Dan Gorenstein: Today is the final day of Trump Week.

We’ve looked at Obamacare…

Emily Gee: The Trump administration has chipped away at the edges of the ACA.

DG: Medicaid…

Robin Rudowitz: Many of these proposals were designed to limit the scope of the Medicaid program.

DG: Drug pricing…

Ben Ippolito: Ambitious, but also a bit underwhelming.

DG: And women’s health.

Maya Manian: Between about 70,000 and 126,000 women would lose birth control coverage.

DG: From the Annenberg Studio at the University of Pennsylvania, finally the president’s actions on the pandemic, and a look ahead to what four more years of this administration could mean for health policy.

I’m Dan Gorenstein, and this is Tradeoffs.

DG: Our producer Ryan Levi is with me today to wrap up the series on the president’s  record over his first term. Hey, Ryan, thanks for coming in.

RL: Absolutely, Dan.

DG: Let’s pull back the curtain a bit for a second and let people know what’s gone into producing these episodes, and to be honest, I’m curious myself, how many people have you actually talked to, Ryan?

RL: I talked to more than 30 experts in the lead up to this series. These are folks from across the ideological spectrum. They work at think tanks, they’re academics, former government officials, you know, folks who really pay close attention to health policy. 

DG: Right, and we’ve heard from a few of those experts on the show this week talking about the Affordable Care Act, Medicaid, prescription drugs and women’s health.

Of course, you and I both know that’s not everything.

What other policies, though, did the experts you’ve talked to find noteworthy that we haven’t touched on this week so far?

RL: So price transparency is a big one. We did an episode on this earlier this year with the president’s move to have hospitals make public the prices that they negotiate with insurers. The president and his supporters really tout this as a big accomplishment, something that could really lower prices. 

President Trump: People have no idea how big it is. Some people say it’s bigger than health care itself. This is something that’s going to be very important.

RL: The evidence is still out. We don’t really know what impact it will have. But it is certainly something one of the few policies that the administration has pushed that is actually for now going forward. And then obviously there’s COVID, which is on top of everyone’s mind right now.

DG: Totally, you can’t talk about President Trump’s record without talking about COVID. Was there any kind of consensus around how the Trump administration has handled the response to the pandemic?

RL: You know, as we’re talking today, it’s September 17. There have been more than 6.5 million confirmed cases in the U.S. Nearly 200,000 people have died from COVID-19. The U.S. has just 4% of the world’s population, but we account for about 20% of the world’s COVID deaths, so far. There have been several polls that have found that about 6-in-10 Americans disapprove of the president’s handling of the pandemic. And all that is pretty similar to what I have heard from the experts that I talk to, you know, especially looking at the administration’s early handling of the pandemic, you know, really downplaying its severity and not getting the testing that we needed up and running.

DG: What about the flip side? Is there any consensus around giving the president good marks for any action?

RL: You know, honestly, a lot of the experts I talked to had very little positive to say about the president’s response. That being said, there was some pretty widespread agreements on the benefits of the administration’s moves on telehealth.

Telehealth news clip montage

RL: You know this telehealth explosion is something that a lot of folks think is going to be here to stay and could really change how care is delivered in this country. The other thing to mention here is around vaccines. 

Trump: We have reached an agreement with Moderna to manufacture and deliver 100 million doses of their coronavirus vaccine candidate.

RL: You know, on one hand, the administration has been incredibly aggressive, has poured a ton of money and time into this helping cover the costs of building up production of all of these vaccines. And then if and when one of them is proven safe and effective, we’ve got a guaranteed order in place. Now, on the other hand, this is all happening as fears grow about the politicization of a vaccine. The president is rushing to get something out the door before the election. He’s contradicting government scientists who say it is unlikely that there will be a widely available vaccine before the end of this year, and that’s all raising questions about safety and fueling this growing skepticism about whether people are actually going to take a vaccine. A recent Kaiser Family Foundation poll found that more than half of folks would not take a vaccine if it was approved before Election Day, and I really think this speaks to a broader dissatisfaction with the administration’s response to the pandemic going back all the way to the beginning.

DG: So that’s looking back at the first term. Let’s shift gears and look ahead. If President Trump is elected, Ryan, what do these policy experts you’ve talked to think his agenda will look like? And let me just say quickly, we don’t know what the makeup of Congress is going to be, and that will have a huge influence on what the president is or is not able to do if he is reelected.

RL: You know, most of them expected to see pretty much the same things we’ve seen this term, you know, kind of a continuation of the administration’s priorities. And that’s basically what we heard from the president when he accepted the nomination at the Republican National Convention last month.

Trump: We will end surprise medical billing, require price transparency, and further reduce the cost of prescription drugs and health insurance premiums. They’re coming way down. 

RL: You know, one interesting thing that the president didn’t mention, but I heard from some of the conservative experts that I talked to, was this potential for the administration to focus on consolidation in health care. You know, this is something that we’ve talked about on the show, Dan, you know, where we’re seeing hospitals and private physician practices, you know, merge and join together and really dominate the markets that they’re in. And Lanhee Chen, who’s a fellow at the Hoover Institution, he mentioned this as an idea that he thinks a second Trump administration should really look at.

Lanhee Chen: This is really one of the reasons why we see higher costs in our health care system is in some cases, a lack of competition. And so one of the things I’ve called for is expanding funding for the Federal Trade Commission and the Department of Justice to fight anti-competitive mergers and growing consolidation in health care.

RL: You know, so that could be an interesting policy to follow in a potential Trump second term, along with the greatest hits that they keep trotting out.

DG: I’d certainly expect another priority for the Trump administration in a second term would be a continued response to COVID. 

RL: Absolutely, that’s, you know, whether it’s a priority or not, it’s going to have to happen. COVID is not going anywhere. You know, one other thing that could really upend or be a wild card in a second Trump term is if the Supreme Court strikes down the Affordable Care Act.

News clip: The fate of the health care law often referred to as Obamacare will be on the line again as the COVID pandemic plays out.

News clip: The administration in a new filing asked the Supreme Court to abolish Obamacare.

RL: That case is going to be heard this November, right after Election Day. You know, Trump has repeatedly said that he’s got a great new health care plan, a great replacement for the Affordable Care Act, just ready to go. We haven’t seen anything like that from him. But if he’s reelected and the ACA is overturned, he’s going to need to come up with something.

DG: One of the questions I’ve personally found most illuminating is when we’ve asked the guests this week to use one word or one phrase to sum up the administration’s approach on the ACA or Medicaid or what-have-you. I want to put that question to you: What’s one word or phrase you would use to sum up the Trump administration’s health policy goals over the first term?

RL: I think I’d have to go with limited, I think that’s kind of been the through line that I’ve heard both through the conversations that we’ve had this week and the other conversations I’ve had with experts. The things that the administration has been able to make changes on has mostly been through executive actions, administrative actions. And, you know, this failure, is something that we heard from Brian Blase, who we talked to, who, you know, was a senior adviser to the president on health care.

Brian Blase: You know, there was an opportunity to really reform America’s health care system in lasting ways by passing legislation, and that effort collapsed.

RL: You know, he’s talking specifically there about the effort to repeal the Affordable Care Act, but I think does a nice job of honestly summing up the administration’s entire health policy record. You know, the president came in with these really big, bold, radical, in some cases plans for health policy, you know, repeal the Affordable Care Act, fundamentally change how Medicaid works, go after the drug companies and really try to be aggressive in lowering prices. But he wasn’t able to get any of that into legislation, wasn’t able to get any of that done with Congress. And so at the end of the day, he hasn’t really been able to leave much of a permanent mark on our health care system.

DG: Ryan Levi, producer at Tradeoffs, thank you so much for all the work you have put into this series. Great job, thanks, sir.

RL: Thank you.

DG: Thanks to all of you for joining us for the first part of our two-week series on health care and the 2020 election.

We’ll finish the series next week with two episodes focused on former Vice President Joe Biden’s health care proposals.

If you missed any of the episodes, you can find them — and all of our reporting for this series — on our website at tradeoffs.org/trumpbiden.

I’m Dan Gorenstein, this is Tradeoffs.