Trump announces health care plan to cut ACA costs requiring Congress’ approval

The Trump administration announced a plan aimed at lowering health care costs in the U.S. on Thursday, just as Affordable Care Act open enrollment ends in most states. But the plan lacks key details and largely restates proposals President Donald Trump has previously outlined.

The proposal, dubbed “The Great Healthcare Plan,” is being framed by administration officials as a broader effort to rein in health costs, including lowering prescription drug prices, redirecting government subsidies from insurers to consumers and expanding price transparency requirements.

Trump has been promising a health care plan overhaul for months. The outline for the plan lands as Republicans in Congress negotiate for a bill to extend the enhanced ACA tax credits, which expired Dec. 31 and led to higher premiums for millions of Americans. The Senate is set leave for a week-long recess, further diminishing any chance of a deal.

The Trump proposal also comes as more Americans voice concerns about affordability issues in the U.S.

Trump has previously pitched sending federal funds directly to patients to address skyrocketing premiums under the ACA.

”The government is going to pay the money directly to you,” Trump said in a video the White House released. “It goes to you, and then you take the money and buy your own health care.”

Direct payments and other proposals, however, would require action from Congress, raising questions about how quickly — or whether — they could be implemented.

“When it comes to health reform, the devil is in the details, and this is very light on details,” said Cynthia Cox, the director of the program on the ACA at KFF, a nonpartisan health policy research group.

On Monday, the federal government released data showing ACA sign ups are running more than 800,000 lower compared to the same time last year.

During a call with reporters Thursday, administration officials offered no details on how the government would distribute money directly to patients, how large those payments would be or who would qualify.

The official said the administration is giving Congress “broad” leeway to decide how the direct payments would work.

“We want to start to see that money moved directly to people,” an administration official said. “There are a lot of different ways that could take place. We are open to working with Congress on how to effectuate that.”

Trump has proposed sending funds to Americans health savings accounts, which people could use to help cover out of pocket costs, such as deductibles and copays — something Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, also suggested on the call.

“Directing it directly to the American people who are eligible, it will allow them to buy health insurance and other programs like health savings accounts of their choice, use that money more wisely,” Oz said.

Art Caplan, the head of the medical ethics division at NYU Grossman School of Medicine in New York City, said sending money directly to people doesn’t work in the health care space, adding that the plan asks people to be “savvy shoppers.”

“It’s a broken plan and a broken idea,” Caplan said. People are “easily ripped off. The average consumer doesn’t really have time to go shopping when they need to go to the hospital for a premature birth or a car accident.”

Cox said the plan could send the ACA marketplace into a “death spiral.”

The Obamacare tax credits don’t go directly to insurers as extra money. They’re applied to a person’s monthly premium bill each month, lowering the amount they owe. Without the credits, many people wouldn’t be able to afford their monthly premiums.

“It has the potential to severely impact the stability of the ACA marketplaces,” Cox said. ”And leaving people with pre-existing conditions without an option for comprehensive coverage.”

The administration official said the plan does not “close the door” on ongoing negotiations to extend the enhanced subsidies. This month, the House passed a bill to extend the credits for three more years, and the Senate is drafting its own separate version. Trump, however, has suggested he might veto an extension.

Trump’s preference, the administration official said on the call, is to send the money directly to patients.

On Thursday’s call, Oz also touted Trump’s “most favored nation” drug pricing push, which ties U.S. prices to those paid in other wealthy countries.

Trump first announced that initiative last May, and the administration has so far reached agreements with 14 major drugmakers.

Oz also highlighted TrumpRx, the new self-pay prescription drug platform that is expected to launch later this month.

Experts have questioned how much people would actually save on the platform, since most insured patients already get lower prices through their coverage and the Medicaid program pays some of the lowest rates. What’s more, some of the drugs that will be on the platform already have generic versions that are typically cheaper for patients, and the drugs that don’t have a generic are used by a relatively small group of people.

The administration urged Congress to pass legislation “without delay,” saying it would deliver relief from what it called the “Unaffordable Care Act” — a quip often used by Trump to criticize the program’s high costs.