President Trump signed an executive order yesterday that says it is the “policy of the United States” that health insurers cannot deny coverage to people with pre-existing conditions, even if the Supreme Court strikes down the same protections in the Affordable Care Act (ACA) often called Obamacare.

Trump, who has been unable to overturn the 2010 health insurance law, plans to offer a comprehensive healthcare plan to “create true competition in healthcare,” he said during a campaign stop in North Carolina yesterday.

“We will have a better and less expensive plan that will always protect people with preexisting conditions,” Trump said, promising quality health care at affordable prices, lower prescription drug costs, more consumer choice and greater transparency. The executive order would also to try to end surprise medical bills.

It follows another executive order Trump signed two weeks ago to create a “most favored nation” drug pricing system in Medicare. Under the executive order, the Secretary of Health and Human Services will create a demonstration program through which Medicare would pay no more money for a drug than the lowest price in countries in the Organization for Economic Cooperation and Development.

Trump’s overall healthcare vision, which he outlined yesterday, would allow individuals to customize their plans based on their own needs and family health history. The plan would also give small businesses with 50 or fewer employees the ability to band together to create the level of purchasing power large employers currently have when buying and administering employee retirement plans. 

“We need this type of competition,” said Gordana Schifanelli, an attorney and president of Allsource Financial Management LLC, Annapolis, MD.

“During Obama, small businesses and individuals here in Maryland and across the country had no choices,” she said. “Everyone was terminated from their existing plans. UnitedHealthcare, our previous insurer, terminated their plan with Maryland, so our premiums for a family of five skyrocketed from $575 per month with a deductible per person of $1,500 to $1,750 per month with a deductible of $6,000 per person. Many of my clients who run small businesses have been in the same boat.”

As a result of the increases, Schifanelli said she was forced to self-insure her family, but avoided the Obamacare tax penalty for doing so, which Trump subsequently overturned, because of her husband’s military insurance.

Critics, including House Speaker Nancy Pelosi and the Washington Post, faulted Trump’s plan for being light on details or redundant to some facets of Obamacare. For example, the right for coverage of pre-existing conditions is already guaranteed in the Obama-era health law that the Trump administration is asking the Supreme Court to overturn.

Other skeptics note that President Trump touted a more efficient alternative to the ACA when he entered office in 2017 and has yet to produce a detailed plan. Pelosi and Democrats are betting that Obamacare will win the day on healthcare with votes for presidential candidate Joe Biden. The results of the 2018 mid-term elections in which Democrats too control of the House of Representatives would appear to support this perspective.

Schifanelli, however, said that specifics of Trump’s vision for healthcare will come from individual private insurance companies and that the market will determine private contracts.”

“Under the Trump plan, each insurer will be able to offer specifics to correspond to guidelines put forth by the White House and Health and Human Services,” she said. “What is critical is that we have to open up the entire system to competition.”