During the first two nights of the Republican National Convention, speakers touched on a COVID-19 vaccine, opportunity zones, mental health and substance abuse, and preexisting conditions.
COVID-19 vaccine: During a speech given at the convention, President Donald Trump said that COVID-19 vaccines will be out years sooner than they would have been under other administrations. The federal government has invested in the fast-tracked development of COVID-19 vaccines, an initiative termed Operation Warp Speed. Concerns have been raised that even if an effective vaccine is developed quickly, distribution could be a challenge.
Opportunity zones: In a speech, President Trump said he would continue to expand opportunity zones. Sen. Tim Scott, a Republican of South Carolina, also discussed opportunity zones as part of an effort to tackle poverty. Opportunity zones, created by the 2017 Tax Cuts and Jobs Act, offer benefits to taxpayers reinvesting capital gains in special funds aimed at improving economically distressed communities. This includes funding to address the social determinants of health—a critical driver of health status and health outcomes (see HRI’s discussion of the intersection of opportunity zones and healthcare here).
Mental health and substance abuse: In her speech, First Lady Melania Trump spoke about the need to dispel the stigma around mental health issues and substance abuse, and acknowledged that both issues have been exacerbated by the pandemic. Employers have advanced efforts around mental health over the past couple of years, working to dispel stigmas and increasing access to services. Access to proper mental healthcare during the pandemic is crucial.
In a survey conducted by HRI in the spring, Americans reported increased feelings of isolation and loneliness early in the pandemic. A survey conducted in June by researchers from multiple institutions found that substance use increased to cope with the stress of the pandemic and that one in four individuals aged 18 to 24 had seriously considered suicide in the previous 30 days.
Preexisting conditions: In his speech Monday, President Trump said he and Republicans had and will protect preexisting conditions. Covering all preexisting conditions is also a priority listed on President Trump’s second-term agenda.
The Affordable Care Act (ACA) already prohibits insurance plans from rejecting, charging more or refusing to pay for essential health benefits for preexisting conditions for health insurance products that fall under its scope, including individual and small group plans. The prohibition on preexisting conditions does not apply to short-term limited duration insurance (short-term) or association health plans.
The Trump administration is supporting a legal challenge to the ACA that could result in its nullification. That case is set to be heard by the US Supreme Court this fall, although a decision is not expected until after the election (see HRI’s briefing on the case). The administration has not proposed a policy remedy to protect preexisting conditions should the Supreme Court decide to strike down the ACA in part or in full.
Over the weekend, the Trump campaign published a list of second-term priorities. That list includes healthcare priorities that the administration has worked on since 2017.
Cut prescription drug prices: President Trump announced four executive orders on drug pricing in late July, calling for a rollback of safe harbors on rebates, reimportation of certain prescription drugs, 340B prices for insulin and epinephrine pens to be passed on to consumers with low incomes, and implementation of the international pricing index (IPI) if drug manufacturers did not come up with another method to reduce Medicare Part B drug costs. According to Sarah Owermohle and Susannah Luthi of Politico, the board of PhRMA, the trade association for pharmaceutical researchers and manufacturers, submitted a proposal to the Trump administration in recent days that would save Medicare more than $100 billion over a decade.
Lower healthcare insurance premiums: The Trump administration expanded the availability of short-term and association health plans in 2018. That expansion was recently upheld by the US Court of Appeals for the District of Columbia Circuit.
These plans typically offer lower premiums for coverage that is less comprehensive than ACA-compliant plans. These plans do not have to cover the 10 categories of ACA essential health benefits, can exclude coverage for preexisting conditions, can impose annual and lifetime dollar limits on benefits, and can deny initial coverage or renewal of coverage based on a person’s health status.
End surprise billing: The Trump administration was pushing for legislation on so-called surprise medical billing before the pandemic. The effort has since lost steam, although HHS did issue a report at the end of July in response to President Trump’s executive order on surprise billing from May 2019. Minor progress was also made during the pandemic.
Providers receiving money from the CARES Act Provider Relief Fund are prohibited by the terms and conditions associated with that funding from balance billing patients. Under those terms and conditions, out-of-network providers treating COVID-19 patients cannot bill patients for out-of-pocket expenses above what the patients would have otherwise been required to pay if the care was provided in-network.
President Trump’s healthcare proposals largely represent a continuation of policies his administration has pursued since he took office in 2017. The administration has, during the first term, cut corporate taxes, pushed for greater transparency of prices of drugs and medical services, and continued the long march toward value-based care. It failed to repeal and replace the ACA in 2017, and has instead pulled support for some of the law’s programs, shortened enrollment periods and supported a Republican-led lawsuit challenging the law’s constitutionality.
The proposals also reveal areas of bipartisan support, particularly desires to move some critical drug and medical device manufacturing to the US, to address drug prices and to end surprise medical billing. The pandemic response also has cleared away some regulation inhibiting use of telehealth, at least temporarily, and also, perhaps temporarily, allowed for greater reimbursement for these virtual services. These moves have helped fuel an explosion in telehealth use during the pandemic. Trump administration officials have indicated support for continuing at least some of these policy changes after the pandemic ebbs.