Where’s the Plan? Trump Executive Order Fails to Include any Policy to Protect Health Care if the ACA is Struck Down

Some of us are old enough to remember an iconic Wendy’s ad from the 1980s, in which a sharp-eyed senior citizen was smart enough to see she was being sold a bill of goods by a rival burger chain. “Where’s the beef?” she asked. The American people should be asking the same thing of the Trump administration’s so-called health care plan. Promised for months, it was finally released on September 24, 2020.


The nomination of Judge Amy Coney Barret to replace Justice Ruth Bader Ginsburg on the Supreme Court has completely changed the odds for the Affordable Care Act’s (ACA) future. With Justice Ginsburg on the court, it was hard to imagine a majority approving the plaintiffs’ specious argument that the entire law should be struck down simply because Congress voted in 2017 to reduce the individual mandate penalty to $0. Barret, however, is no fan of the ACA and criticized Justice Roberts’s previous decision to uphold the law in 2012. If confirmed, she could provide the pivotal 5th vote to strike down the law.

It is hard to overstate the consequences if the Supreme Court decides the ACA is unconstitutional. Twelve million will lose their Medicaid coverage, 8.5 million will lose subsidized private coverage, and an estimated 133 million Americans with pre-existing conditions – including the 7 million and counting who have tested positive for coronavirus – will once again face the risk of being denied insurance, charged a higher premium, or having benefits excluded from their health plans. The 157 million Americans with employer-based insurance will lose guaranteed free preventive services like vaccines, mammograms, and colonoscopies, as well as caps on their annual out-of-pocket spending. Medicare beneficiaries also will lose preventive benefits and be required to pay more for prescription drugs.

The Trump Administration knows all this, but has chosen to side with the plaintiffs in this lawsuit, aiding and abetting the chaos that will result if the law is overturned. The President justified this position, in part, by claiming that he was preparing a “full and complete” health care plan to replace the ACA. Last week the President rolled out that plan in the form of an Executive Order, and its cynicism is breathtaking.

Effectively, the President’s order says it will be the “policy” of the United States to “ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.” That’s it. That’s all it does.

No mention of how the government will restore coverage to the 21 million slated to lose it if the ACA is struck down. Or how they intend to limit the ability of private insurance companies to deny people health insurance policies, or charge them more, based on their health status. No mention of how they will restore no-cost preventive services, seniors’ drug benefits, or coverage for young adults forced off their parents’ health plans. Nothing about how they will stop the projected 82 percent increase in uncompensated care costs for providers.

In short, the Trump administration has no plan, or even a semblance of a plan. The only thing they appear to have is the cynical belief that, unlike the lady from the Wendy’s ad, most Americans won’t check under the bun.