President Donald Trump, on January 15 released “The Great Healthcare Plan,” a health care policy framework for Congress to enact legislation to rein in escalating consumer costs.
Making up the framework are four pillars: lowering drug prices and insurance premiums, holding “big insurance companies accountable,” and maximizing price transparency.
General Specifics
The framework’s fact sheet is a mere 328 words, listing nine points of action.
Lowering drug prices would include legislation to codify Trump’s recent “Most-Favored-Nation” drug pricing deals, which the fact sheet emphasizes were voluntary. The framework also specifies allowing for “more over-the-counter medicines,” which ultimately is up to the U.S. Food and Drug Administration. The plan does not say how to accomplish this goal, but rather its benefits, such as reducing the need for doctor visits and increasing competition.
Under “lower insurance premiums,” the fact sheet calls for sending “the money directly to the American People,” funding a “cost-sharing reduction program,” aimed at cutting Obamacare premiums by 10 percent and saving taxpayers $36 billion. The third point calls for cutting “kickback costs” to pharmacy benefit managers (PBMs), drug plan administrators who “deceptively raise the cost of health insurance.”
Under “hold big insurance companies accountable,” the framework calls for creating ‘plain-English’ rate and coverage language on their websites, requiring health insurers to publish the percentage of their revenues going to pay claims, and publicizing on their websites the number of rejected claims and average wait times for routine care
The framework specifically lists “maximize price transparency” as a point of action, requiring hospitals and insurance companies that accept either Medicare or Medicaid to “publicly and prominently” post their prices to avoid surprise medical bills.
Congress Bypasses Framework
Less than one week later, federal lawmakers unveiled a “bipartisan” funding proposal that omits all but one of Trump’s framework points — PBM reform. Congress introduced the 771-page, $1.2 trillion funding package to avoid a partial government shutdown on January 30, reports Becker’s Hospital Review.
The original proposal left out Obamacare subsidy extensions but delayed Medicaid Disproportionate Share Hospital Payments (DSH) cuts until fiscal year 2028, which were set to begin in 2024. The package extended funding for two rural hospital programs and allows continuation of Medicare pandemic-era telehealth waivers through 2027, and extends for five years a hospital at-home acute care program.
The proposal allocates $4.1 billion for National Institutes of Health research and a $195 million increase for Center of Medicare and Medicaid Services operations.
The final bill passed the House by a vote of 341-88 and provides a full year of funding.
Rep. Tim Burchett (R-TN) blasted the bill. On X, Burchett posted “a lot to be ticked off about. We lied to you and enabled the Marxist left,” referring to Republicans who failed to hold the line on spending and did little on reform. A critical article in Revolver points out “just a couple of weeks ago, 17 Republicans voted with Dems to keep Obamacare alive.”
Restrained Optimism
Congress did act on the framework’s bullet point to cut “kickback costs” to PBMs, an idea not wholeheartedly embraced by free-market reformers.
“It’s not clear additional oversight will do much about abusive PBMs,” said Devon Herrick, a health care economist who writes for the Goodman Institute Health Blog.
“The fundamental problem with PBMs is that the industry was allowed to consolidate to where the three biggest PBMs control about 80 percent of drug distribution,” said Herrick. “With little competition, PBMs can seek large rebates for themselves rather than low prices for their clients. For example, cheap, generic drugs don’t pay rebates, whereas expensive name-brand drugs offer large rebates.”
Missed Opportunity
Congressional Republicans missed an opportunity to show leadership on making health care more affordable, says Dean Clancy, a senior health policy fellow at Americans for Prosperity.
“Republicans should be nervous about heading into election season without having done anything truly transformational on health care,” said Clancy. “Voters are demanding relief on health care affordability, but this bipartisan package fails to address that concern.”
Voters have made it clear how Republicans and Democrats should act.
“Polls show nearly half of Americans find it difficult to afford health care,” said Clancy. “Our own polling finds 82 percent of voters say bringing down health care costs should be a top priority for Congress. This package suggests Washington has other priorities.”
Reforms, Not Spending
In its press release, the House Appropriations Committee, led by Republicans, says H.R. 7148 describes the package of bills it approved related to health: maintaining $1.9 billion for community health centers, and providing $418 for rural health, $1.4 billion to “strengthen” the health workforce, and $1.2 billion on maternal and child health.
“I strongly support this bipartisan, bicameral funding package,” said House Appropriations Committee Ranking Member Rosa DeLauro. “I look forward to voting for it later this week.”
While H.R. 7148’s primary task was to keep the government funded, there was more that could have been done to show voters Congress is serious about fixing health care.
“Eighty-three percent of voters tell us they prefer reforms that increase options for personalized care over more government control and subsidies,” said Clancy. “President Trump has shown the GOP how to win on health care, with his call to ‘fund patients, not insurance companies.’ Republicans need to act on that idea, fast.”
This year, all members of the U.S. House are up for election, and 33 seats in the Senate. The Republicans hold a five-vote majority in the House and a six-vote majority in the Senate, not including Vice President J.D. Vance.
“A big red alarm light is flashing on this issue, and Republicans need to wake up before it’s too late,” said Clancy.
AnneMarie Schieber ([email protected]) is the managing editor of Health Care News.
