Make Sure Price Is Right

Tom Price, secretary of health and human services.

As the nation has learned in 2½ months of Donald Trump’s presidency, little is as it appears. Worse, little is as he says.

The problem is that his comments, pro and con, rotate around an important issue as quickly as the International Space Station orbits Earth.

When the House of Representative’s health care bill failed March 24, following mighty pushing and schmoozing by Trump and House Speaker Paul Ryan, the two were glum.

“This is a setback, no two ways about it,” Ryan said. “Obamacare is the law of the land,” he said, and it will be “for the foreseeable future.”

“I’m disappointed,” Trump said. Before the day was through, Trump circled around the other side of the health care globe to say, “I want to have a great health care bill and plan — and we will.”

Ryan said Tuesday that he would allow House Republicans to try again on health care. “We are all going to work together and listen together until we get this right.” Ryan did not provide a plan or schedule.

While Trump and Ryan entertain wishful thinking, the executive branch is obligated to carry out every aspect of the Affordable Care Act, as Obamacare is titled.

NO EXCUSE

Tom Price, secretary of health and human services, has that duty. Obamacare is healthy. The nonpartisan Congressional Budget Office predicted March 13 that insurance markets will remain stable.

As such, Price has no excuse for anything other than vigorous support for Obamacare as its executive leader and through his Department of Health and Human Services.

Neither may Price fall back on the ultraconservative, anti-Obamacare positions he held as a Republican member of the U.S. House. In the House, Price was a member of the Tea Party, much of whose outlook is shared by the House Freedom Caucus. Caucus members opposed the conservative House health bill as too liberal.

Concern about Price’s willingness to meet the requirements of his position has proved valid in the short time since his Feb. 10 confirmation by the Senate.

Price’s agency delayed a health rule March 21. The HHS notice pushed back reform of Medicare payment for follow-up treatment after a heart attack, or heart-bypass or joint-replacement surgery. For months, Trump has promised no Medicare reductions.

PROTECTIONS

This mischief shows just a sliver of the worrisome possibilities. Price must keep at full strength a wide range of Obamacare protections, particularly its essential health benefits. Among them:

• The individual mandate, which requires nearly all to have health insurance or pay a tax penalty. This makes possible the coverage of people with pre-existing conditions.
• Preventive coverage. Examinations and tests find problems about which patients are unaware. Early detection makes treatment easier and reduces cost. The benefits of laboratory-test coverage and chronic-disease management are similar.
• Emergency coverage ensures that one can receive comprehensive hospital care immediately. Before Obamacare, too many could not get beyond emergency rooms and too many died.
• Maternity care for mother and child is important for them and future society. Often, it was an exception before Obamacare. Mental health was covered at a reduced rate. Equal mental health coverage helps both patient and populace.

Between insurance exchanges and Medicaid expansion, some 20 million Americans have health insurance because of Obamacare. The CBO projects the percentage of uninsured people to stay between 9.5 percent and 10 percent for a decade. Before, it reached 16.3 percent.

The Affordable Care Act needs an advocate at the top level of government. Because he accepted nomination, was confirmed and swore to uphold his duty, Tom Price is that advocate.

Price must perform. President Trump, Congress and the people must hold him accountable.

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Killer Health Care ‘Choice’

Mick Mulvaney, director of the Office of Management and Budget.

Since his election as president, Donald Trump has promised to improve health care in the United States, offer coverage to all and to make it less expensive.

As the months progressed, Trump added “choice.” Consider it lesser coverage.

Trump lieutenants use choice to explain away the contradictions of a policy that promises more, better and cheaper health insurance simultaneously. The number of people covered is secondary, they say, ignoring the danger of losing health insurance.

Choice would fool many into buying cheap, insufficient insurance. This would cause the cost of robust coverage to increase.

THE PROMISES

“It’ll be better health care, much better, for less money,” Trump told Lesley Stahl of CBS News in a “60 Minutes” interview conducted three days after his election.

“We’re going to have insurance for everybody,” Trump told The Washington Post in an interview the weekend before his Jan. 20 inauguration. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

“I am also calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs and, at the same time, provide better health care,” Trump said Feb. 28 to a joint session of the House of Representatives and the Senate.

THE POLS

“The fact that certain groups will pay less tax is not central to the issue,” said Mick Mulvaney, director of the Office of Management and Budget. Mulvaney was responding to a March 12 question from George Stephanopoulos of ABC News on “This Week.” Stephanopoulos had asked if predictions were correct that the House’s health care bill would cover millions fewer Americans, force millions of those with health insurance to pay more and cut taxes for wealthy people.

“Congressman Morgan Griffith from Virginia had some really good ideas regarding things like changing the expansion date or perhaps putting work requirements in on Medicaid — those are great ideas that would improve the bill,” Mulvaney said. Stephanopoulos had asked about House Republicans, such as Griffith, meeting with Trump and discussing the end of Medicaid expansion in 2018 rather than 2020, as proposed by the bill.

“Nobody will be worse off financially in the process that we’re going through, understanding that they’ll have choices that they can select the kind of coverage that they want,” said Tom Price, secretary of health and human services, on the March 12 “Meet the Press.”

THE DOCTOR

“Lack of access. Lack of jobs. Very poor health care in the past,” said Dr. Mitch Jacques of the Cabin Creek Health Clinic in Dawes, West Virginia. He was answering a question from Michael Barbaro of The New York Times about health conditions before Obamacare. The March 10 edition of “The Daily” podcast, which Barbaro hosts, contains the interview.

“It was not uncommon for someone to go to the emergency room and have a major heart procedure, and not follow up with anyone,” Jacques said about pre-Obamacare treatment in the coal-mining area of southern West Virginia.

“By 2020, there may be virtual elimination of the Medicaid expansion, under the Affordable Care Act,” Jacques said in answer to a Barbaro question of effects expected if the House bill succeeds Obamacare. “If that occurs, many of our patients will lose their insurance,” he said. The group that operates the clinic estimates a loss of 20 percent to 30 percent.

“What would that do to the community?” Barbaro asked.

“Without question, if the Republican policy goes through, and health care is withdrawn from 20 to 25 percent of our patients, a number of those people will die for lack of appropriate health care,” Jacques said.

Choice is the word. For too many, death would be the sentence.

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Trump Can Be Replaced

President Donald Trump can be replaced. No impeachment required.

This is true for any president, under the Constitution’s 25th Amendment. Although political problems would abound, the mechanism for judging the president’s ability to carry out his duties is solid.

Vice President Mike Pence would take the first step, following Section 4 of the amendment.

The vice president would gather support from a majority of Cabinet members.

Together, they would write a declaration to the Senate president pro tempore and the speaker of the House that the “president is unable to discharge the powers and duties of his office.”

The vice president would take over as acting president immediately.

The president could resume his position by writing to the Senate president pro tempore and the speaker that “no inability exists.”

The vice president and a majority of the Cabinet could challenge the president’s declaration by submitting their own declaration, again, within four days.

The vice president would resume his place as acting president, and Congress would take up the challenge. It would have 21 days to decide if the president is able to serve.

Votes of two-thirds in both the House and Senate would keep presidential power under the vice president as acting president. Otherwise, the president would regain power.

The 25th Amendment does not prohibit the president from declaring again that he is able to meet the requirements of office. That would have the potential for resetting the cycle of a vice president-Cabinet declaration and congressional votes.

POWERS AND DUTIES

The president holds power over life and death. He commands the military. The power of clemency allows him to pardon a criminal or commute a prison sentence.

He may propose legislation, and sign or veto legislative bills passed by Congress. He directs foreign policy and deals with leaders worldwide.

He appoints ambassadors, as well as thousands of government officials. They include Cabinet members, federal judges and heads of agencies. The Senate confirms many of the appointments.

In short, the president runs the federal government day to day. His actions must adhere to the Constitution and federal laws.

REPERCUSSIONS

Critics question Trump’s fitness as president because of false and nonsensical statements.

On March 4, Trump wrote on Twitter: “How low has President Obama gone to tapp [sic] my phones during the very sacred election process. This is Nixon/Watergate. Bad (or sick) guy!”

Trump offered no evidence that Obama had tapped his phones. Obama did not have the authority. Trump shamed himself and his presidency, rather than Obama.

On Feb. 18, Trump held a campaign rally in Melbourne, Fla. “We’ve got to keep our country safe. You look at what’s happening,” he said. “You look at what’s happening last night in Sweden.”

He implied and the next day confirmed reference to problems with immigrants, of which there is some. Nonetheless, was there trouble in Sweden on the night of Feb. 17? None. Trump’s claim: nonsense.

In an interview with Bill O’Reilly of Fox News, shown before the Super Bowl on Feb. 5, Trump said enforcement of his Jan. 27 travel-ban executive order affected just “109 people.”

In truth, federal officials said, 60,000 visas were revoked because of the travel ban.

With a manner opposite to President Trump’s impertinence, Vice President Pence is loyal, serious and substantially more conservative.

Those qualities would lead Pence to ignore a challenge to Trump’s presidency, other than emergence of an ability-to-serve problem clear both for supporters and opponents to see.

Pence’s calm, purposeful demeanor sets an example for the executive branch.

The nation would owe Pence a debt of gratitude if he would counsel Trump. Advise him to focus outward on the needs of others — rather than inward on himself — to build respect and power.

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21st-Century Health Insurance

President Donald Trump said he would "make health insurance available to everyone" when he addressed Congress on Tuesday night.

Trump asked Congress to "repeal and replace Obamacare with reforms that expand choice, increase access, lower costs and, at the same time, provide better health care."

The Affordable Care Act, the formal name for Obamacare, set 21st-century standards for coverage. For a "Trumpcare" plan to succeed, it must equal the 2010 act's rigor.

The standards protect people with insurance obtained through employers, as well as plans obtained via Obamacare.

With Trump's challenge to Congress on Tuesday, he crossed the starting line with his campaign promise to kill Obamacare and replace it with something superior. Despite his rush, the race could prove long.

First, the president and Congress must produce a detailed plan. The people should examine each point deeply.

They should demand of their representatives and senators no slippage in coverage. That has been the case with previous congressional plans.

STANDARDS

Health insurance in the United States must continue to cover:

• People with pre-existing conditions. (Trump called on Congress to do so.)
• Dependents, typically adult children on parental insurance, until age 26.
• Patients beyond the time of an illness. Coverage cannot be dropped for getting sick.
• Medical costs, regardless of total cost — no coverage caps.
• Medical expenses up to an annual limit on patient payments. This year, the caps for out-of-pocket costs are $7,150 for an individual and $14,300 for a family.
• Mental health, substance abuse and behavioral-health treatment at the same rate as for general medical care — at parity. This includes psychotherapy and counseling.
• Preventive care, without cost sharing — insurance covers the full cost. This includes screenings and vaccines.
• Emergency care. The cost for out-of-network emergency care is charged at no more than the cost for emergency care within an insurance plan's network of doctors and hospitals.
• Ambulatory care. Commonly called outpatient care, this is health care that does not require hospitalization.
• Chronic-disease management. Such management coordinates care for ongoing disease. It includes screenings, checkups and related education for the patient. Among its aims is limiting the effects of a disease on the patient.
• Hospitalization.
• Laboratory services.
• Maternity-and-newborn care, including for plans obtained after the mother becomes pregnant and for a newborn child added to a plan after birth.
• Pediatric dental-and-vision care.
• Prescription drugs.
• Rehabilitative and habilitative services — to regain or gain health and ability.

Before Obamacare, many of these services were not covered by health insurance, or were covered partially or at extra cost.

Some members of Congress favor repealing Obamacare without replacing it. The public would not stand for such selfishness, nor, it appears, would the president.

Trump's call for a replacement plan to guarantee health insurance for all people in the United States is important. Nonetheless, that is nothing more than what we have.

Trumpcare can cross the finish line and claim victory only if it includes or improves upon every aspect of 21st-century health insurance.

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