America still awaits Trump's 'great' health plan

During the 2016 presidential campaign, Donald Trump repeatedly vowed to “make America great again" if elected. Many voters were never clear on what exactly that meant. 

After a Republican-controlled Congress failed to repeal the Affordable Care Act this year, the frustrated president said he would work with Democrats to create “great” health care for Americans. When he took steps on Thursday to undermine Obamacare, he again pledged to deliver a “great” plan. 

An adjective is not a strategy. "Great" is not a clear plan. And while Trump has not provided concrete, consistent details about the type of health insurance system he is seeking, the direction he's moving will not result in anything positive for consumers or health insurance companies. 

Trump’s new executive order seeks, among other changes, to allow the sale of insurance plans that do not meet specific coverage requirements. In other words, he wants to welcome back the kind of junk policies that proliferated before Obamacare.

The health reform law didn’t only provide health insurance to about 20 million previously uninsured Americans. Subsequent rules required insurers to actually cover the services people need, including preventative care and hospitalization. The government required insurers to provide minimum benefits because too many Americans didn't realize how bad their coverage was until they were diagnosed with an illness or landed in the hospital. 

That was the case with Jan and Gary Clausen, an Audubon couple a Register editorial writer interviewed before the passage of the ACA. The AARP-endorsed UnitedHealth insurance plan they had paid thousands in premiums for left them with $250,000 in medical bills after Gary was diagnosed with cancer. 

Yet this seems to be the kind of sham coverage the current president believes will make Americans “very happy.” 

The same day Trump signed this executive order he announced he would end “cost-sharing reduction” payments to private insurance companies offering plans on exchanges created by Obamacare. 

The sudden loss of these payments, expected to total about $7 billion this year, will put more financial strain on the already dwindling number of private insurers now offering coverage and discourage them from offering it in the future. 

Medica, the sole insurer planning to sell individual policies in Iowa for 2018, said it anticipated the loss of this money. Many state regulators did, too, granting companies extra rate increases to make up for the loss of federal funding if Trump followed through on threats to cut this money. Medica plans a 57 percent premium increase, the largest health insurance price rise in Iowa history.

Trump’s order will further destabilize an already unstable insurance market, a result that flies in the face of Republicans’ affection for private insurers. They have long supported subsidizing companies, instead of expanding government programs, to deliver health insurance to Americans. Apparently Trump didn’t get his party’s memo about embracing privatization.

So congressional Republicans will once again busy themselves with damage control efforts. Sen. Ron Johnson, a Republican from Wisconsin, is expected to introduce legislation this week to fund the payments to insurers. 

Congress cannot keep up with the whims of this president. Neither can states, businesses or private health insurers who are likely tired of the uncertainty being created by this administration. Average Americans have no idea what the future holds. 

It appears Trump has no concrete plan for health care. He has not outlined a vision for a better system. His primary goal seems to be holding press conferences to announce his latest random, disruptive change. And everyone is supposed to believe the ensuing chaos will result in something "great."