What is Donald Trump’s Position on Health Care?

What the Trump Campaign Says?

Let’s start at the source- Donald Trump’s official presidential website section on healthcare. Trump begins with a vow to repeal the Affordable Care Act [ACA] on his first day in office, replacing it with reforms “following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.” [emphasis in original]

The Trump campaign then lists a number of previous Congressional attempts at reform which he would want to come to fruition on his election, including changing Medicaid to block-grants to the states, and allowing drug imports from overseas. Other reforms listed as necessary to produce the financial security of Trump’s vision include enforcing current immigration laws to prevent persons not in the country legally from obtaining health care (which he estimates to be an $11 billion savings annually), and “energizing our economy” so fewer people will require the assistance of public health programs such as CHIP and Medicaid.

In closing, the website says Mr. Trump believes it is “the moral responsibility of a nation’s government to do what is best for the people and what is in the interest of securing the future of the nation.” To do so requires a President who has leadership skills, and “the will and courage to engage the American people and convince Congress to do what is best for the country.”

Commentary and Concern About Mr. Trump’s Position

Mr. Trump is certainly not unique in calling for the repeal of Obamacare- John Kasich and Ted Cruz hold the same position. [We will get back to both of them in future Fontenotes.]

What makes Mr. Trump stand out in the Republican pack are questions about both past and recent statements which seem to conflict with his platform as stated on his website. To illustrate I will look at a sampling of these comments and inconsistencies in chronologic order.

1999: In an interview with Larry King  Mr. Trump described himself as “very liberal” on the issue of health care, adding “I believe in universal health care. I believe in whatever it takes to make people well and better.”

6/28/15:  In a CNN interview Mr. Trump admitted that he had previously supported a single-payer health system (such as proposed currently by Bernie Sanders):

Q: But the single payer, you’re not interested anymore?
A: No. No, these are different times. And over the years, you are going to change your attitudes… I have evolved on that issue…

7/17/15: Mr. Trump reiterated his former support for a universal health care system with governmental participation on  Morning Joe, saying he is “a little bit different” than other Republican candidates in that he wants “healthcare for everybody.”

7/31/15: An article in Forbes reviews promises Trump had recently made, including repealing Obamacare and replacing it with “something terrific”. The campaign representative interviewed affirmed Mr. Trump’s support of a “universal ‘market-based’ plan that would offer a range of choices.”

When Forbes asked about Mr. Trump’s prior support for universal health care, the spokesperson’s response was an answer about socialized health care, which is a completely different question, which left this reader wondering if the Trump campaign understands the difference. [For more on the difference please read Fontenotes Number 17.]

9/27/15: In September in an interview with CBS’ Scott Pelley on 60 Minutes Mr. Trump raised a stir with the following exchange:

Scott Pelley: [Are you in favor of] Universal health care?
Donald Trump: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.
Scott Pelley: The uninsured person is going to be taken care of how?
Donald Trump: They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably–
Scott Pelley: Make a deal? Who pays for it?
Donald Trump:the government’s gonna pay for it

In an assessment of the 60 Minutes interview,  Forbes noted that his plan “doesn’t appear to curtail government intervention” and most likely would be achieved through price controls, which would require government involvement of some sort.

2/18/16: Donald Trump got himself in Republican hot water again at a February town hall meeting for saying “I like the mandate”, referring to the individual mandate which is a core component of the ACA. The backlash from the Republican establishment was immediate, including a statement by Rush Limbaugh: “You can’t talk about repealing Obamacare and like the mandate.”

Trump tweeted 24 hours later that he had been misunderstood, that what he really said was he likes the part of the ACA that prohibits pre-existing condition exclusion from coverage, not the individual mandate- but he would still repeal Obamacare all the same.

Uncertainty Remains

This list of comments and inconsistencies is not meant to be all-inclusive- Mr. Trump has made multiple statements regarding health care that are not mentioned here. However, I think it is a fair assessment of this sampling to say it is difficult to know exactly where Donald Trump stands on the issue of health care.

There is no refuting that he has said multiple times that he would repeal the ACA, but he hasn’t offered details on how he would replace the law. Many of the necessary reforms listed on his website to replace Obamacare are actually already in the ACA, including:

  1. fighting fraud & waste,
  2. allowing market forces to regulate costs through the marketplace,
  3. allowing the government to negotiate drug prices,
  4. price transparency among healthcare providers so patients can obtain the best cost for their care,
  5. working with states and Medicaid “to ensure that those who want healthcare coverage can have it”,
  6. reforming our mental health care system, and
  7. increasing knowledge and tools for patients and their families so people know how they can best help themselves and their loved ones.

More to the point, I would add that Mr. Trump’s support of Universal Health Care may not be inconsistent- but that position, in itself, conflicts with his vow to repeal Obamacare. The Affordable Care Act [as originally designed before states were allowed to opt-out of Medicaid expansion] was meant “to take care of everybody”, and is Universal Health Care.

Not everything proposed by Mr. Trump is already in the ACA. He does endorse allowing people to buy insurance across state lines, but the actual impact of that proposal is questionable in an increasingly consolidated insurance market. He is also fond of telling his audiences he will make “deals” with hospitals so they will take care of the poor– without explaining how hospitals will absorb those costs, or how prices can be lowered without government involvement mandating price controls.

Mr. Trump is not alone in the lack of details he provides on how he would move forward with his own health care plan. As said in a heated opinion piece on Fox News:

Each candidate needs to answer this very simple question: If your plan is to repeal ObamaCare, then what’s your plan to replace it?” If your plan is to make changes to it, then exactly what changes and how? It’s an insult to all of us that we’re still waiting for the answers.

We will get back to the other candidates in my next Fontenotes. But for now, I think it is clear why many people are questioning whether Mr. Trump is a “true conservative” on the issue of health care.

Want to Know More?

We will be getting back to all of the remaining Presidential candidates, but in the interim here are their position statements on health care, as listed on their own websites [in alphabetical order]:

Hillary Clinton

John Kasich

Donald Trump

In addition, Ted Cruz has made some statements about health care, but it is not listed as an issue on his website. A review of quotes and comments by the candidate on the subject are listed here.