The Washington PostDemocracy Dies in Darkness

The Health 202: Trump's new health-care plan isn't really a plan

with Alexandra Ellerbeck

Four years ago, Donald Trump promised voters in Charlotte, N.C. he would “repeal and replace Obamacare” if they sent him to the White House.

In a speech there yesterday, he insisted the health-care law is “no longer Obamacare" – even though nearly all of the sweeping 2010 Affordable Care Act is still in place.

“Obamacare is no longer Obamacare, as we worked on it and managed it very well,” Trump said. “What we have now is a much better plan. It is no longer Obamacare because we got rid of the worse part of it, the individual mandate.”

The “America First Health Plan” Trump introduced yesterday isn't a health-care plan.

Instead, it's mostly a list of various incremental and modest things the president's administration tried to do on health care after it became clear Trump wouldn't be able to accomplish his main promise in 2016 of replacing the ACA. These include some small tweaks to the health-care law – some that undermined the law and others that may have expanded its insurance offerings – and some cost reductions for seniors in the Medicare program.

“The failure to repeal and replace Obamacare has not stopped Trump from repeatedly promising a soon-to-come health-care plan, in a repetitive cycle of boastful pledges and missed deadlines that intensified in recent weeks ahead of the November election,” my colleague Toluse Olorunnipa writes.

Trump has run up against wall after wall in nearly all of his health-care efforts.

That includes not only the attempted ACA repeal but also in various measures to lower U.S. drug prices. Those failures didn't stop the president and his aides from describing his health-care record in glowing terms yesterday.

“The dysfunctions plaguing healthcare in America are varied and complex, but no president has been more comprehensive, methodical, and effective in addressing them than President Trump,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services.

Trump insisted the health-care issue belongs to Republicans, even as they consistently trail Democrats in polls on who voters trust more to fix the nation’s pricey and patchworked health-care system.

“We’ve really become the health-care party — the Republican Party,” Trump said, speaking in Charlotte. “But nobody knows it.”

From a Cato Institute's director of health policy studies:

Trump's “plan” includes two toothless executive orders, one of them possibly illegal.

The first executive order tries to save face for the president on protecting Americans with preexisting conditions.

It declares it the “policy” of the United States to protect people with preexisting conditions — even though these protections are already enshrined into law by the ACA.

The order is a direct counter to criticism from Democrats, who continually remind voters that Trump is refusing to defend the health-care law in a high-profile case before the Supreme Court. In the case, Republican-led states are arguing that the law's protections for preexisting conditions – and everything else in the law – isn't constitutional without its mandate to buy coverage.

“The historic action I’m taking today includes the first-ever executive order to affirm it is the official policy of the United States government to protect patients with preexisting conditions,” Trump said. “We’re making that official. We’re putting it down in a stamp, because our opponents the Democrats like to constantly talk about it.”

Observers warned it could be a misuse of the president's executive order powers.

Executive orders are typically used by presidents to direct government agencies to act in specific ways within the authority Congress has given them. Or they can use an executive order in specific ways during an emergency or on foreign policy matters.

When President Barack Obama wanted to pass a health overhaul, he directed Congress to write extensive legislation, which included a requirement for insurers to cover people the same regardless of any preexisting condition. He didn’t issue an executive order to do so.

Nicholas Bagley, health law professor at the University of Michigan:

Julie Rovner, chief Washington correspondent for Kaiser Health News, added this:

More from Cannon:

Larry Levitt, senior vice president at the Kaiser Family Foundation:

Trump also ordered Congress to come up with a solution to surprise medical bills.

The executive order says that if Congress doesn’t pass a reform before Jan. 1, the secretary of Health and Human Services must explore ways to do so through regulation.

But it’s not as though the House and Senate hadn’t been working on this problem already. Lawmakers spent much of last year crafting various bills to protect patients from often hefty “surprise” bills, which can result from emergency care out of their plan’s network or from being treated by an out-of-network physician at an in-network hospital.

Several committees drafted several different versions, but the whole effort got caught up in a fight between insurers and health providers, with each party angling for more leverage in how surprise bills might be negotiated.

It’s unlikely any real advances on surprise billing legislation will be made in November and December, given it will be a lame-duck Congress and a pandemic is still raging. But Sen. Lamar Alexander (R-Tenn.), who has a bipartisan bill on surprise billing, called Trump “right to call on Congress” to deal with the issue.

“Ending surprise medical bills is a problem that requires a permanent solution passed by Congress this year,” Alexander said in a statement.

Stat News reporter Lev Facher:

Margot Sanger Katz, health-care reporter for the New York Times:

Ahh, oof and ouch

AHH: The chances of surviving the next four years are 90.3 percent for Trump and 95.2 percent for Biden.

That's according to University of Illinois researcher S. Jay Olshansky, who has updated previous estimates of the two candidates' lifetime longevities. As we recently noted, Olshansky gave Trump an 85 percent chance of surviving a second term and Biden a 79 percent chance of surviving a first term, but those estimates were based merely on their age and gender.

Olshansky's updated estimates, published today in the Journal on Active Aging, take into account personal health information made available by Trump and Biden. The medical records of each candidate were independently evaluated by three medical doctors with experience in aging and a team of research scientists with expertise in epidemiology, public health, survival analysis and statistics.  

They found Biden and Trump have a higher-than-average probability of surviving a four-year term as president, relative to other men of their age. The two men may be “super-agers,” a subgroup of people that maintain their mental and physical functioning and tend to live longer than the average person their age.

“It is our conclusion that chronological age is not a relevant factor for either candidate running for president of the United States,” the authors wrote. “Both candidates face a lower than average risk of experiencing significant health or cognitive functioning challenges during the next four years.”  

The researchers estimate that Biden, albeit older than Trump, will outlive Trump given his “nearly perfect health profile for a man his age.” Trump, who is overweight, has “significant but modifiable” risk factors. Neither candidate is expected to have major cognitive challenges now or during the next four years, Olshansky and his colleagues wrote.

OOF: Pelosi is shifting course and renewing a last-minute push for a coronavirus relief bill.

“House Speaker Nancy Pelosi abruptly shifted course Thursday and moved to assemble a new coronavirus relief bill to form the basis for renewed talks with the White House, amid mounting pressure from moderates in her caucus and increasingly alarming economic news,” Erica Werner and Rachael Bade report.

Pelosi told House Democratic leaders that the proposed stimulus package would be around $2.4 trillion, significantly less than the $3.4 trillion Heroes Act that the House passed in May. 

“The package is expected to include stimulus checks, aid for airlines, small businesses, cities and states, as well as rental assistance, unemployment assistance and funds for election security and the U.S. Postal Service,” Wener and Bade write.

Pelosi has been under pressure from moderate members of her caucus, many facing close elections in traditionally GOP districts, to reach a deal. At the same time, there are growing signs that the economic rebound over the summer could stall.

Trump last week also pushed for a deal, calling on Republicans to accept a larger aid package.

The window for a deal is narrow, however. Congress is supposed to adjourn at the end of next week through the election, although lawmakers could be called back for a vote. Congress has also made little progress resolving key disputes — including disagreements over state and local aid or Republicans’ push for liability protections for businesses — that contributed to negotiations falling apart in August.

OUCH: Science academies raise alarm over political interference in the work of scientists and health experts.

“Two prominent groups of scientists who regularly advise the government on Thursday warned of ‘alarming’ political interference in the work of scientists and public health experts contributing to the government's coronavirus response,” Politico’s Sarah Owermohle reports.

“We find ongoing reports and incidents of the politicization of science, particularly the overriding of evidence and advice from public health officials and derision of government scientists, to be alarming,” National Academy of Sciences President Marcia McNutt and National Academy of Medicine President Victor Dzau wrote in a statement.

The statement comes just one day after Trump said that he might reject a Food and Drug Administration proposal to apply tougher standards for emergency use of any coronavirus vaccine. The proposed standards, which were seen as an effort to shore up public confidence in a vaccine, would have required a two-month follow-up on patients who received the experimental shot. 

The past few weeks have also seen reports that political appointees at the Department of Health and Human Services have sought to interfere with weekly scientific reports from the CDC and with media appearances by top government scientists. 

“Public confidence in vaccines has plummeted nationwide amid the record-breaking effort to develop coronavirus shots and the president's repeated assurances that a vaccine will be ready soon. Sixty-two percent of people are worried about taking a Covid-19 shot while more than half would flat out refuse it, according to a recent Kaiser Family Foundation poll,” Sarah writes.

Race for a vaccine

Secret safety panels may decide whether to give coronavirus vaccine trials the greenlight. 

Decisions about whether to halt a clinical trial of a vaccine or fast-track it may fall under the purview of “a small, secret panel of experts,” Kaiser Health News’s Rachana Pradhan reports.

A data and safety monitoring board, composed of 10 to 15 experts, will be tasked with reviewing unblinded data across trials for multiple coronavirus vaccine, including products from Moderna, AstraZeneca, and Johnson & Johnson. The National Institute of Allergy and Infectious Diseases, the National Institutes of Health agency run by Anthony Fauci, is overseeing the board but the experts on it are outside scientists, not federal employees.

So far, the identities of the scientists, save one, are anonymous, a step that is standard for these types of panels and meant to shield them from pressure by the companies or from the public. 

But as pharmaceutical companies race to produce a vaccine, “the board’s anonymity has stirred concerns that the cloak of secrecy could, paradoxically, allow undue influence,” Rachana reports. 

The one exception to the board’s anonymity is Richard Whitley, an expert in pediatric infectious diseases at the University of Alabama at Birmingham, whose university announced his appointment as chair of the safety monitoring board. Whitley’s appointment has already raised concerns about conflict of interest related to the pediatric specialist’s ties to the drug industry.

Companies at the head of the coronavirus vaccine race may not be the ones that win out.

“Corporate giants Sanofi and Merck, which got a relatively late start in developing Covid-19 vaccines, may seem far behind the frontrunners. But experts say they also have such deep experience developing and testing vaccine candidates, and producing vaccine at commercial scale, that both could well close the gap considerably in the months ahead,” Stat’s Helen Branswell reports.

Pfizer, Moderna, AstraZeneca and Johnson & Johnson are all in Phase 3 trials and are the closest to producing data on a vaccine, and on Thursday, Novavax announced that it would start a 10,000-person Phase 3 trial of its vaccine candidate in the United Kingdom.

But the fact that these companies are ahead now doesn't mean that they will ultimately dominate the market for a vaccine. Moderna, for instance, has not brought a vaccine through an approval process before.

Both Sanofi and Merck are behind this group, but both companies have significant experience developing vaccines at scale. If these companies are able to create a vaccine that is easier to store or to produce using established technologies, they could also gain a leg up on competitors.

“The race for a vaccine is not a winner-take-all situation. The world is expected to need vaccines from any number of manufacturers to curb the Covid-19 pandemic, and it’s likely that some that aren’t among the first to cross the finish line will have advantages the earliest vaccines do not,” Helen writes.

Chinese company says it will have a coronavirus vaccine ready by 2021 for distribution in the United States.

“A Chinese pharmaceutical company said Thursday the coronavirus vaccine it is developing should be ready by early 2021 for distribution worldwide, including the United States,” the Associated Press reports.

While stringent regulations in the United States have historically blocked the sale of Chinese vaccines, Yin Weidong, CEO of SinoVac, vowed to apply to the Food and Drug Administration to sell his company’s vaccine in the United States if it is successful in Phase 3 trials.

“Our goal is to provide the vaccine to the world, including the U.S., E.U. and others,” Yin said.

SinoVac, which is developing one of China’s top four vaccine candidates, is conducting clinical trials with 24,000 people enrolled in Brazil, Turkey and Indonesia. 

Even though the company has not completed Phase 3 trials, it has already injected thousands of people in China with the vaccine under an emergency use authorization. SinoVac employees also qualified for emergency use of the vaccine on the grounds that an outbreak in the company could cripple research. Yin himself received a dose of the vaccine, along with about 90 percent of the company’s staff.

More on the vaccine race

  • The British government says that it may take part in challenge studies for an experimental coronavirus vaccine in which subjects are deliberately infected with the coronavirus. These studies can produce faster results, but they raise ethical questions when used for a disease such as covid-19, for which the long-term impacts are still not well understood, the AP’s Danica Kirka reports.
  • New York Gov. Andrew M. Cuomo (D) announced his state would independently convene a panel of experts to review the safety and efficacy of any vaccine approved by the federal government. The governor cited concerns the federal approval process has become politicized, the New York Times’s Michael Gold and Jesse McKinley report.

Coronavirus latest

  • California will allow public health officials to participate in a program to keep their home addresses confidential. The program — previously reserved for reproductive health-care workers and victims of violence, abuse and stalking — is being expanded after numerous reports of harassment and threats against public health officials over their role in promoting masks and stay-at-home orders, Kaiser Health News’s Anna Maria Barry-Jester reports.
  • After 850 workers at the Iowa Premium Beef Plant in Tama, Iowa, tested positive for the virus, Iowa regulators fined the plant $957 for a minor record-keeping violations. Democrats and labor activists have blasted Iowa’s worker safety agency over lax enforcement during the pandemic, the AP’s Ryan Foley reports.
  • New data from the Centers for Medicare and Medicaid Services shows child vaccinations are down more than 20 percent and dental visits fell 70 percent during the pandemic, raising concerns about long-term health effects for children, The Washington Post’s live blog reports.

Elsewhere in health care

Activists on both sides of the abortion fight are revving up spending.

“The death of liberal Supreme Court justice Ruth Bader Ginsburg is galvanizing activists on both sides of the abortion issue, who were already ramping up on-the-ground efforts to rally behind candidates on the national and state level as the Nov. 3 elections approach,” Roll Call’s Sandhya Raman reports. “Republicans are in sight of a 6-3 majority, the culmination of a nearly five-decade push to remake the courts after the 1973 landmark Roe v. Wade case affirmed a nationwide right to abortion.”

Planned Parenthood Votes announced a six-figure ad buy this week aimed at protecting Ginsburg’s legacy. Planned Parenthood initially budgeted $45 million for this election cycle, 50 percent more than it spent in 2016. Meanwhile, the Democratic fundraising platform ActBlue saw a surge in donations — more than $200 million in small donations since Ginsburg’s death.

An ad from Planned Parenthood Action:

Abortion rights opponents are also rallying. The Susan B. Anthony List, an antiabortion nonprofit, and its partner super PAC planned to spend $52 million on this year’s election. After Ginsburg’s death, the group announced it would spend another seven-figure sum pushing for confirmation of Trump’s Supreme Court nominee.

“A Gallup Poll in July found that 24 percent of voters said a candidate must share their views on abortion. Abortion opponents are more likely to call the issue key to their votes, with 30 percent calling it a threshold issue, compared to 19 percent of abortion rights supporters,” Sandhya writes.

The pesticide industry lobbied against any mention of fungicides in international health guidelines.

Emails show that pesticide industry lobbyists urged U.S. agriculture officials to keep antifungal compounds out of U.N. guidelines on combating drug-resistance, the New York Times reports.

Health officials have long warned about the dangers from overuse of antibiotics in agriculture. At least 35,000 Americans die each year of drug-resistant infections, and overuse of antibiotics can favor the survival of pathogens that are resistant to treatments. There is less extensive research on agricultural fungicides, but researchers believe that the use of these pesticides could be behind deadly drug-resistant fungal infections.

When an intergovernmental task force on antimicrobial resistance met in South Korea in 2018, “the American delegation insisted that the guidelines omit any references to fungicides, a stance that infuriated other participants and forced a monthslong delay in the task force’s work,” the New York Times reports.

  • Six Democratic Party committees released a memo arguing that health care is a top issue for voters and claiming the party has had “tremendous electoral success” running on expanded access to health care and promises to lower costs. The memo, which provides insight into the party’s electoral strategy, focuses heavily on the Trump administration’s support for a lawsuit challenging the ACA and argues votes to gut the law have also been “a stumbling block” for vulnerable Republicans.
  • Blue Cross Blue Shield  has negotiated a tentative $2.7 billion settlement in a sweeping antitrust case. The deal could also increase competition among the insurance group’s three dozen member companies, the Wall Street Journal’s Anna Wilde Mathews and Brent Kendall report.
  • Washington state’s 2021 health insurance exchange is seeing an average rate decrease of 3.2 percent for health insurers. The news is part of a broader trend: While premiums rose dramatically after the marketplaces were created in 2014, they’ve risen more slowly or even fallen in the past few years.

Sugar rush