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Will Trump’s health care executive orders have an impact?

Amid coronavirus and Ruth Bader Ginsburg's death, health care is becoming an even more prominent issue in the presidential race. The Affordable Care Act's fate could be determined by the Supreme Court right after the election. Now, President Trump has issued two health-related executive orders. But do they have real impact? William Brangham talks to The Washington Post’s Paige Winfield Cunningham.

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  • Judy Woodruff:

    With just 40 days until Election Day, health care is becoming a bigger issue in the campaign. That is due in part to the death of Supreme Court Justice Ginsburg and the possibility that the fate of the federal health care law could be argued before the Supreme Court just one week after the election.

    Today, President Trump tried to broaden his appeal on his health care record.

    William Brangham checks the rhetoric against the record.

  • William Brangham:

    Judy, President Trump today signed what he calls two key executive orders.

    One of them pledges to end what's known as surprise medical billing, which can leave patients with huge unexpected debts. The second says the U.S. will make sure that insurers don't discriminate against people with preexisting conditions. But these orders don't change any laws. Congress has to do that.

    And all of this comes as the president is trying to repeal the Affordable Care Act, which already protects preexisting conditions.

    For more on all of this, I am joined by Paige Winfield Cunningham. she covers health care for The Washington Post

    Paige Winfield Cunningham, very good to have you here.

    So, today's event was billed as the America First health care plan, but this wasn't really a plan, per se, the long-promised plan from the president. This was the signing of two executive orders.

    As I mentioned, one deals with preexisting conditions. I think we have about a quarter of all Americans have what would be considered a preexisting condition. What is this order? And does it help protect them?

  • Paige Winfield Cunningham:


    Well, this is really clearly an effort by Trump six weeks before the election to try to look like he is on sort of the winning side of this issue.

    But there's a lot of dispute over whether he can even legally use the executive authority, use an executive order to extend these protections, and almost certainly this would be challenged in court. A lot of people are questioning this already.

    And of course, the Affordable Care Act, passed in 2010, pioneered this, was the first — was legislation that extended these protections to Americans. And the administration has refused to defend that law, and the case will be heard by the Supreme Court, of course, on November 10.

    And it's really been remarkable, I would say, last year and this year, especially, as you have seen President Trump and Republicans try to completely rewrite the record on who has been in favor of these protections.

    It plays really, really well with voters, and Democrats have successfully leveraged it against Republicans in the 2018 elections. And so there's this very blatant attempt by Trump to make it look as he has sort of been a champion of this all along, even though, behind the scenes, he's done a lot of things to actually undermine those very protections.

  • William Brangham:

    So, if the Supreme Court were to do away with the Affordable Care Act, and Congress, as this executive order orders them to do to try to address this issue, if that does not happen, theoretically, a quarter of Americans could face some kind of discrimination with regards to their coverage?

  • Paige Winfield Cunningham:


    So, what would happen if we saw these protections fall — and I should add, we aren't certain of that. There's a lot of different scenarios that could play out. And there's actually a very simple fix Congress could do to all of this to make this lawsuit go away.

    But, if they were toppled, this would kind of go back to the lay of the land before the ACA was passed, before 2010, where it was up to states to regulate this. And you really saw a variety of approaches. Some of the more liberal states, say, California and other states, run by Democrats — tended to more be run by Democrats, would put restrictions on what insurers could discriminate based on.

    Other states had very few restrictions. You saw Arizona was an example of essentially insurers could discriminate against essentially anything. And not only that, but they could refuse — if they knew that someone had had a particular condition in the past, they could refuse to cover treatment in the future that was in any way related to that condition that someone had had.

    So, it was really the Wild Wild West in the individual market for these folks.

  • William Brangham:

    So, let's turn quickly, in the last half-minute we have before we have to go.

    The second executive order addresses surprise medical billing. Again, is there — are there teeth this executive order? Will this actually solve this very serious problem?

  • Paige Winfield Cunningham:

    This is an extremely tricky legislative problem.

    You saw Congress really struggling through the nitty-gritty details of exactly how to do this. All of last year, we had different legislation in the House and the Senate, different opinions about how to tackle this. It's very complex.

    The only thing this executive order does is, it basically instructs Congress to keep working on the issue. And then, if they don't produce legislation by January 1, that HHS should then try to figure out how they could tackle this administratively.

    But, again, it is a very complex issue. This is why Congress hasn't yet been able to unify around a single bill. And so Trump just coming out today and claiming that he's solved surprise medical billing is extremely far from the truth and a very misleading thing to tell the American people.

  • William Brangham:

    All right, Paige Winfield Cunningham of The Washington Post, thank you very much.

  • Paige Winfield Cunningham:

    Thank you.

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