful practice of overpaying for services simply because they are provided in more expensive hospital settings and streamlining the program’s benefit offerings by, for example, creating a single deductible for all care and capping seniors’ out-of-pocket exposure to drugs.

Mr. Trump has an opportunity to lay out a second-term agenda that will build on his initial successes and further expand choice, transparency and competition to help Americans obtain better health care at lower cost. A clear vision will show voters that this year’s election represents a true choice between two very disparate views of the future: One where government rules and middlemen limit our choices and access to care, or one where patients and their doctors are in control.

• Brian C. Blase was a special assistant to President Trump at the National Economic Council, 2017-19. He is president of Blase Policy Strategies. Lanhee J. Chen is the David and Diane Steffy Fellow in American Public Policy Studies at the Hoover Institution and Director of Domestic Policy Studies in Public Policy at Stanford University.

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