Trump releases health plan, but it’s short on specifics

Under pressure to address affordability issues in the country, President Donald Trump on Thursday released his long-awaited health care plan, urging Congress to pass measures that would codify steps his administration has taken to try to lower drug costs and providing what a White House official called "broad direction" to back health savings accounts.

The plan was short on specific details and left much of the direction for how to finalize it up to Congress. It amounted to a few paragraphs on a webpage, released with a video of Trump promoting what he called "the great health care plan."

The plan rejects efforts to extend the enhanced Affordable Care Act benefits that expired at the end of the year and have been the subject of intense debate on Capitol Hill. Trump briefly considered supporting an extension of those insurance subsidies but has since backed away. Congress is continuing to consider options for extending the funding, though prospects for passage seem dim, and the enrollment period for insurance concludes Thursday.

Sen. Lisa Murkowski, R-Alaska, part of a group of senators trying to reinstate the subsidies, said the talks would be continuing. "I'm not giving up," she said Thursday. Still, she acknowledged that any plan would struggle to move forward without White House support.

Instead, Trump's plan calls for redirecting insurance subsidies into individual health savings accounts, which people could use to purchase health care services directly. Lawmakers have been discussing a few similar proposals, with varying details about the magnitude of the funding and how the money could be used.

One such plan came up for a vote on the Senate floor last month, and Senate Republicans did not have the 60 votes necessary to advance past a filibuster. It would have replaced the expiring subsidies by putting similar amounts into health savings accounts for consumers who chose high deductible insurance plans.

The proposal would require insurance companies to provide more transparency on the prices they pay medical providers and their profit margins, though both sets of data are already required of the industry to some degree. Trump has long believed that improving the transparency of health care prices will drive down costs, though evidence for that contention is limited, and some economists believe publishing health care prices could actually help raise them.

It also calls for a requirement that would force insurance companies to prominently post the frequency with which they deny care. And it calls for more regulation of pharmacy benefit managers - giant middlemen companies like CVS Caremark and Express Scripts that manage prescription drug benefits for Americans with health insurance.

The proposal builds on another long-standing health care priority of the president's - lowering prescription drug prices. It asks Congress to codify voluntary deals Trump has made with drug companies. Those deals cover 16 of the 17 major drugmakers to which the president sent letters last summer demanding lower prices. The last holdout, Regeneron, said it is still in talks with the administration.

The deals seek to align some U.S. drug prices with the lower levels in European countries, a long-sought goal of Trump's. Drugmakers agreed to offer those lower international prices to state Medicaid programs, which cover lower-income Americans and already pay the lowest prices in the United States for drugs. They also pledged to introduce new drugs in the United States at prices comparable to what they ask European countries to pay.

And the companies committed to setting up websites to sell some of their drugs directly to American patients, without going through insurance; a site to help patients navigate those company websites, TrumpRx.gov, is expected to become operational later this month.

Alex Schriver, a senior vice president of public affairs at industry trade group PhRMA, criticized the international pricing idea as a form of importing the "flawed strategies of other countries.

"Imposing broad-based price controls does nothing to address insurance barriers and would instead threaten access to breakthrough treatments and undermine critical investments that strengthen the U.S. economy," he said in a statement.

The effects of those pricing deals are likely to be limited, at least in the short term, because they do not cut the prices that drugmakers currently offer to employers, private insurers and other government programs. Nor do they address the high out-of-pocket drug costs for most American patients.

"The president is responding to the many people who are talking to him about the problems in health care," said Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, adding: "People are complaining about drug prices. We have a framework for addressing that. They complain about insurance premiums in general, not just in the ACA. They are complaining about the lack of accountability of big insurance."

As he described the proposals, Oz referred to the document as both a "framework" and a "plan."

"This is a beautiful framework, and that's why - it's a health care plan that I think we can celebrate when we're done." he said. "That's what makes it great."

Republicans passed major Medicaid cuts as part of their major tax and domestic policy legislation this past summer. But there has been little appetite among congressional leaders for another major health care bill.

This article originally appeared in The New York Times.