Trump’s ‘Great Healthcare Plan’ Is Not Great. It’s Not Even a Plan.

DONALD TRUMP ON THURSDAY rolled out what he is calling “The Great Healthcare Plan” and the single most important thing to know about it is that it’s not really a plan.

A real plan would have details and numbers, plus experts on standby to explain and defend it. It would reflect weeks of behind-the-scenes work, and represent the beginning of a serious, persistent effort to get a bill through Congress. That is not what the White House produced.

The online summary is just 350 words and fits on a single printed page. The extended “fact sheet” clocks in at just 825 words. There are days Trump writes more than that in his posts on Truth Social.

And it’s not like those 825 words are dense with policy substance. About a third is a summary of some modest—er, “historic”—executive actions Trump has already taken. The rest is a list of ideas either Trump or Republicans in Congress have endorsed before, with no guidance on the specifics that it would take to turn them into legislation.

It’s hard to know what kind of effort went into this proposal; probably there were some knowledgeable, diligent wonks at the Office of Management and Budget or the Domestic Policy Council staying up late recently to craft and vet the document’s language. But the reaction on Capitol Hill was a collective shrug, which suggests the White House didn’t spend much time coordinating with the people whose input and support would be necessary to pass a health care law.

“It doesn’t appear to have done anything positive,” Debbie Curtis, a principal at the health care lobbying and consulting firm McDermott+, told me. “If Congress wants to tackle health care, they have to think through what they want to do. This doesn’t help them do that.”

None of this is surprising. Trump has been promising to release plans for “great” health care throughout his two presidential terms, going back to the very first days of his initial campaign when he was launching his crusade to repeal the Affordable Care Act. “I am going to take care of everybody,” Trump boasted in a 2015 CBS News interview. “Everybody’s going to be taken care of much better than they’re taken care of now.”

But you can count on one hand the number of times Trump has actually produced a written proposal. And even those documents were more like “concepts of a plan”—that is, press releases with talking points, which is a fair description of what his administration put out Thursday.

Honestly, it’s become a running joke among those of us who follow health policy. And yet there a bunch of us were on Thursday, on Zoom for a White House briefing call, wondering if maybe this time would be different—not because Trump has done anything to suggest he’s gotten more serious about policymaking, but because political circumstances seemed to demand some kind of action.

TRUMP’S POLL NUMBERS are in the dumps, with voters identifying the high cost of living as a top concern. That includes the price of health care, which just went up for more than 20 million Americans who rely on the Affordable Care Act. The reason for the increase—as loyal readers of The Breakdown know well!—is the expiration of a temporary boost in the program’s subsidies, which Democrats have been pushing to renew.

Republicans have refused to go along, because most see any expansion of health care as sacrilege, especially if it’s connected to “Obamacare.” GOP leaders refused to consider the subsidy expansion even when Democrats shut down the government over it, and then declared victory when a December Senate vote on extension failed.

But things haven’t gone so well for the Republicans since. All over the country, GOP lawmakers are hearing from constituents whose premiums have gone up—sometimes by hundreds or thousands of dollars a year, and in extreme cases by many thousands. These people are sucking up the increase, switching into cheaper plans that stick them with higher copays and deductibles, or they are dropping coverage altogether.¹

That pressure was enough to get legislation extending the subsidies out of the House, where seventeen Republicans broke ranks and voted with the Democrats. And while the Senate last week rejected that proposal, a bipartisan group has been hard at work, trying to find some kind of compromise that can pass (and then go back to the House for passage there).