On the 24th of September 2020, President Donald Trump passed an Executive Order (EO) entitled, “An America-First Health Care Plan.” This EO is nearly 4,200 words long, however less than 500 words discuss the objectives of lower drug costs and access to care, without a clear path on how these will be implemented. Therefore, this EO carries no legal weight and is mostly symbolic. Historically, EOs could be seen as directives or instructions to federal agencies on operations or current statutes. However, what is (in)significant about the America-First Health Care Plan, is that it does not do either. Most of the EO discusses past Trump administration EOs or statutes on health care. The current active health legislation, The Affordable Care Act (ACA aka Obamacare), is only mentioned to point out its flaws but not how to fix them.

The ACA produced multiple other failures. The average insurance premium in the individual market more than doubled from 2013 to 2017, and those who have not received generous Federal subsidies have struggled to maintain coverage.

The presidential election is less than a month away and the people will be voting on health care. This EO was signed as a symbolic move to show that Trump has kept his promises to lower drug costs, end “surprise medical billings,” protect those with pre-existing conditions, and improve access to care for everyone. These promises are shown through a list of prior EO’s he signed, many of which, have not resulted in the intended outcome. For example, the EO initially mentions the repeal of the individual mandate of the ACA that Trump signed in December 2017.

On December 22, 2017, I signed into law the repeal of the burdensome individual-mandate penalty, liberating millions of low-income Americans from a tax that penalized them for not purchasing health-insurance coverage they did not want or could not afford. Through Executive Order 13813 of October 12, 2017 (Promoting Health Care Choice and Competition Across the United States), my Administration has expanded coverage options for millions of Americans in several ways.

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It says that the Trump administration expanded access with alternative insurance plans such as short-term, limited-duration health plans, but these plans do not pay for hospital stays or prescription drugs. These plans require a medical assessment, meaning some consumers may be charged higher premiums. Additionally, the Trump administration has been actively working to dismantle the ACA, the only legislation that protects people with pre-existing conditions, and reproductive care for women. Thus, he has been limiting access to health care and not expanding it.

“This EO reads as Trump’s “greatest hits of EO’s” as a piecemeal approach to address a systemic problem. Health care will continue to become more expensive, where quality care and drugs are reserved for those who can afford it.”

Regarding his promise to lower drug costs, the EO discusses multiple policies. The first is to accelerate the approvals of new generic drugs which are often cheaper than brand prescriptions and the second is to import drugs from other countries. Also, there is a policy to stop hospitals from overcharging for drugs. But, it seems that Medicare recipients may benefit most from these policies, as these are reforms being led by Centers for Medicare and Medicaid Services, but not those who have private insurance. It’s unclear how those who are privately insured will see lower drug costs, especially if hospitals can continue to overcharge private insurance companies.

In sum, this EO reads as Trump’s “greatest hits of EO’s” as a piecemeal approach to address a systemic problem. Health care will continue to become more expensive, where quality care and drugs are reserved for those who can afford it. This is not because the American health care system is broken, rather it was designed this way and is working as intended; hence why many working and middle-income Americans are drowning in health care debt. This is on top of the ongoing economic recession that the country is in due to the COVID-19 pandemic. Trump and the Republican party have been promising to “repeal and replace” the ACA with something better that would guarantee those with pre-existing conditions will not be denied insurance, lower drug costs, and affordable care. However, despite entering his term with a majority in the House and the Senate, no legislative bills were passed. When the House flipped in 2018 to a Democratic majority, there were still no legislative bills to improve on what the ACA started. Now, with the rush to replace the late Justice Ginsburg, it seems that Trump and his party has passed the buck to the Supreme Court to “repeal” the ACA without the burden of having to come up with a replacement.

“Neither party wants to be held responsible, so they all hot potato with health care, and nothing gets done: except for meaningless EO’s.”

This demonstrates another problem with our democratic institutions. Although the ACA is imperfect in many ways, the fact is, coverage for those with pre-existing conditions and Medicaid expansion are two popular features in red, blue, and purple states. Across the spectrum, our elected officials know this and yet we have one side of the aisle actively working to dismantle this bill and the other side of the aisle passively watching it happen. Neither party wants to be held responsible, so they all hot potato with health care, and nothing gets done: except for meaningless EO’s. So, while Trump’s administration has proven to govern incompetently on matters of health and social welfare, just remember that it happened because our entire political system failed us and not just Trump.


Sabine Franklin
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Sabine Franklin earned her Ph.D. from the School of Organisations, Economy and Society at the University of Westminster. Her thesis examines the local governance of the 2014 Ebola Epidemic in a comparative case study of Sierra Leone and Liberia. She has an interest in international development, global health governance, and qualitative fieldwork methods. Her area of expertise is to use evidence-based research to inform policy. Her work is also in Africa SpectrumSAGE Research Methods CasesRevistas Brasileira de Estudos Políticos, and Springer’s upcoming Encyclopedia of the UN Sustainable Development Goals, vol. 16: Peace, Justice and Strong Institutions.