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Five Provisions of Trump Reform Plan That Put Consumers in Charge of Health Care

Numerous surveys indicate the American public broadly supports moving the nation’s health care system to a more consumer-oriented model, say John C. Goodman, a health economist and co-publisher of Health Care News, and Marie Fishpaw, director of domestic-policy studies at The Heritage Foundation.

In an August 15, 2019 analysis, Goodman and Fishpaw describe five areas where President Donald Trump’s plan, “Reforming America’s Healthcare System Through Choice and Competition,” would do that. (See related article, Trump Health Reform Plan Stands as Alternative to Government Health Care Takeover.)

Personal, Portable Health Insurance

The Trump reform not only allows employees to have insurance they own individually, it encourages it. As of January 1, employers are now able to put pretax money into accounts called Health Reimbursement Arrangements (HRAs) so employees can buy the insurance that best meets their needs. The insurance can travel with them from job to job and in and out of the labor market, instead of being tied to their current employer.

Round-the Clock Care

Direct primary care (DPC) is an arrangement under which patients pay a flat fee, often as little as $50 a month, for 24/7 access to a doctor. Communication by phone and email is common and is especially important as an alternative to visiting hospital emergency rooms at night and on weekends. The Trump administration has been working on allowing Medicare to pay to pay for DPC. The use of pre-tax accounts for a broader population to pay for DPC will require an act of Congress.


The coronavirus pandemic kicked open the door to virtual health care. Previously, federal law prevented Medicare from paying for telemedicine except under rare circumstances. Under President Trump’s emergency declaration order of March 13, 2020, Medicare now allows doctors to provide care by means of phone, Skype, Zoom, and other devices without physically being in the same room with patients.

Care from the Best

Under current law, health plans are required to be all things to all patients. Plans are not allowed to offer specialized coverage such as care for cancer. Last year, the Trump administration took steps to change that. Under the new rules, Medicare Advantage plans may specialize in conditions such as diabetes and heart and lung disease. Such plans should be available to all consumers under equal tax treatment.

Savings Accounts for Chronically Ill

With moderate training, patients with chronic conditions can manage their own care as well as or better than under traditional care approaches, studies show. It follows that they should be allowed to manage the dollars that pay for that care. The Trump administration is making it easier for this to happen, such as by loosening the across-the board deductible rule to allow HSAs to be more flexible with respect to chronic care in general and COVID-19 testing and treatment in particular.

Staff reports


AnneMarie Schieber
AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News, Heartland's monthly newspaper for health care reform.


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