Health Care

Sept. 24/updated Sept. 25, 2020 - Health Care is looming as a major issue in the Nov. 3 elections.  Democrats point out that the Trump administration has systematically undermined the Affordable Care Act (Obamacare) and in fact is seeking to overturn the law entirely in a case to be heard by the U.S. Supreme Court on Nov. 10, 2020.  Likely confirmation of Judge Amy Coney Barrett to the Supreme Court before then, raises the stakes, as she is seen as an opponent of the law.  Democrats further argue that Republicans offer no replacement to the ACA, potentially affecting tens of millions of Americans in the midst of a pandemic.  In this context on Sept. 24 President Trump set out his "vision for a healthcare system that puts patients first, families first, and — perhaps most importantly for all of us — America first."  Trump signed an executive order which most observers say will have only limited effects and which critics described as "bogus" and a "nothingburger."

The White House
September 24, 2020

Remarks by President Trump on the America First Healthcare Plan

Duke Energy Hangar

Charlotte, North Carolina

4:56 P.M. EDT

THE PRESIDENT:  Well, thank you very much.  Thank you.  (Applause.)  Thank you very much.  So many doctors.  So many fantastic doctors, nurses.  That’s great.  Please, sit down.

I’m thrilled to be here in North Carolina with so many of these unbelievable professionals, doctors, nurses, and amazing healthcare workers.  It’s really an honor of mine.

As the world witnessed during our battle against the China virus, America has the greatest medical professionals anywhere on Earth.

Today, I will lay out my vision for a healthcare system that puts patients first, families first, and — perhaps most importantly for all of us — America first.  (Applause.)  Thank you.  Thank you.

Under the America First Healthcare Plan, we will ensure the highest standard of care anywhere in the world, cutting-edge treatments, state-of-the-art medicine, groundbreaking cures, and true health security for you and your loved ones.  And we will do it rapidly, and it’s in very good order, and some of it has already been implemented.

In short, we are delivering better care with more choice, at much lower cost, and working to ensure Americans have access to the care they need.

My plan expands affordable insurance options, reduces the cost of prescription drugs, will end surprise medical billing, increases fairness through price transparency, streamlines bureaucracy, accelerates innovation, strongly protects Medicare, and always protects patients with preexisting conditions.  (Applause.)  Thank you.

By contrast, the Democrat Party is pushing a socialist nightmare.  Their plans will result in rationing care, denying choice, putting Americans on waitlists, driving the best doctors out of medicine permanently, and delaying lifesaving cures.

Over 130 Democrats in Congress, including Senator Harris, have endorsed legislation to outlaw the private health plans of 180 million Americans.

On top of it all, former Vice President Joe Biden promised to give free federal healthcare to anyone in the world who illegally crosses our border.  His plan to provide government healthcare to illegal immigrants would bankrupt our healthcare system, collapse our hospitals, and destroy Medicare, while bringing millions and millions of people — lured — into our country.  As long as I am President, we will safeguard our borders and our seniors.

We are pleased to be joined today by Secretary of Health and Human Services — done a great job — Alex Azar.  Alex.  Hi, Alex.  (Applause.)  Thank you.  And very importantly, CMS Administrator Seema Verma.  Thank you, Seema.  (Applause.)

A great friend of mine and a great friend of healthcare, frankly, Senator Bill Cassidy.  Bill.  Hi, Bill.  (Applause.)

Representatives Michael Burgess and Greg Murphy — so instrumental.  Thank you.  Thank you, fellas.  (Applause.)

And many, many state and local officials are here with us.  Thank you very much.

Since the plague arrived from China, we have seen our doctors, nurses, first responders, scientists, and researchers at their very best.  We slashed red tape to accelerate the development of lifesaving treatments, reducing the fatality rate by 85 percent since April.  Incredible.

Overall, Europe has seen an almost 50 percent greater excess mortality rate than that of the United States.  And despite Europe’s punishing lockdowns, they are now seeing a huge surge, very sadly, in cases.

Under Operation Warp Speed, my administration is developing a vaccine in record time.  It will be distributed before the end of the year, and maybe quite a bit sooner than that.  Four vaccines are now in the final stage of clinical trials.  They’re just about at the end.  A lot of things are looking very good.  It is the most ambitious vaccine program in U.S. history, probably in any history.  The vaccines are being mass-produced in advance so they can be delivered within 24 hours of approval.   The vaccine will be safe and it will be effective.  It will defeat the virus and it will end the pandemic.

The economy will surge to record highs.  You see what’s happening with the numbers that are coming out — records all.  Normal life will fully resume.  That will be great.  And next year will be one of the greatest years in the history of our country from an economic and, hopefully, in many other ways.

When I was elected, I inherited a thing called “Obamacare.”  Has anybody heard of Obamacare?


THE PRESIDENT:  It was terrible.  That’s the way I feel, too.  (Laughter.)  It was terrible and very, very expensive.  Hurt a lot of people.  Premiums were too high.  Deductibles were a disaster.  Patients had no choice.  You couldn’t keep your doctor.  But, by far, the worst part of Obamacare was this thing called the “individual mandate.”

As part of our largest-ever tax cut in the history of the United States, we put in a provision to kill this worst provision of Obamacare: the individual mandate.  It was a disaster, and it was really the essence of Obamacare.  It made you pay a tremendous amount of money in order to not have to pay for health insurance.  Think of that: You had to pay a fortune in order not to have health insurance.  It was really terrible and so unfair to so many.  Destroyed families.

We were able to terminate the individual mandate, but kept the provision protecting patients with preexisting conditions.  That would not have been — that particular law would never have been signed if it were otherwise.  Obamacare is no longer Obamacare.  As we worked on it and managed it very well.  We stabilized it and got premiums down very substantially.  That was Alex and that was Seema.  You did a fantastic job.

But it’s still unacceptable to me because it’s too expensive and doesn’t really do the job as well as we could have.  So what we have now is a much better plan.  It is no longer Obamacare because we’ve gotten rid of the worst part of it — the individual mandate — and made it much less expensive.  A lot of that was through good management.  We manage it properly.  We have tremendous people working on it.  Simultaneously with all of this, we are joining in a lawsuit to end this ill-conceived plan.  I’m in court to terminate this really, really terrible situation.

If we win, we will have a better and less expensive plan that will always protect individuals with preexisting conditions.  If we lose, what we have now is better than the original — the original version of Obamacare, by far.  Much better.  Much better.  Again, we will always protect patients with preexisting conditions.

So today I’m laying out my vision for the future of American healthcare with the America First Healthcare Plan.  As we restore America to full strength, the first healthcare plan will be a core part of our national renewal.

In a few moments, I’ll sign an executive order outlining the three pillars of my plan and directing my administration to implement these critical reforms.

The first pillar of my plan is more choice — more choice for the American patients.  (Applause.)  Very important.  The last administration severely restricted consumer choice through the greatest healthcare lie ever told: “If you like your plan, you can keep your plan.  If you like your doctor, you can keep your doctor.”  You remember that?  Twenty-eight times that was stated by our President, but it turned out not to be true.

When I took office, more than 50 percent of counties nationwide offered plans from only a single insurance company on the individual market.  Starting next month, more than 90 percent of the counties will have multiple options to choose from, which is really some difference.  (Applause.)

Under our plan, you’ll have the freedom to shop for the option that is right for you and your family.  These options include new, affordable choices that cost up to 60 percent less than Obamacare.  Think of that: 60 percent less.

For example, we’re opening up short-term plans that are much cheaper than Obamacare and that can be customized to your individual needs.  We’re also offering association health plans that allow small businesses to pool together and offer more affordable policies to the employees.  These are tremendous options that didn’t exist before we came into office.

And through a massive expansion of health reimbursement arrangements, millions of Americans will be able to shop for a plan of their choice on the individual market and then have their employer cover the full cost.  Furthermore, I’ll work to make individual healthcare premiums fully tax deductible.  That will be a big difference, all right?  (Applause.)  Through these and other reforms, we’re putting American patients back in charge and we’re putting them first.

My plan will also revolutionize access to telehealth.  That’s something that really has taken off during the pandemic.  It’s taken off like a rocket ship.  (Applause.)  It’s increased close to 9,000 percent.  Nobody was using it.  And when we had the pandemic, they started using it.  Then they started really liking it.  Then it started getting better and better.  Bill, now it’s up to 9,000 percent.  Who would think that, right?  One of the few things that we got from this disaster that came from China.

When we rapidly expanded its availability for Medicare beneficiaries during the pandemic, the number of telehealth users increased so incredibly to 14,000 a week.  It was 1.7 million.  It was increasing at levels that nobody has ever seen before in just about any kind of a program.  This is the future of healthcare.  We will ensure all Americans have the freedom to consult with doctors from the safety and convenience of their homes.

The second pillar of my plan is lower costs for families and seniors — lower costs.  (Applause.)  For years, patients have been shocked to receive unexpected bills for thousands of dollars in medical services they never agreed to.  The first America First Healthcare Plan bans this deeply unfair practice.  We will end surprise medical billing.  The days of ripping off American patients are over.

My plan also includes the vital reform of price transparency.  (Applause.)  And tra- — transparency is great for the great doctors, the good doctors, and it’s also great for the great and good hospitals.  That’s where it’s really fantastic: for them, too — in addition, obviously, to the patients.

For the first time ever, we will create true competition in healthcare.  Both hospitals and insurance companies will be required to post all of their prices online.  This transformative policy will allow you to see your exact out-of-pocket costs before you go for treatment, making it easy to shop for the best price.  Costs will come way down.  Some people think this will have a bigger impact than healthcare itself.  It’s a tremendous thing.  No matter where it’s been put, it’s been an incredible service, and it’s — it’s worked miracles.  It’s been brilliant for patients.

Next, I’m taking on the lobbyists and the special interests to lower the price of prescription drugs.  For years, American patients have subsidized socialist nations.  (Applause.)  And you know that.  We talk about it all the time.  Congress, they come over — we’ve been talking about it for a long time.  They’ve been talking about it for years.  They know the problem.  But we’ve been subsidizing socialist nations and others by paying the highest drug prices in the world by far, and yet we’re the largest purchaser of prescription drugs by far.  And this is all while countries got away with paying so much less — so much less, incredibly less.

Under my plan, we will pay the exact same price as other countries.  That’s at the lowest level.  So we will be matching the lowest price with what’s now many times the highest price, and we won’t pay a penny more.  What will happen is the lower prices will come up a little bit, but you’ll get discounts of 40, 50, 60, 80, 90 — who knows? — percent — numbers that you wouldn’t even believe.

And we were the only ones in 52 years to bring drug prices down.  Last year, they went down, as you know.  (Applause.)  But that was before this.  They went down just a little bit, but just a little bit was the only time in 52 years.  Now they’re going to go down massively — favored nations.  This will lead to a very large savings for American families and plummeting drug prices.  They will plummet.

The Obama-Biden administration caved to Big Pharma and allowed drug prices to explode.  The only bad part about this transaction is that they are advertising like crazy.  “Make sure you don’t elect Trump.”  And all it means is that your drug prices are coming down.  So, it’s a — it’s incredible.  They have unlimited money for ads, but they’re taking ads.  And every time you see an ad, just think that your drug prices are coming down.

I now understand why other politicians wouldn’t do it, because it was a very easy thing to do.  But it took a certain amount of courage, I will say that.  (Applause.)

So it means that I’m taking on Big Pharma like never before.  Nobody has done this before.  They understood favored nations.  Favored nations is you get the best prices, the lowest — no matter where it is anywhere in the world.

So if Germany is paying 10 cents for a pill, and we’re paying two and a half dollars for the same exact pill — from the same place, same plant, same genius scientist, same everything, same laboratory — we get the same price as they do.  You’re talking about numbers that are unthinkable. Favored nations clause.  So it’s really something.

And they’re attacking me viciously.  We know that.  And they’re attacking me, really, because I’m fighting for you.  But it’s worth the fight.  It’s worth the fight.  I think people are going understand.  (Applause.)

And I can say this, I think — I don’t think it’s confidential.  Our chief of staff is here, Mark Meadows, from a very great state, known as North Carolina.  (Applause.)  Happens to come from North Carolina.  That’s good stuff.  He wanted to be here for that reason, probably more than even listening to this, because you’ve heard it.  But Mark will tell you that Big Pharma is calling and negotiating and negotiating, and they want to make a deal.

And there’s a deal somewhere, but it’s — it’s something that’s taking place right now.  So they’re negotiating.  But this is where we are, and they’re negotiating for one reason; before that, they wouldn’t even think about negotiating with any other administration.  They would — they cannot believe this is actually happening.

And if we can make a deal, we will.  But, Mark, you’re negotiating, literally, as we speak, right?  So if he doesn’t make a great deal, we’ll blame North Carolina, okay?  (Laughter.)  So that’s great.  No, Mark is a real pro at this.  Understands it — complicated business, but he understands it very well.

Today, my administration is taking action on every piece of the executive order I signed on prescription drug importation in July.  The American people pay an average of over — listen to this — three times more for medicine than Canadians.  So you could be two feet away on each side of the border — three times more.  And that’s the way it is.  Canada is far more than many other countries.

My plan will allow states, wholesalers, and pharmacies to do something career politicians have promised for decades — because it was very simple as an idea — but never delivered.  We will finally allow the safe and legal importation of prescription drugs from Canada.

So this means — (applause) — so this means a state or whatever — it can go to Canada and buy your drugs for a fraction of the price that they’re charging right now.  Massive numbers of — tremendous numbers.  Florida wants to do it, Colorado wants to do it — many states want to do it, and they will be doing it.  But that’s still higher than the favored nations.  So as favored nations kicks in, I think that probably beats everybody no matter where you are, no matter where you’re trying to buy.

This will be a game changer for American seniors.  And by allowing you to do this through Canada, we’re doing it very, very quickly.  So it goes very fast.  And the new rule goes into effect as of today.  Is that fast enough?  I think so.  What do you think?  (Applause.)  Our congressmen.

The America First Healthcare Plan includes another historic provision to benefit our great seniors.  Under my plan, 33 million Medicare beneficiaries will soon receive a card in the mail containing $200 that they can use to help pay for prescription drugs.  Nobody has seen this before.  These cards are incredible.  The cards will be mailed out in coming weeks.

I will always take care of our wonderful senior citizens.  Joe Biden won’t be doing this.  (Applause.)  And this is also partially because of the tremendous money that we’re going to be saving with the favored nations and various other things that we’ve done.

We’ve approved more affordable generic drugs than any administration in history.  I had no idea, but I have had many doctors who I have great respect for, by the way, come to me.  And I said, “Well what’s the difference between this and this?”  One is a very well-known name; one is just a pill in a bottle with no tag on it.  And they said, “Zero.”  I said, “Must be a little bit better, right?  The name — zero.”  And yet, the name brand will cost five and even 10 times more money than the generic.  So we’ve approved more generic drugs than anybody — at a rapid pace too.

We’re also requiring that low-income patients receive the benefits of government discounts on insulin and the EpiPen, and that — you know, that is a big — that is a big deal.  That is a big deal.  Insulin is one of the most common medicines for seniors.  (Applause.)  And this is something that Seema worked on so hard.

Insulin prices soared under the last administration like you wouldn’t believe.  Right, Seema?  Under my plan, hundreds of thousands of Medicare patients will see their insulin costs capped at just $35 a month.  That’s a 66 percent cost reduction.  (Applause.)  And this feature will be avail- — available on over 1,600 Medicare plans that seniors can begin signing up for starting October 1st.  And under certain circumstances, Seema, it’s literally almost free.  This insulin, which they were just ripping you on, is close to being free — even lower than the $35 a month.  So, you did a fantastic job on that.  Thank you very much.  (Applause.)

And Seema would come to my office, “Sir, I have something so exciting.”  She worked on that for a long time in getting that done.  But it was — it is exciting.  If you need insulin — a lot of people were going without it.  They just couldn’t afford it.  Now they can definitely afford it.

We’ll accelerate our relentless effort to save seniors money on their premiums.  Since I took office, we reduced Medicare Part D premiums by 12 percent, Medicare Advantage premiums are also down dramatically — a 44 percent reduction in North Carolina — (applause).  That’s good.  Forty-three percent lower in Pennsylvania.  And a 54 percent lower price in Michigan.  So that’s something.  (Applause.)  And we have them all over the country.  All over the country, there are numbers just like that.

We’ll ensure that all seniors pay the same price for the same service, whether at a hospital, a surgery center, or a doctor’s office.  This will save seniors billions and billions of dollars a year.  We’re talking about the billions.  And it also saves our government a lot of money, but we’ll save our senior citizens billions of dollars a year.  Fantastic job.

We’re putting into place the largest package of saving for seniors of any administration in history.  No administration is even close to what we’ve done.  And I’ve said it, having to do much more than even healthcare, there’s no administration in its first three and a half years that’s done anywhere close to the things we’ve done.  And I never even get criticized for saying it.  That must mean it’s true, right?   My congressman and my great senator.  (Applause.)

Under the Democrat plan, costs will skyrocket.  Our seniors will lose the benefits they paid into their entire — I mean, they’ve been paying for their entire lives tremendous amounts of money — all to finance socialism and open borders.  I mean, we’re just helping other countries — countries that aren’t even friends of ours.  But we help our friends and we help socialism all over the world and we hurt our people, and we’re not doing that any longer.  (Applause.)

As long as I’m President, no one will lay a hand on your Medicare.  Your Medicare is going to be safe and it’s going to be solid.  (Applause.)

The final pillar of America First Healthcare Plan is better care.  That’s better care for American patients.  (Applause.)

The historic action I’m taking today includes the first-ever executive order to affirm it is the official policy of the United States government to protect patients with preexisting conditions.  So we’re making that official.  (Applause.)  We’re putting it down in a (inaudible) because our opponents, the Democrats, like to constantly talk about it, and yet preexisting conditions are much safer with us than they are with them.  And now we have it affirmed.  This is affirmed, signed, and done so we can put that to rest.  They’ll say it anyway because it’s disinformation.  (Applause.)  Disinformation.

Same thing goes for Social Security.  Remember, during the last campaign four years ago, they kept saying I was going to destroy Social Security?  I made Social Security stronger, better.  They will be the ones that destroy Social Security because they’re going to destroy our country; they will destroy our economy.  So Social Security — nothing happened.  I keep saying, “Whatever happened to Social Security?”  Remember?  “He is going to immediately attack.”  No, just the opposite.  Your Social Security is 100 percent with me, but it’s not 100 percent with them.

Any healthcare reform legislation that comes to my desk from Congress must protect the preexisting conditions or I won’t sign it.  And I made that pledge and I made that pledge last week, but now I’m making it in writing.  We’re putting it down, and we have it signed and we have it sealed.  (Applause.)

The new Democrat lie is that they will cover preexisting conditions, but in truth, the socialist takeover, economic shutdowns that they talk about — if you look at this state, frankly, where you have Democrat governors, Democrat leaders.  Those states — those states are in very, very bad shape with all of their shutdowns.

Pennsylvania — you take a look at what’s going on in Pennsylvania with the shutdown.  We just won a big court case, where a judge — a great federal judge — ruled it unconstitutional what they were doing.  They’re hurting people.  There’s damage on the side of a shutdown.  People don’t realize, with suicides, and drug use, and all of the — alcohol.  It’s a terrible thing that happens.  And Michigan is another state — the shutdown is very severe.

By the way, on November 4th, I’m sure everything will be open.  They’ll announce on the evening of November 3rd that we’re opening up.  (Applause.)  Unless these unsolicited ballots don’t come in for weeks and weeks and weeks, you know?  They want them to come in over a long period of time.  It’s going to be a very interesting day: November 3rd.  It’s going to be a very interesting day.

And coverage for illegal immigrants will collapse — our economy will collapse under their system and make your healthcare system totally insolvent.  You know that.  As great doctors and people that do this, you know that.  What they’re doing is socialized medicine, and it’s not acceptable.  It’s going to be a disaster, in terms of quality and cost.  It’ll ruin our country.

Under their plan, you’ll lose your doctor again and you will lose your coverage.  You will lose everything having to do with what we’re talking about.  On my watch, I will never let the radical left take away your healthcare.  You’ll always have healthcare.  (Applause.)

The America First Healthcare Plan will deliver another long awaited reform: We will put you in control of your own medical records when we — (applause).  Good.  We’ll require doctors to make your records available electronically, and you’ll own them, and you’ll control them, and they will be portable, and you’ll be able to work seamlessly with all of your medical providers.  It’ll make your life a lot easier.  Much, much easier.

The previous administration, led by Sleepy Joe Biden, spent $35 billion and failed to get it done.  You know that — $35 billion.  Where they failed, we are delivering.

To give critically ill patients access to lifesaving treatment, I also signed Right to Try.  You know what Right to Try is.  I’m very — (applause) — to me, Right to Try is so great.  It’s so great.

And what I think I’d like to do — I’ll do it really quickly.  I’m going to run through just a quick list of accomplishments that we’ve done.  And, you know, we’ve really become the healthcare party — the Republican Party — and nobody knows that.  (Applause.)  The news doesn’t talk about it.

But I’m going to just say — I mean, it’s a list of things that we’ve done, and it’ll go quickly, but I just thought I’d take it out.  I said, “You know, I’d like to read that to the audience of professionals today.”  And this is just a partial list.

We repealed the individual mandate; eliminated Obamacare’s health insurance, medical device, and the Cadillac taxes.  That’s a big deal.  (Applause.)  People forget all of this.  They say, “I wonder who did that?  Could it have been Joe Biden?”  He doesn’t know what it is.  (Laughter.)

Expanded association health plans; increased availability of short-term, limited-duration plans.  (Applause.)  Expanded health reimbursement arrangements — big deal.  Lowered prescription drug prices — and you will see them at a level that you will never — you’ll never see this again.  They will go down so low.  (Applause.)  And as I said, we had the largest annual decrease.  We had the only decrease over a 52-year period.

More generic prescriptions approved, savings America — saving America an estimated $2.6 billion in the first 18 months of the administration alone.  So, in 18 months, we saved $2.6 billion with generic drugs.

Signed four executive orders to lower prescription drug prices.  Signed legislation banning pharmacy gag clauses.  Does that makes sense to you?  (Applause.)  I mean, what — what people were under.  What even the pharmacist had to do was — it made them — it was embarrassing to them.

Took executive action to ensure price transparency and healthcare.  That’ll be one of the biggest things, and most people have no idea what it means.  And I said — some people said, “That’s bigger than healthcare.”

Required hospitals to post standard prices on the Internet.  Modernized and strengthened Medicare with more options, more benefits, and lower premiums substantially.  Improve kidney care — such a big deal — with more transplants and better treatment.  Kidney care is so tough for people with the problem.  (Applause.)

Very substantially lowered the price of insulin, as we said, for our seniors.  Invested in advances in generic therapy for sickle cell disease.  (Applause.)  Big thing.  Big thing.  Big, big thing.

Launched a $500 million initiative to find cures for childhood cancers — $500 million.  (Applause.)

Combated drug demand.  We really went very, very strong on drug demand and the opioid crisis with expanded access to medication-assisted treatment and lifesaving naloxone.  Naloxone.  (Applause.)  Opioid prescribed decrease by over 35 percent.  So, if you look at the opioid, obviously, horror show, it decreased by over 35 percent since January of 2017.  We’ve worked very, very hard on that.

Launched to connect those with substance abuse disorder to treatment.  We have an incredible situation — it’s

Passed Right to Try to give critically ill patients access to lifesaving cures where it hasn’t been approved yet by the FDA.  Incredible.  (Applause.)  And, by the way, many of you know what that has meant.  We have had some examples of success that — on Right to Try — that have been amazing.

Launched an initiative to end AIDS — HIV/AIDS — in America.  We think, in six years, it will be largely eradicated.  Who would have ever thought?  And this could have started two years before I got there, but they chose not to do it, but we have.  And we’ve launched the initiative; it’s into it’s almost fourth year.  And at the time we did it, it was going to be 10 years — at the end of 10 years.  Now six years — we’re already down to six.  It will largely eradicate AIDS — HIV/AIDS in America.  Who would have thought?  It’s incredible.  When I first heard about it — (applause) — when I first heard about it, I said, “Why wouldn’t they have started it earlier?”  But they didn’t.

Expanded access to telehealth, especially in rural and underserved areas.  Telehealth.

Signed historic VA Choice legislation; that’s a big deal.  (Applause.)  That’s a big deal.  And it’s — it’s the real — it’s the real Choice, not the weak Choice — the very, very weak — the Choice that didn’t mean anything.  But it’s been a tremendous success.  And we just got a 91 percent approval rating from our vets — the highest we’ve ever had by a lot.  (Applause.)

And we also — while we’re at it, we signed the Accountability — VA accountability.  That’s where people who don’t love our vets — if they don’t take care of our vets, you couldn’t do anything about it.  Didn’t — you’d have to — they’d have to live in hell with these vets with — with the people that were supposed to be taking care of them.  And we have a thing called VA Accountability.  They’re accountable now.  If they don’t treat our vets great, if they don’t take care of our vets, if they don’t love our vets, our country, we can fire them.  We can say, “You’re fired.”  (Applause.)  We can fire them.  VA Accountability, that’s a big thing.  So VA Choice, VA Accountability.

Took executive action to prevent veteran suicide and launch the 24-hour veteran hotline for suicide.  And it’s really working.  (Applause.)

And signed the largest-ever increase in childcare development block grants.

Those are just — (applause) — those are just some of the — those are some of the things that we’ve done.  We’ve done actually a lot more than that, but we have to get back to business here.  Right?  Those are things that we’ve done, and nobody has any idea.

When you look at a list like that, Democrats have never done anything like that.  Under the Democrat socialist agenda, an avalanche of regulation would extinguish the flame of excellence that makes America the center of scientific discovery, groundbreaking treatment, and lifesaving cures.

In our all-out war against the virus, we’ve lifted bureaucratic barriers and marshaled America’s scientific, industrial, and technical brilliance.  And we do have total brilliance.  Some of it’s in this room, by the way, in case you don’t know.  I will apply — (applause) — it really is — some of the people.  Right?  Right, Bill?  Some incredible people in this room.

I’ll apply the same determination to accelerate medical breakthroughs in all areas, including for Alzheimer’s, diabetes, generic treatments for sickle cell disease, early detection of cancer, and much, much more.

Already, to improve care for Americans with kidney disease, we enabled patients to receive at-home dialysis, and we’re investing in the creation of an artificial kidney.  We’re getting very close.  And we introduced critical incentives to make more kidneys available for transplant, a change that will save tens of thousands of lives.  What people have to go through with kidney disease is incredible.  It’s incredible.

They work so hard.  I said, “How do they do?”  They can live a long life but it’s so much work to do it that they literally — one doctor told me that they die of hard work.  It’s such a job to go and — I guess, dialysis, et cetera.  It’s such a hard job that they die of — of — literally, they die of just hard work.  It’s — it’s incredible what we’ve done there and what we’re doing.  And especially with some of the research that’s been done, what we’re coming up with — you’ll be seeing it very soon, I believe.

As we invest in the future, we will permanently bring our medical supply chains back home.  (Applause.)  We will produce our medical supplies, pharmaceuticals, and treatments right here in the United States, right here in North Carolina.  We’re going to bring a lot of business, too.

If you remember, Puerto Rico used to do it, and then they brought tax legislation that destroyed that whole thing.  They all left.  But they are happy in Puerto Rico.  We’re going to bring it back to Puerto Rico and many of our states that — that will be doing it.  And North Carolina, I see, is on the list as being a very top one.  So we’re going to bring it back to North Carolina and the country.  (Applause.)

And we’ll reverse the disastrous and heartless decision Joe Biden made in 1996 to shut down the pharmaceutical industry in Puerto Rico.  It took place in 1996.  Biden shut down the whole Puerto Rico industry.  This was a very good industry.  They were doing a fantastic job.  And one day, it was just literally gone.  Biden shut it down with what he did with taxes.  And it was — it was a disgrace, but we will bring it back.  (Applause.)

Under our leadership, American medicine will make the biggest breakthroughs, the largest leaps, the most exciting strides, and the most outstanding discoveries.

Before I sign a historic executive order implementing this ambitious agenda, let me introduce two Americans — great Americans who will benefit from our policies.

Julia Stathopoulos was born in — Freeman-Sheldon syndrome, or with — with the Freeman-Sheldon syndrome — which is tough — an extremely rare muscle and bone disorder.  Under the previous administration, Julia’s family saw their premiums on the individual market skyrocket to $3,000 a month and more.  Her parents had to go without health insurance just to afford coverage for their children.

Since I was elected, their family’s premiums have been slashed by more than 40 percent, and we’re going down further.  (Applause.)  And everyone is now covered, and Julia always has access to the doctors she needs.  Julia, we are with you.  I don’t know where you are, Julia.  Where is Julia?  Wow.  Thank you.  Thank you.  (Applause.)  You look great, Julia.  Thank you.  That’s great.  Thank you, Julia.  It’s a great story.  But we’re inspired by your courage.  Thank you very much.

Also with us is Sharon Leader, a financial planner from nearby Concord.  After spending less than 24 hours in the hospital and receiving a few basic tests, she received surprise bills that added up to $4,000 — that’s a lot of money — despite having insurance.

Sharon, those days will soon be over, because we’ll end surprise medical billing once and for all.  Where is Sharon?  (Applause.)  Hi, Sharon.  That’s why they call it surprise billing.  She got home and she was surprised.  (Laughter.)  They sent you the bill, you opened it up, you thought it was going to be $25, and it was a little more than that, right?  Yeah.  That’s great.  Well, we’re taking care of it.  Thank you very much, Sharon.

We’re standing up for our people.  We’re standing up to special interests.  We’re taking on the powerful lobbyists.  We’re stopping the radical socialists and communists, to be honest with you.  I think we’ve gone — it’s a little bit above socialism or below it, if you want to call it that way.  But we are standing up to both — whichever one you want to choose.  And we are fighting for the incredible people of North Carolina.  They’re incredible people — people I love.  I love the people.  We named — as you know, my grandchild is named Carolina, so — (applause.)  Right?  Beautiful Carolina, my gran- — most beautiful child.

But we’re providing better care and more choice at a lower cost — substantially lower cost.  We’re delivering a healthier, safer, brighter, and more prosperous future for every citizen in our magnificent land because we are proudly putting America first.  It hasn’t happened for a long time.  (Applause.)

On behalf of all Americans, I will now sign the executive order.  I want to thank you all for being here.  God bless you.  God bless North Carolina.  And God bless America.  Thank you very much.  (Applause.)

(The executive order is signed.)  (Applause.)

THE PRESIDENT:  Thank you very much, everybody.  Thank you.  (Applause.)

END             5:40 P.M. EDT

Executive Order on An America-First Healthcare Plan

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

Section 1.  Purpose.  Since January 20, 2017, my Administration has been committed to the goal of bringing great healthcare to the American people and putting patients first.  To that end, my Administration has taken monumental steps to improve the efficiency and quality of healthcare in the United States.

(a)  My Administration has been committed to restoring choice and control to the American patient.

On December 22, 2017, I signed into law the repeal of the burdensome individual-mandate penalty, liberating millions of low-income Americans from a tax that penalized them for not purchasing health-insurance coverage they did not want or could not afford.  Through Executive Order 13813 of October 12, 2017 (Promoting Healthcare Choice and Competition Across the United States), my Administration has expanded coverage options for millions of Americans in several ways.  My Administration increased the availability of renewable short-term, limited-duration healthcare plans, providing options that are up to 60 percent cheaper than the least expensive alternatives under the Patient Protection and Affordable Care Act (ACA) and are projected to cover 500,000 individuals who would otherwise be uninsured.  My Administration expanded health reimbursement arrangements, which have been projected by the Department of the Treasury to reach 800,000 businesses and over 11 million employees and to expand coverage to more than 800,000 individuals who would otherwise be uninsured.  My Administration also issued a rule to increase the availability of association health plans for small businesses, which, upon implementation of the rule, are projected to cover up to 400,000 previously uninsured individuals for on average 30 percent less cost.

As set forth in the Economic Report of the President (February 2020), my Administration’s expansion of health savings accounts will further help millions of Americans pay for health expenditures by allowing them to save more of their own money free from Federal taxation, and will especially help Americans with chronic conditions who now have more flexibility to enroll in plans that fit their complicated care needs and can be paired with a tax-advantaged account.

At the beginning of the current COVID-19 pandemic, my Administration acted to dramatically increase the accessibility and availability of telehealth services for Medicare beneficiaries, enabling millions of individuals to use these services.  Pursuant to Executive Order 13941 of August 3, 2020 (Improving Rural Health and Telehealth Access), the Secretary of Health and Human Services will make permanent many of the new policies that improve the accessibility and availability of telehealth services.  In addition, pursuant to that order, the Secretary of Health and Human Services and the Secretary of Agriculture will develop and implement a strategy to improve the physical and communications healthcare infrastructure available to rural Americans.

Through our State Relief and Empowerment Waivers, my Administration has given States additional health-insurance flexibility, which has expanded health-insurance coverage options for consumers and lowered costs for patients.  These waivers allow States to move away from the ACA’s rigid structure and are estimated to have lowered premiums by approximately 11 percent in Wisconsin, 20 percent in Minnesota, and 43 percent in Maryland.  Due to actions my Administration took, like the State Relief and Empowerment Waivers, after years of dwindling choices and escalating prices, plan options for consumers increased and for 2019, for the first time ever, benchmark premiums actually decreased on  For 2020, the average benchmark premium dropped by nearly 4 percent.

After the prior Administration spent tens of billions of dollars creating electronic health records systems unable to accurately or effectively record and communicate patient data, my Administration has paved the way for a new wave of innovation to allow patients to safely send their own medical records to care providers of their choosing.  My Patients over Paperwork initiative has cut red tape for doctors and nurses so they can spend more time with their patients, which the Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS) has estimated to save over 40 million hours of wasted time for providers and suppliers between 2017 and 2021.

(b)  My Administration has been ceaseless in its efforts to lower costs to make healthcare more affordable for American patients.

Under my tenure, prescription drugs saw their largest annual price decrease in nearly half a century.  For three consecutive years, we have approved a record number of generic drugs.  The Council of Economic Advisers has estimated that these approvals saved patients $26 billion in the first 18 months of my Administration alone.  As part of the Further Consolidated Appropriations Act, 2020, I signed into law the Creating and Restoring Equal Access to Equivalent Samples Act, which will pave the way for even more generic drugs and is projected to save taxpayers $3.3 billion from 2019 to 2029.

CMS has acted to offer Medicare beneficiaries prescription drug plans with the option of insulin capped at $35 in out-of-pocket expenses for a 30-day supply.  We are also reducing Government payments to overcharging hospitals participating in the 340B Drug Pricing Program by instead paying rates that more accurately reflect the hospitals’ acquisition costs, which CMS estimated would save Medicare beneficiaries $320 million on copayments for drugs alone.

As a result of Executive Order 13937 of July 24, 2020 (Access to Affordable Life-Saving Medications), low-income Americans who receive care from a federally qualified health center will have access to insulin and injectable epinephrine at prices lower than ever before.  Under Executive Order 13938 of July 24, 2020 (Increasing Drug Importation to Lower Prices for American Patients), my Administration will be the first to complete a rulemaking to authorize the safe importation of certain lower-cost prescription drugs from Canada.  Pursuant to Executive Order 13939 of July 24, 2020 (Lowering Prices for Patients by Eliminating Kickbacks to Middlemen), my Administration is taking action to eliminate wasteful payments to middlemen by passing drug discounts through to patients at the pharmacy counter without increasing premiums for beneficiaries or cost to Federal taxpayers.  And my Administration is taking action to ensure that Medicare patients receive the lowest price that drug companies offer comparable foreign nations through Executive Order 13948 of September 13, 2020 (Lowering Drug Prices by Putting America First).

As part of the Further Consolidated Appropriations Act, 2020, I also signed into law the repeal of the medical device tax, the annual fee on health-insurance providers, and the “Cadillac” tax on certain employer-sponsored health insurance, which threatened to dramatically increase the cost of healthcare for working families.

My Administration is transforming the black-box hospital and insurance pricing systems to be transparent about price and quality.  Regardless of health-insurance coverage, two‑thirds of adults in America still worry about the threat of unexpected medical bills.  This fear is the result of a system under which individuals and employers are unable to see how insurance companies, pharmacy benefit managers, insurance brokers, and providers are or will be paid.  One major culprit is the practice of “surprise billing,” in which a patient receives unexpected bills at highly inflated prices from providers who are not part of the patient’s insurance network, even if the patient was treated at a hospital that was part of the patient’s network.  Patients can receive these bills despite having no opportunity to select around an out-of-network provider in advance.

On May 9, 2019, I announced four principles to guide congressional efforts to prohibit exorbitant bills resulting from patients’ accidentally or unknowingly receiving services from out-of-network physicians.  Unfortunately, the Congress has failed to act, and patients remain vulnerable to surprise billing.

In the absence of congressional action, my Administration has already taken strong and decisive action to make healthcare prices more transparent.  On June 24, 2019, I signed Executive Order 13877 (Improving Price and Quality Transparency in American Healthcare to Put Patients First), directing certain agencies — for the first time ever — to make sure patients have access to meaningful price and quality information prior to the delivery of care.  Beginning January 1, 2021, hospitals will be required to publish their real price for every service, and publicly display in a consumer-friendly, easy-to-understand format the prices of at least 300 different common services that are able to be shopped for in advance.

We have also taken some concrete steps to eliminate surprise out‑of-network bills.  For example, on April 10, 2020, my Administration required providers to certify, as a condition of receiving supplemental COVID-19 funding, that they would not seek to collect out-of-pocket expenses from a patient for treatment related to COVID-19 in an amount greater than what the patient would have otherwise been required to pay for care by an in-network provider.  These initiatives have made important progress, although additional efforts are necessary.

Not all hospitals allow for surprise bills.  But many do.  Unfortunately, surprise billing has become sufficiently pervasive that the fear of receiving a surprise bill may dissuade patients from seeking appropriate care.  And research suggests a correlation between hospitals that frequently allow surprise billing and increases in hospital admissions and imaging procedures, putting patients at risk of receiving unnecessary services, which can lead to physical harm and threatens the long-term financial sustainability of Medicare.

Efforts to limit surprise billing and increase the number of providers participating in the same insurance network as the hospital in which they work would correspondingly streamline the ability of patients to receive care and reduce time spent on billing disputes.

On May 15, 2020, HHS released the Health Quality Roadmap to empower patients to make fully informed decisions about their healthcare by facilitating the availability of appropriate and meaningful price and quality information.  These transformative actions will arm patients with the tools to be active and effective shoppers for healthcare services, enabling them to identify high-value providers and services, and ultimately place downward pressure on prices.

My Administration has cracked down on waste, fraud, and abuse that direct valuable taxpayer resources away from those who need them most.  My Administration implemented a “site neutral” payment system between hospital outpatient departments and physicians’ offices, to ensure Medicare beneficiaries are charged the same price for the same service regardless of where it takes place, which CMS estimates will save them approximately $160 million in co-payments for 2020.  We also changed the rules to enable Government watchdogs to proactively identify and stop perpetrators of fraud before money goes out the door.

(c)  My Administration has been dedicated to providing better care for all Americans.

This includes a steadfast commitment to always protecting individuals with pre-existing conditions and ensuring they have access to the high-quality healthcare they deserve.  No American should have to risk going without health insurance based on a health history that he or she cannot change.

In an attempt to justify the ACA, the previous Administration claimed that, absent action by the Congress, up to 129 million (later updated to 133 million) non-elderly people with what it described as pre-existing conditions were in danger of being denied health-insurance coverage.  According to the previous Administration, however, only 2.7 percent of such individuals actually gained access to health insurance through the ACA, given existing laws and programs already in place to cover them.  For example, the Health Insurance Portability and Accountability Act of 1996 has long protected individuals with pre-existing conditions, including individuals covered by group health plans and individuals who had such coverage but lost it.

The ACA produced multiple other failures.  The average insurance premium in the individual market more than doubled from 2013 to 2017, and those who have not received generous Federal subsidies have struggled to maintain coverage.  For those who have managed to maintain coverage, many have experienced a substantial rise in deductibles, limited choice of insurers, and limited provider networks that exclude their doctors and the facilities best suited to care for them.

Additionally, approximately 30 million Americans remain uninsured, notwithstanding the previous Administration’s promises that the ACA would address this intractable problem.  On top of these disappointing results, Federal taxpayers and, unfortunately, future generations of American workers, have been left with an enormous bill.  The ACA’s Medicaid expansion and subsidies for the individual market are projected by the Congressional Budget Office to cost more than $1.8 trillion over the next decade.

The ACA is neither the best nor the only way to ensure that Americans who suffer from pre-existing conditions have access to health-insurance coverage.  I have agreed with the States challenging the ACA, who have won in the Federal district court and court of appeals, that the ACA, as amended, exceeds the power of the Congress.  The ACA was flawed from its inception and should be struck down.  However, access to health insurance despite underlying health conditions should be maintained, even if the Supreme Court invalidates the unconstitutional, and largely harmful, ACA.

My Administration has always been committed to ensuring that patients with pre-existing conditions can obtain affordable healthcare, to lowering healthcare costs, to improving quality of care, and to enabling individuals to choose the healthcare that meets their needs.  For example, when the COVID-19 pandemic hit, my Administration implemented a program to provide any individual without health-insurance coverage access to necessary COVID‑19‑related testing and treatment.

My commitment to improving care across our country expands vastly beyond the rules governing health insurance.  On July 10, 2019, I signed Executive Order 13879 (Advancing American Kidney Health) to improve care for the hundreds of thousands of Americans suffering from end-stage renal disease.  Pursuant to that order, my Administration launched a program to encourage home dialysis and promote transplants for patients, and expects to enroll approximately 120,000 Medicare beneficiaries with end‑stage renal disease in the program.  We also have removed financial barriers to living organ donation by adding additional financial support for living donors, such as by reimbursing expenses for lost wages, child care, and elder care.  HHS, together with the American Society of Nephrology, issued two phases of awards through KidneyX’s Redesign Dialysis Price Competition to work toward the creation of an artificial kidney.

My Administration has taken unprecedented action to improve the quality of and access to care for individuals with HIV, as part of our goal of ending the epidemic of HIV in the United States by 2030.  HHS has awarded at least $226 million to expand access to HIV care, treatment, medication, and prevention services, focused on 48 counties, Washington, D.C., and San Juan, Puerto Rico, where more than 50 percent of new HIV diagnoses occurred in 2016 and 2017, as well as seven States with a substantial rural HIV rate.  We secured a historic donation of a groundbreaking HIV preventive medication that is available at no cost to eligible patients.

My Administration has started a transformation in healthcare in rural America.  This includes a new effort, pursuant to my directive in Executive Order 13941, to support small hospitals and health clinics in rural communities in transitioning from volume-based Medicare and Medicaid reimbursement, which has failed rural communities that struggle with a lack of patient volume, and toward value-based payment mechanisms that are tailored to meet the needs of their communities.  We updated Medicare payment policies to address a problem in the program’s payment calculation that has historically disadvantaged rural hospitals, and released a Rural Action Plan to incorporate recommendations from experts and leaders across the Federal Government.  We have also dedicated a special focus on improving care offered through the Indian Health Service (IHS) within HHS, including by creating the Office of Quality, implementing an increase in annual funding for IHS by $243 million from 2019 to 2020, and expanding nationwide IHS’s successful Alaska Community Health Aide Program.

My Administration has additionally demonstrated an incredible dedication to protecting and improving care for those most in need, including senior citizens, those with substance use disorders, and those to whom our Nation owes the greatest debt:  our veterans.

I have protected the viability of the Medicare program.  For example, on February 9, 2018, I signed into law the repeal of the Independent Payment Advisory Board, which would have been a group of unelected bureaucrats created by the ACA, designed to be insulated from the will of America’s elected leaders for the purpose of cutting the spending of this important program.  On October 3, 2019, I signed Executive Order 13890 (Protecting and Improving Medicare for Our Nation’s Seniors), to modernize the Medicare program and continue its viability.  According to CMS estimates, seniors have saved $2.65 billion in lower Medicare premiums under my Administration while benefiting from more choices.  For example, the average monthly Medicare Advantage premium has declined an estimated 28 percent since 2017, and Medicare Advantage has included about 1,200 more plan options since 2018.  New Medicare Advantage supplemental benefits have helped seniors stay safe in their homes, improved respite care for caregivers, and provided transportation, more in-home support services and assistance, and non-opioid pain management alternatives like therapeutic massages.  Medicare Part D premiums are at their lowest level in their history, with the average basic premium declining 13.5 percent since 2016.

My Administration has directed unprecedented attention on the substance use disorder epidemic, with a focus on reducing overdose deaths from prescription opioids and the deadly synthetic opioid fentanyl.  On October 24, 2018, I signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, enabling the expenditure of billions of dollars of funding for important programs to support prevention and recovery.  My Administration has provided approximately $22.5 billion from 2017 to 2020 to address the opioid crisis and improve access to prevention, treatment, and recovery services.  We saw a 34 percent decrease in total opioids dispensed monthly by pharmacies between 2017 and 2019, an approximate increase of 64 percent in the number of Americans who receive medication-assisted treatment for opioid use disorder since 2016, and a 484 percent increase in naloxone prescriptions since 2017.  Data show that drug overdose deaths fell nationwide for the first time in decades between 2017 and 2018, with many of the hardest-hit States leading the way.

Improving care for our Nation’s veterans has been a priority since the beginning of my Administration.  On June 6, 2018, I signed the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, which authorized billions of dollars to improve options for veterans to receive care outside of Department of Veterans Affairs (VA) healthcare providers.  Since taking effect, the VA estimates that more than 2.4 million veterans have benefited from more than 6.5 million referrals to the 725,000 private healthcare providers with which the VA is now working.  On June 23, 2017, I signed the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017 to hold our civil servants accountable for maintaining the best quality of care possible for our Nation’s veterans by giving the Secretary of Veterans Affairs more power to discipline employees and shorten an appeals process that can last years.  On March 5, 2019, I signed Executive Order 13861 (National Roadmap to Empower Veterans and End Suicide) to ensure that the Federal Government leads a collective effort to prevent suicide among our veterans.

I have used scientific research to focus on areas most pressing for the health of Americans.  On September 19, 2019, I signed Executive Order 13887 (Modernizing Influenza Vaccines in the United States to Promote National Security and Public Health), recognizing the threat that pandemic influenza continues to represent and putting forward a plan to prepare for future influenza pandemics.  To modernize influenza vaccines and promote national security and public health, HHS issued a 6‑year, $226 million contract to retain and increase capacity to produce recombinant influenza vaccine domestically, and the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health within HHS, initiated the Collaborative Influenza Vaccine Innovation Centers program.

Investments my Administration has made in scientific research will help tackle some of our most pressing medical challenges and pay dividends for generations to come.  This includes working to increase funding for Alzheimer’s disease research by billions of dollars since 2017 and a plan to invest more than $500 million over the next decade to improve pediatric cancer research.  On December 18, 2018, I signed the Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2018 to provide support for research into sickle cell disease, which disproportionately impacts African Americans and Hispanics, and to authorize programs relating to sickle cell disease surveillance, prevention, and treatment.

On May 30, 2018, I signed the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017, which gives terminally ill patients the right to access certain treatments without being blocked by onerous Federal regulations.

In response to the COVID-19 pandemic, my Administration launched Operation Warp Speed, a groundbreaking effort of the Federal Government to engage with the private sector to quickly develop and deliver safe and effective vaccines, therapeutics, and diagnostics for COVID-19.  On August 6, 2020, I signed Executive Order 13944 (Combating Public Health Emergencies and Strengthening National Security by Ensuring Essential Medicines, Medical Countermeasures, and Critical Inputs Are Made in the United States), to protect Americans through reduced dependence on foreign manufacturers for essential medicines and other items and to strengthen the Nation’s Public Health Industrial Base.

Taken together, these extraordinary reforms constitute an ongoing effort to improve American healthcare by putting patients first and delivering continuous innovation.  And this effort will continue to succeed because of my Administration’s commitment to delivering great healthcare with more choices, better care, and lower costs for all Americans.

Sec. 2.  Policy.  It has been and will continue to be the policy of the United States to give Americans seeking healthcare more choice, lower costs, and better care and to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.

Sec. 3.  Giving Americans More Choice in Healthcare.  The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services shall maintain and build upon existing actions to expand access to and options for affordable healthcare.

Sec. 4.  Lowering Healthcare Costs for Americans.  (a)  The Secretary of Health and Human Services, in coordination with the Commissioner of Food and Drugs, shall maintain and build upon existing actions to expand access to affordable medicines, including accelerating the approvals of new generic and biosimilar drugs and facilitating the safe importation of affordable prescription drugs from abroad.

(b)  The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services shall maintain and build upon existing actions to ensure consumers have access to meaningful price and quality information prior to the delivery of care.

(i)    Recognizing that both chambers of the Congress have made substantial progress towards a solution to end surprise billing, the Secretary of Health and Human Services shall work with the Congress to reach a legislative solution by December 31, 2020.

(ii)   In the event a legislative solution is not reached by December 31, 2020, the Secretary of Health and Human Services shall take administrative action to prevent a patient from receiving a bill for out-of-pocket expenses that the patient could not have reasonably foreseen.

(iii)  Within 180 days of the date of this order, the Secretary of Health and Human Services shall update the Hospital Compare website to inform beneficiaries of hospital billing quality, including:

(A)  whether the hospital is in compliance with the Hospital Price Transparency Final Rule, as amended (84 Fed. Reg. 65524), effective January 1, 2021;

(B)  whether, upon discharge, the hospital provides patients with a receipt that includes a list of itemized services received during a hospital stay; and

(C)  how often the hospital pursues legal action against patients, including to garnish wages, to place a lien on a patient’s home, or to withdraw money from a patient’s income tax refund.

(c)  The Secretary of Health and Human Services, in coordination with the Administrator of CMS, shall maintain and build upon existing actions to reduce waste, fraud, and abuse in the healthcare system.

Sec. 5.  Providing Better Care to Americans.  (a)  The Secretary of Health and Human Services and the Secretary of Veterans Affairs shall maintain and build upon existing actions to improve quality in the delivery of care for veterans.

(b)  The Secretary of Health and Human Services shall continue to promote medical innovations to find novel and improved treatments for COVID-19, Alzheimer’s disease, sickle cell disease, pediatric cancer, and other conditions threatening the well-being of Americans.

Sec. 6 General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect:

(i)   the authority granted by law to an executive department or agency, or the head thereof; or

(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

Donald J. Trump for President, Inc.
September 24, 2020

Trump campaign statement on President Trump’s vision for healthcare

“President Trump has a better record on healthcare than Joe Biden no matter how you look at it. Health insurance premiums went up under Joe Biden, they have come down under President Trump. The President will protect people with pre-existing conditions, end surprise billing, drive down prescription drug prices, help seniors pay for medicine, and provide affordable insulin and EpiPens for low-income Americans. This builds on his record of success in healthcare, which includes reducing Obamacare premiums for the first time, eliminating the unfair Obamacare individual mandate, expanding healthcare choice, enacting Right to Try legislation, and making real progress in reducing the price of prescription drugs. The President has improved healthcare quality, provided greater choice, and made it more affordable.

“The fact that Joe Biden even has a healthcare proposal is proof that Obamacare was a colossal failure from the beginning. Premiums went through the roof, choices dwindled, and people suffered under the twin lies that they could keep their doctors and their existing healthcare plans. Biden’s new proposal would lead to a government takeover of the entire healthcare system and would end with the elimination of employer-provided health insurance for 180 million Americans. He would threaten 1,000 rural hospitals with bankruptcy, leaving millions of Americans without a place to go for serious healthcare needs. Finally, he would provide illegal aliens with taxpayer-funded healthcare, again placing the interests of people who broke our immigration laws ahead of our own citizens. Joe Biden is selling socialized healthcare and Americans won’t buy it.”

- Tim Murtaugh, Trump 2020 communications director

Democratic National Committee
September 24, 2020

DNC on Trump’s Health Care ‘Vision’

In response to Trump’s remarks laying out his health care “vision,” DNC senior spokesperson and advisor Lily Adams released the following statement:

“Trump is currently fighting to take health care away from tens of millions of Americans and eliminate protections for as many as 133 million Americans with preexisting conditions. That’s his ‘vision.’ He can lie all he wants or say a new plan is coming, but the American people know the truth: his only plan is to overturn the ACA and its protections for millions, during a pandemic.”

American Bridge 21st Century
September 24, 2020

“Since being sworn in, Donald Trump has systematically undermined the Affordable Care Act, skyrocketed premiums and out-of-pocket costs, and sued the American people to rip away their health care – with no plan to protect people with pre-existing conditions. With 40 days left in the election, he’s trying to gaslight voters into believing his failed proposals are somehow a ‘new’ and ’comprehensive plan,’” said Kyle Morse, an American Bridge 21st Century spokesperson. “Trump’s nothingburger announcement will not protect patients, lower costs, or increase access to care. It speaks volumes that after 1,343 days in office, Donald Trump still can’t get the job done. Voters do not trust Trump with their health care, and this November, they are going to send him packing because of it.”

TO: Interested Parties
FROM: Ohio Democratic Party
DATE: Friday, Sept. 25
RE: Ahead of Cleveland Debate, Trump Continues Attacks on Ohioans’ Health Care
Ahead of his arrival in Cleveland for the first 2020 presidential debate, Donald Trump continues to break his most basic promises to Ohioans, waging a cruel campaign to take away working families’ health care in the midst of a still-worsening pandemic.

As a candidate, Donald Trump promised Ohioans that he would deliver a “great health care system.”

  • “We’re going to approve and get something that is so much less expensive and so good. A great health care system, a system that you deserve. That’s what we're going to be doing.” [Trump Campaign Rally, Cleveland, Oct. 22, 2016]

  • “We’re going to have a really great plan that’s going to cost much less and be much better.” [Trump Campaign Rally, Toledo, Oct. 27, 2016]

  • “We’re going to lead on health care. [...] We’re going to start winning on health care.” [Trump Campaign Rally, Cincinnati, March 13, 2016]

But as president, Trump has overseen a rise in uninsured Ohioans — especially among children.

  • “The Trump administration in 2017 cut funding to the Navigator program, a service that helps people understand and enroll in Medicaid and the Affordable Care Act exchanges. The funding cuts eliminated Navigator programs in Northeast Ohio.
  • WKSU: Report Finds Surge in Number of Uninsured Children in Ohio. “An increasing number of Ohio children have no health insurance coverage. A report from Georgetown University’s Center for Children and Families indicates the number of uninsured children in the state increased by 28% from 2016 to 2018. That amounts to nearly 30,000 children.
    • In Ohio, a total of 133,000 kids have no health insurance coverage. The number of uninsured children under age six increased by more than 13%.”

Even in the midst of a global pandemic, Trump is suing to overturn the Affordable Care Act.

  • Cleveland Plain Dealer: “A little more than a decade after President Barack Obama signed the Affordable Care Act (ACA) into law, and as the nation struggles to recover from the coronavirus pandemic, President Donald Trump will bring his efforts to overturn the law to the U.S. Supreme Court

  • “John Corlett, a former Ohio Medicaid director […] said expanding Medicaid eligibility to Ohioans reduced death rates as it reduced the number of people who couldn’t pay for the medical care they needed.”

  • “He said the ACA’s repeal would eliminate that Medicaid expansion, as well as the law’s prohibition on insurance carriers using pre-existing medical conditions to charge patients more or deny them coverage.”

Trump’s lawsuit is endangering hundreds of thousands of Ohioans’ health coverage right when they need it most.

  • If Trump overturns the Affordable Care Act, 741,000 Ohioans would lose their health coverage — more than doubling the number of uninsured patients across the state.

  • Trump’s lawsuit comes in the midst of surging unemployment in Ohio — and an unprecedented loss of employment-based health insurance. More than 1.7 million Ohioans have filed for unemployment since the outbreak of the COVID-19 pandemic, more than the last four years combined.

Millions of Ohioans with pre-existing conditions — including COVID-19 survivors — would pay higher premiums and face the threat of being denied coverage.

  • New York Times: “An existing medical condition includes such common ailments as high blood pressure or asthma, any of which could require those buying insurance on their own to pay much more for a policy, if they could get one at all.
    • “The coronavirus, which has infected nearly seven million Americans to date and may have long-term health implications for many of those who become ill, could also become one of the many medical histories that would make it challenging for someone to find insurance.”

Ohio public health leaders have warned that repealing the Affordable Care Act  would have severe consequences for patients and local hospitals.

  • The Ohio Hospital Association has warned that repealing the ACA would put a quarter of the state’s hospitals at risk of closure: “That can take a precariously situated hospital and put them into a situation where they could no longer provide services to the community.”

Even Ohio Republicans are running away from Trump’s attacks on working families’ health care.

To: Interested Parties
From: DNC Chair Tom Perez, DSCC Chair Catherine Cortez Masto, DCCC Chair Cheri Bustos, DGA Chair Phil Murphy, DAGA Co-Chairs Maura Healey and Ellen Rosenblum, DLCC Chair Andrea Stewart-Cousins

Date: September 24, 2020
Subject: Health Care Is On Every Ballot, From Top To Bottom


“There is no question that access to affordable health care is on the ballot this November. Republicans have made it clear time and again their only position is to repeal the ACA—and with it eliminate Medicaid expansion and protections for more than 100 million people with pre-existing conditions. In the middle of a global health crisis that has taken the lives of more than 200,000 Americans—they still offer no replacement. Americans know that Republicans won’t protect their health care and there’s no greater proof point than the fact that the GOP continues to plow ahead with their lawsuit to overturn the entire health care law amid a pandemic. We’re going to keep reminding voters of Republicans’ toxic efforts to gut their health care over the final weeks of this election.”


Democrats experienced tremendous electoral success in 2017, 2018, and 2019 by running on health care. Democrats flipped 435 state legislative seats, four state AG seats, nine governors’ seats, three Senate seats, and 40 seats in the US House, as well as control of the Speaker’s gavel by promising to work to lower health care and prescription drug costs, expand access, and oppose Republican attacks on Americans’ health care. Since those wins, Democrats at all levels of government have kept those promises, using their offices to expand Medicaid, work to lower health care and prescription drug costs, defend the Affordable Care Act (ACA) in court, and stand firmly against Republican efforts to eliminate protections for Americans with pre-existing conditions.

Health care remains top of mind for voters in the 2020 elections
, and Democrats have continued to focus on this defining issue this cycle. The COVID-19 pandemic has only served to underscore the urgency of our efforts to protect Americans’ access to affordable health care. New polling shows that nearly a majority of Americans, 48%, want to see the Affordable Care Act expanded and that Americans want to keep or expand the ACA by a margin of 11 points.

The Republican Attorneys General lawsuit—with support from the Trump Administration—would eliminate the ACA,
including protections for more than 100 million Americans with pre-existing conditions and other benefits. This issue is even more stark as a public health crisis that has killed more than 200,000 Americans hits the six-month mark, with many experts saying it’s likely to continue well into 2021.

The GOP’s reckless lawsuit puts in jeopardy the ACA’s protections for the newly jobless, Medicaid recipients, and Americans battling COVID-19. The lawsuit risks eliminating coverage protections for vaccinations, essential health benefits, and other provisions that
doctors, hospitals, and public health experts have deemed essential to combating the epidemic. And, if the GOP lawsuit is successful, the millions of Americans who have tested positive for COVID-19 or antibodies and may now have a pre-existing condition will facesky-rocketing coverage rates.

One week after Election Day, Republican Attorneys General will be at the Supreme Court using taxpayer dollars trying to take health care away from those same taxpayers. Republicans have talked about a hypothetical “repeal & replace” strategy for a decade, but this November, they will argue for repeal with no credible replacement in sight, ripping away coverage for people with pre-existing conditions.

Republican Attorneys General (several of whom ran for governor or U.S. Senate and three of whom are running for re-election this November)
filed the litigation in Texas v. Azar – now called California v. Texas. The Trump Administration joined their cause, and House Republicans repeatedly voted in favor of the Trump Administration’s efforts. In fact, the House and Senate Republicans’ vote for the GOP tax law made the entire lawsuit possible. Then, Republicans doubled down on their efforts to terminate the Affordable Care Act, even as it became undeniable that the law is a critical tool for combating the virus.

President Trump has broken his promises to make health care widely available.
Meanwhile, President Trump keeps lying to Americans about protecting their health care — but he has already broken his biggest health care promises. Trump promised that whoever “wanted health care” would have it under his administration, but the Trump-backed lawsuit could cause more than 20 million Americans to lose their insurance. Trump promised he would put a stop to rising health care costs and even reduce them — but his lawsuit would raise out-of-pocket costs for premiums and prescription drugs. Trump promised to support pre-existing condition protections and said that costs for people with pre-existing conditions would be “much lower” under his leadership — but his lawsuit would end these vital protections. And Trump promised to protect Medicaid — but his lawsuit would end access to Medicaid for millions of Americans enrolled through the ACA’s expansion program.
Republicans at all levels own this lawsuit’s attack on Americans’ health care. They will be held responsible for their party-wide obsession with throwing our health care system into chaos and stripping health care from 23 million Americans during a global pandemic. Republican governors and state legislators haven’t waited for the Supreme Court to issue a decision in California v. Texas, either. Their opposition to expanding Medicaid already endangers health care access for millions of Americans during this crisis.

While Trump and Republican Attorneys General refuse to back out of the ACA repeal lawsuit, Republicans in tough races are struggling to distance themselves from their party’s toxic effort to eliminate protections for pre-existing conditions, while at the same time refusing to oppose it. U.S. Attorney General William Barr warned the Trump Administration before its deadline for filing its brief in California v. Texas that seeking to repeal the entire Affordable Care Act would hurt Republicans in the November elections, and as one senior Republican strategist told CNN in May, “Republicans can’t afford to litigate health care for the second election in a row.”

Their votes to gut the ACA have proved a “
stumbling block” for vulnerable Senate Republicans, whose anti-health care records are now a “political liability” in tight Senate races and who are airing false and misleading campaign ads attempting to “obscure” their records on pre-existing conditions. Endangered House Republican Rodney Davis changed his position on whether to open the ACA’s health insurance marketplace depending upon who was interviewing him. Republican gubernatorial candidates have attempted to have it both ways on this issue – in Montana, Greg Gianforte has said he would continue to vote to dismantle the ACA, piece by piece, while pretending Montana’s popular Medicaid expansion doesn’t rely on the ACA’s existence. Even a few Republican Attorneys General in swing states like New Hampshire, Ohio & Montana chose to file briefs in support of parts of the law.

Publicly available polling on health care is stark for Republicans. In May,
Navigator Polling found that 53 percent of registered voters disapprove of the President’s handling of health care and that voters trust Democrats in Congress to improve the health care system over the President by a 14-point margin. Similarly, a late April DCCC poll of 41 Trump-won districts and 23 Clinton-won districts found that Republicans are most vulnerable on health care – with 62 percent of likely general election voters souring on Republicans after hearing they are still attacking health care amidst the COVID-19 pandemic. Morning Consult/Politico polling found that the majority of Americans disapproved of the President’s decision to keep the health insurance marketplaces closed. The latest Kaiser Family Foundation national poll this month found that Americans approve of the ACA by a +7 margin. Democratic governors, working closely with public health experts, have also received higher approval ratings for their leadership during this crisis than their Republican counterparts.

We only need to turn to the story of Medicaid expansion to see how this will play out for Republicans in just a few weeks. After years of fighting and losing this health care battle, the former head of the RGA declared:
“The battle has been fought and lost on Medicaid expansion.” The message may not have reached every Republican however: in North Carolina, where Democratic Governor Roy Cooper has navigated the state through the crisis, his Republican opponent still opposes Medicaid expansion and has refused to oppose the ACA lawsuit which would undermine the health care of millions. And just last month, Missouri voters supported a ballot initiative to bring Medicaid expansion to their state—proving that access to affordable health care is still on the top of minds for voters and a winning message in “red” states.


With the ACA and its coverage protections for pre-existing conditions “in greater danger than ever” after Justice Ruth Bader Ginsburg’s passing, it’s far too late for Republicans to walk back their years of attacks on the Affordable Care Act and the lifeline it provides to millions of Americans. For more than a decade, Republicans have been the architects of countless votes to repeal, lawsuits, electoral blockades, and executive intransigence that continue to threaten access to affordable health care for millions while the nation battles a deadly virus.

In the presidential campaign
, the DNC is holding Trump accountable each day by responding to his false claims about protecting Americans’ health care, highlighting how he is trying to take health care away from millions during a pandemic, and holding events in key battleground states with state leaders, surrogates, and everyday Americans who can personalize and define Trump’s disastrous health care agenda and his failed leadership in the midst of this pandemic. From the beginning, Trump has lied to the American people, admitting he downplayed the seriousness of the virus early on, leading to more lives lost, more people sick, and more jobs lost. Meanwhile, Vice President Biden has been demonstrating he has the strong, steady leadership and experience to guide our country out of this crisis and help build our economy back better.

At the U.S. Senate level,
vulnerable Republicans are being held accountable for voting to gut protections for people with pre-existing conditions, enabling their party’s lawsuit to overturn the entire health care law, confirming a slew of anti-health care judges, and defending ‘junk’ insurance plans. But instead of taking responsibility, GOP senators are trying to mislead voters. Independent fact checkers have been forced to debunk Republicans’ false claims that they support protections for people with pre-existing conditions when “their records show the opposite.” From threatening Medicaid expansion and backing cuts to Medicare, to blocking meaningful prescription drug reform, health care is losing terrain for Republicans because they are on the wrong side of what is still voters’ top concern. Flipping the Senate will mean protecting the progress we’ve made on health care, bringing down costs, and expanding access to coverage.

At the congressional level
, Democrats will continue to hold Republicans accountable for their votes to repeal the ACA and their continued support of the Republican lawsuit. Republicans lost the majority in 2018 in part because of their votes to eliminate protections for Americans battling pre-existing conditions. In 2020, they’ll have to defend their votes to let insurance companies discriminate against patients battling COVID-19. House Republicans twice voted to support the Republican ACA lawsuit – and Republican challengers have continued to support repealing the ACA. House Democrats will continue to remind voters that our majority is the firewall against Washington Republican efforts to take away their health care during this pandemic.

At the gubernatorial level,
Democratic governors will continue to fight for Medicaid expansion and hold Republican nominees and governors accountable for the human cost of opposing expanded access to health care. In gubernatorial races in 11 states this year, Democrats are making the case for evidence-based policymaking that protects lives and livelihoods. The DGA will also hold Republicans accountable for opposing widely popular and life-saving policies like Medicaid expansion, targeted restrictions during the COVID-19 pandemic, and commonsense safety nets that would protect Americans from the fallout of unforeseeable emergencies.

At the state attorney general level,
there is no clearer distinction for voters than Democratic Attorneys General at the Supreme Court defending the right to meaningful health care and Republican Attorneys General on the other side trying to take that health care away. The three Republican AG incumbents running for re-election this year—Missouri AG Eric Schmitt, Utah AG Sean Reyes, and West Virginia AG Patrick Morrisey—are part of the GOP coalition using taxpayer dollars to take health care away. All Republican AG candidates running this year support the repeal of the ACA. In fact, in the toss up race for Montana Attorney General, GOP candidate Austin Knudsen specifically cited his desire to join the GOP repeal effort to gut health care for 200,000 Montanans as the main reason he is running for Attorney General. Republican AGs and candidates are avoiding explaining to voters their dangerous position to take away affordable health care and end protections for people with pre-existing conditions in the middle of a global pandemic. DAGA is planning to invest as much as $15 million in battleground races this cycle including continuing efforts to educate voters where AG candidates stand on health care as they cast their ballots.

At the state legislative level,
Democratic trifectas are the last line of defense against Republican attempts to roll back health care access through the courts. Democrats will continue focusing on Republican legislators’ disastrous record on health care. Even in the midst of the pandemic, the GOP has doubled down on blocking Medicaid expansion, denying affordable coverage to millions of Americans. Instead of prioritizing public health, they’ve wasted time spreading conspiracy theories, fighting to undermine necessary public health restrictions, and fought against statewide and local mask mandates. Democratic legislators and candidates are united in the importance of protecting and expanding health care in their states. 

Republicans have been unable to answer voters' concerns around their party’s dangerous position on health care—going so far as to
falsify their party’s position in a desperate attempt to stay in office. Democratic candidates across the country—and across the ballot—will continue to call out Republicans for their harmful attacks on access to affordable health care, and remind voters of Republicans' decade-long war to eliminate protections for people with pre-existing conditions. The American people can’t afford two more years—let alone during a public health crisis—of Republican-led attacks on affordable and accessible health care.