Nowhere is this more clear than health care in general and Medicare in particular. Last fall, Trump told a group of seniors at one of Florida’s largest retirement communities that Medicare is “under siege” from Democrats. Medicare-for-all, he said, “would totally obliterate Medicare.” What he didn’t tell the audience was that same day he signed an executive order that likely will weaken Medicare. As Michael Hiltzik pointed out at the Los Angeles Times, the order, which demanded the government investigate raising Medicare reimbursement rates, could raise the cost of the program, undermining its finances, not to mention potentially increasing the amounts seniors need to pay over time. At the same time, Trump’s plan — also contained in the executive order — encourages more use of Medicare Advantage, which could ultimately push seniors toward narrow medical networks, cutting access to doctors and restricting choice. Finally, according to The Center for American Progress, the Trump policy could also make it more likely that seniors are subjected to surprise medical bills, something current law mostly protects them from.
In other words, under the guise of protecting seniors, Trump is laying the groundwork to weaken Medicare. “It’s actually a plan to reshape the program in favor of further enriching the health care industry at the expense of the sick,” says Emily Gee, a health economist with the Center for American Progress.
And that’s not the only way Trump is trying to make life harder for seniors. While many are aware that the Republican-backed lawsuit to dismantle the Affordable Care Act would end the law’s protections for preexisting conditions, it’s less widely known that the lawsuit could raise costs significantly for those on Medicare. That’s because the ACA is responsible for the gradual closing of Medicare’s so-called doughnut hole for pharmaceutical expenses. If the law is overturned in full, the doughnut hole could return. So much for seniors paying less for prescription drugs — another Trump campaign promise.
Trump’s anti-regulatory campaign is also hurting seniors most in need of care. A survey in the Proceedings of the National Academy of Sciences finds people have a more than 50 percent chance of spending at least one night in a nursing home. The Obama administration upped the punishment faced by care facilities that kept residents in unsafe conditions, changing the rules so they were fined by the day till the issue was fixed instead of per violation. Under Trump, the federal government has reversed course.
Obama also attempted to stop nursing homes taking federal dollars (think: Medicare and Medicaid) by insisting patients or their families commit to mandatory arbitration in the event of a dispute before admitting those patients to the facility. While the issue was mired in a court challenge, Trump once again stepped in: While the industry cannot require arbitration, homes can still put such agreements in the patient contracts. This is an issue because few people check contracts carefully for such things, and mandatory arbitration, by keeping disputes out of the courts, also makes it less likely other patients will find out about the agreements in the future.
This all sounds horrible. So why aren’t we talking about it more? In part, Democratic candidates could and should step up, explaining this to the group pollsters call “persuadable seniors.” Instead, former vice president Joe Biden — like Trump — intimates that Medicare-for-all could cause catastrophic delays in coverage. Sen. Bernie Sanders (I-Vt.) usually highlights how his Medicare-for-all plan would cover dental, vision and hearing aids — something that’s right now only available on some Medicare Advantage plans — but has put less emphasis on its proposed improvements to long-term care coverage.
But the media is to blame as well. As longtime health-care reporter and advocate Trudy Lieberman points out, while there is a lot of coverage of what Medicare-for-all could do to the Affordable Care Act, the same is not true for threats to Medicare as it exists in the here and now. I’ve often suspected one reason for this is that while both health insurance and Medicare can be enormously complicated, few reporters have personal experience with the latter other than hearing older relatives talk about it. This combination permits Trump to continue to advertise himself as a champion of senior Americans when, in fact, he’s anything but. Democratic candidates should do their best to put a stop to that, and reporters should do more to hold the president to account.