Trump announces plan for more choice in health care, lower drug prices

President Trump released a health care plan Thursday that calls for delivering government assistance directly to consumers rather than through insurance companies and for lowering prescription drug prices.

He also wants to make more medicines available over the counter and impose price transparency mandates on health care providers that accept Medicare or Medicaid.

The president’s “framework,” as the White House described it, largely compiles ideas he has floated publicly with few new details on how he would want them implemented, leaving that to Congress to flesh out.

Lawmakers have been asking Mr. Trump to get more involved in health care negotiations for months, but for some, it did not meet the moment.

His plan was released on the final day of Obamacare open enrollment and two weeks after the Democrats’ pandemic expansion of Obamacare premium tax credits expired.

“His plan may be something that’s considered as a long-term proposal, but unless it deals with the extension of the subsidies, then that leaves the crisis that is still facing us,” said Sen. Angus King, a Maine independent who caucuses with the Democrats.

Mr. King is involved in a bipartisan Senate group that has been negotiating a two-year renewal of the enhanced Obamacare subsidies with an income cap, fraud guardrails and other changes.

Those talks were falling apart when Mr. Trump released a video announcing his plan. He reiterated his opposition to extending the bonus subsidies, which are delivered directly to insurance companies to lower consumers’ out-of-pocket premium costs.

“I want to end this flagrant scam and put extra money straight into the health care savings account in your name,” the president said. He told consumers they can use the money to “choose the care that is right for your family” and save money by shopping outside the Obamacare marketplace.

Republicans failed to repeal and replace Obamacare during Mr. Trump’s first term, but their attempt helped cost them the House majority in the 2018 midterms. The tricky politics and policy have led to continued Republican struggles to address the issue during Mr. Trump’s second term.

Trump administration officials are pitching the president’s plan as a way to “get past lazy lawmaking” and address the root cause of high health care prices.

Sen. Ron Johnson, Wisconsin Republican, said Mr. Trump’s proposal is “aspirational” because the health care system is so reliant on third-party payers such as insurance companies and government programs such as Medicare and Medicaid.

“The only way we’re going to bring down health care costs is if we have consumerism. That means people start paying for health care services and products,” he said. “You have to completely dismantle Obamacare, and so how do you get that done?”

Mr. Trump’s plan won a quick endorsement from Sen. Roger Marshall, Kansas Republican, who has led legislation on price transparency and other ideas the president is now pushing.

Senate Majority Leader John Thune, South Dakota Republican, called the transparency provisions “no-brainers.”

The president also called for health insurance companies to use “plain English” to describe their plans and explain why they sometimes reject claims.

The framework asks Congress to codify the most-favored-nation prices he negotiated with top drugmakers, pegging the cost of medicine to what other developed nations pay.

The most-favored-nation approach has some bipartisan support in Congress, but it is not broadly supported by Republicans. Mr. Trump tried unsuccessfully to get that plan enacted during his first term.

Mr. Trump’s framework is not detailed; instead, it leaves it to Congress to flesh out his broad ideas, such as how to deliver government aid to consumers.

Mehmet Oz, director of the Centers for Medicare & Medicaid Services, said one route would be tax-advantaged health savings accounts, which give consumers and the marketplace “a more active role in driving value and quality into the health care system.”

Under current law, health savings accounts must be paired with a high-deductible insurance plan and cannot be used to pay for premiums, which are at the heart of the Obamacare subsidy debate. The tax-exempt funds can go toward deductibles, co-pays and some health care expenses not covered by insurance.

Republicans have multiple legislative proposals to deliver government aid through health savings accounts, some through the current law structure and others that would create rules with greater flexibility.

The bipartisan Senate group’s plan would give Obamacare consumers the option to receive their bonus subsidy in a health savings account, but not until next year.

Those talks have been hung up in large part over whether to add further abortion restrictions. Republicans say a provision of Obamacare designed to prevent taxpayer funds from being used to subsidize abortions has been abused.

Senate Minority Leader Charles E. Schumer, New York Democrat, has been casting doubt on the bipartisan talks because of that dispute. He has continued to push for a clean three-year extension of the enhanced subsidies and raised it in a Thursday meeting with Mr. Trump, despite failing to secure the 60 votes needed to overcome a filibuster last year.

“If Republicans don’t do it, America will know, and the political price they pay will be severe,” Mr. Schumer said.

Sen. Bernie Moreno, Ohio Republican and a leader of the bipartisan Senate group, said the talks should not continue into next week’s Senate recess, as planned, if Mr. Schumer does not provide “affirmative commentary” that he would support an extension with the types of changes negotiators have been discussing.

“If the answer is no, then it doesn’t seem like we’re going to have a deal,” he said.

Mr. Schumer responded by accusing Mr. Moreno of “trying to distract from the reality: The credits expired, and Americans are paying thousands more because Republicans can’t get their act together.”