President Donald Trump signed an executive order today that declares it a national policy to protect patients with preexisting conditions regardless of the fate of the Affordable Care Act (ACA)—but just how they'll force insurers to comply remains unclear.
Health plans are barred from refusing to cover patients with such conditions under the ACA, but the Trump administration backs a court decision that would strike down the entirety of the law as unconstitutional, including such protections.
The case is currently before the Supreme Court, with oral arguments set to begin after the election.
Department of Health and Human Services (HHS) Secretary Alex Azar said on a call with reporters that the goal of Thursday's order is to make it a "clear national policy" that the federal government protects patients with preexisting conditions, even if the law is struck down by SCOTUS.
The order comes as polling suggests many American voters are skeptical about the president's healthcare agenda. A survey from the Commonwealth Fund released Thursday shows that a majority of voters in 10 key battleground states believe Democratic nominee Joe Biden would more effectively protect patients with preexisting conditions.
A majority of polled voters in nine out of 10 states also said Biden would be more likely to address both COVID-19 and its economic impacts. Trump edged out his competitor among voters in Ohio, however, 48% to 45%, according to the poll.
Healthcare, especially as the coronavirus pandemic continues, is shaping up to be a key issue in the election. Trump and Biden will meet for the first debate next Tuesday, Sept. 29.
Second order tackles surprise medical billing
Trump also signed a second executive order Thursday aimed at addressing surprise medical billing. Azar said on the call that the order will direct him in his role as secretary to work with Congress to get legislation tackling the issue passed in the next several months.
If a piece of surprise billing legislation isn't passed by Jan. 1, Azar said, the order will empower him to seek whatever pathways are necessary to address it instead through regulation at the White House.
Azar said HHS is working now to determine what regulatory avenues it might be able to use to address surprise billing, though he offered no details beyond that. He also didn't endorse any particular legislative approach to address surprise billing either, instead saying the parties involved should work it out themselves.
He said if HHS is tasked with addressing surprise billing, the healthcare industry will "get what you get" in terms of a solution.
Multiple legislative packages tackling surprise medical billing have stalled in Congress due to a deep divide between insurers and providers over the best approach to addressing the issue. Payers prefer a rate-setting approach, which would cap payments to providers, while providers instead back baseball-style arbitration to mitigate disputes, which could favor them over insurance companies.
Trump is also expected to discuss surprise medical bills in his speech today.