Prior to the November elections, National Review editor Rich Lowry made a prediction. If Donald Trump loses, he said, it will be his failure to propose a health plan. As an example of what Trump should be doing, Lowry pointed to an article I wrote with Heritage Foundation scholar Marie Fishpaw discussing key health reforms.
After the election, the editors of the Wall Street Journal echoed Lowry. They also pointed to our article and said this is the roadmap for Republicans, going forward.
Here is what everyone was missing: Marie Fishpaw and I were not writing about what we should do. We were mainly writing about what had already been done. These were remarkable changesradical deregulation of the entire health care industry, in factthat Donald Trump never talked about. And, sorry to say, on the way out the door the Trump administration was still not saying very much.
Donald Trumps most important domestic policy accomplishments were in the area of deregulation. And no industry was more impactfully deregulated than health care.
Here is a brief overview.
Seniors can now talk to their doctors by phone. And not just phone. They can also communicate by means of email, Zoom, Skype, Facebook and other devices. Believe it or not, as we entered 2020 it was illegal (by act of Congress!) for doctors to bill Medicare for consultations by means of telemedicine, except in rare circumstances. The Trump administration had been pushing the envelope, allowing virtual check-ins for example and allowing demonstration projects in the Medicare Advantage plans.
Then, when Congress gave its temporary approval in the face of the Covid-19 crisis, the administration pounced. By April, one in five seniors in rural areas and almost one in three in urban areas had had at least one telehealth visit. And this is the least computer-literate segment of the population!
What made such a rapid change possible? Several years of preparation. The Centers for Medicare and Medicaid (CMS) had to decide what procedures would qualify for a virtual visit and which ones would not (they finally approved 145). They had to decide what fee should be charged: whether a virtual consultation would be paid at the same rate as an in-office visit, and whether an audio-only consultation would be paid the same as an audio/visional one. These decisions took months. And they are the reason why the administration was ready when Covid hit.
Had Hillary Clinton been president, she probably would have been moved to permit telemedicine the same way Congress was moved. But telehealth consultations would not have started in February 2020. More likely they would have started in November or December 2020.
Non-seniors can have virtual consultations. Prior to the Covid-19 breakout, many employers and many health plans made phone consultations available to the younger population. Teledoc, for example, provided the opportunity for phone consultations to 20 million customers. But Zoom, Facebook and other visual devices were off-limits because they did not satisfy the federal governments privacy requirements. Those regulations have now been suspended because of Covid and millions of patients and doctors are taking advantage of that suspension.
Employees can have 24/7 access to primary care. Being able to talk to a doctor at nights and on weekends rather than making a trip to a hospital emergency room used to be a privilege only enjoyed by the rich. It was called concierge care. Today, a similar service is called direct primary care (DPC) and the cost is affordable by just about anyone who can afford to buy health insurance. Atlas MD in Wichita, for example, charges $50 a month for a mother and $10 a month for a child. In addition to 24/7 primary care, patients have access to generic drugs for prices lower than what Medicaid pays and access to inexpensive lab tests as well.
Yet prior to last year, employers were not allowed to put money into an account for employees to use to contract with a DPC doctor of their choice. Thats unfortunate, because DPC at nights and on weekends is not only cheaper than the emergency room, it is much safer.
The Trump administration asked the IRS to approve the use of employee accounts for DPC contracting, and an announcement from the IRS is still pending. As of today, it appears that Health Savings Accounts (HSAs) cannot be used for that purpose, but a similar account called a Health Reimbursement arrangement (HRA) probably can be.
Employees can have personal and portable health insurance.Prior to 2019, it was illegal for employers to purchase insurance that employees owned and could take with them from job to job and in and out of the labor market. In fact, under Obama administration rules, employers caught doing that faced the highest fine in all of Obamacare. Beginning January 1 of last year, however, employers can now fund individually owned health insurance for their employees, and the Trump administration encouraged them to do so.
A missed opportunity. Donald Trump not only failed to campaign on these and other important health reforms, he missed the opportunity to make the case for finishing the job. All of these accomplishments are temporary. In some cases, they are emergency measures tied to Covid. When the virus goes away, for example, the ability of seniors to talk to their doctor by phone also goes away. In other cases, the reforms were the result of executive orders that can be reversed by president Biden or some future president.
What the Trump administration did for health care is one of the best-kept secrets in America. Donald Trump himself is the reason for that.