The "health care plan" unveiled Thursday at a Trump rally billed as a presidential address is actually worth even less than the paper he signed to "enact" it. Nothing Trump puts forward in the orders has the force of law. You can't hand your insurance company an executive order to make them cover your kid's asthma. The administration knows all that, and admits as much, in the order itself. This is about Trump having a lot of fanfare in saying he's doing something about preexisting conditions and drug prices, while in actuality he's making it all much worse. Given that the administration knows this, what was all the hoopla about? The bribe he announced for seniors.
Out of nowhere, Trump announced that every senior on Medicare was going to be getting a $200 card, a "Trump Card" to use to pay their part of prescription drug co-pays. This all started with an idea by chief of staff Mark Meadows during drug pricing negotiations with the industry. The talks fell apart when Meadows insisted that the drug makers fund a scheme consisting of $100 cash cards to Medicare enrollees to be mailed out before the election. With that failure, the Trump team decided to go bigger—$200 and make taxpayers fund it by stealing from Medicare, probably. The Wall Street Journal reports that the money—$6.6 billion—will come from savings from a Medicare waiver program that is definitely not intended to fund a program like this, and offset by a drug-pricing program that doesn't exist yet. So, yes, it's taxpayer funding for Trump's bribes as of now.
“This is stretching the demonstration authority much more than I’ve ever seen,” Larry Levitt, an executive vice president at the Kaiser Family Foundation, told the WSJ. The last time the waiver process was used for anything other than a limited demonstration project was when President Obama used it to incentivize performance for private insurers contracting with Medicare. His program was intended to test whether “stronger financial incentives and investments”—bonuses to insurers—would lead the companies to offer better quality coverage. That enraged Republicans, and the Republican House launched investigations into it. Now it's a brazen political bribe to voters, and not a single Republican lawmaker is making a peep.
Other Republicans, sure. “It’s completely inappropriate: The timing of it reeks of a bribe to seniors before the election,” Doug Holtz-Eakin, the president of the conservative American Action Forum told Stat News. “I see no reason to somehow pretend this is OK. It’s not OK.” One of the former officials in the Obama administration, Eliot Fishman, agreed. He said that the fact Republicans in Congress were not calling out Trump's bald electioneering is “worse than conventional partisan hypocrisy,” because it has constitutional implications. “You’re essentially turning the Medicare program and any other program where there’s executive branch demonstration authority into an open slush fund that can be used to mail checks to key constituencies right before an election,” he said.
Sen. Ron Wyden, a Democrat from Oregon who is the ranking member on the Senate Finance Committee, calls it a "taxpayer-funded bribe." Which it is, because the money the administration says it will use to offset the funds it's raiding from Medicare will be replenished by a program that doesn't even exist yet. It is supposed to come from a “most favored nations” drug pricing proposal, which has not been implemented and might never be. Trump has signed an order directing it, but the regulations haven't been written and the pharmaceutical industry is threatening legal action if the administration tries to enforce it.
All of this comes as Trump has been threatening Social Security, not just for future beneficiaries (as Republicans usually do), but people getting their retirement payments now. Trump has promised that he will "terminate" the payroll tax if he's reelected—the payroll tax that all worker and employers pay in order to fund Social Security and Medicare. Without the payroll tax, the Social Security actuary projects, the Social Security Disability Income fund runs out of money next year. The Social Security retirement fund would run out in 2023.
Trump's team had been fighting him on the payroll tax holiday for months as he tried to get it into coronavirus stimulus bills, knowing that it was not at all helpful when the real economic problem is all the people not on any payroll (and also that it's dangerous to threaten Social Security in an election year). The damage is done politically, and this is what they've got: bribes to seniors with cash cards that might cover a month's worth of prescriptions.