'Politics over policy'? With fate of Obamacare uncertain, Trump pledges to protect Americans with existing medical conditions

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President Donald Trump will sign health care-related executive orders to address surprise medical billing and safeguard insurance for people with existing medical conditions, even as his administration backs a Supreme Court challenge that could undo such protections, senior administration officials said Thursday.

Trump is expected to share more details during an appearance Thursday in Charlotte, North Carolina, administration officials said.

Health and Human Services Secretary Alex Azar said the president's order will make it United States policy to protect Americans with existing medical conditions. The announcement comes as Texas and 17 allied states press a Supreme Court challenge to the decade-old Affordable Care Act, which already forbids health insurers from denying coverage to people with existing health conditions. 

If the nation's high court strikes down all or part of President Barack Obama's signature health law, Trump's executive order will make it clear "that it is the policy of the United States that people who suffer from pre-existing conditions will be protected," Azar said on a Thursday call with reporters.

Kathryn Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, called the move “a gesture and a state of mind, not a policy." 

“There’s no accountability for the statement," she said. "You can’t cover yourself with words about preexisting conditions.”

Trump backed efforts to replace and repeal the Affordable Care Act that has extended insurance coverage to millions of Americans. In addition to guaranteeing individuals with existing medical conditions can purchase health insurance, the law provides sliding-scale subsidies for people to purchase coverage and expanded Medicaid coverage for millions of low-income Americans in more than 30 states. 

Trump also will urge Congress to pass legislation to address surprise medical billing, which occurs when consumers are billed by doctors or hospitals not part of their insurance plan's network. Bipartisan bills to address such runaway medical billing practices have stalled in Congress. If no legislation is passed by Jan. 1, Trump will order Azar to use the "full regulatory power of the United States government to protect patients" against surprise medical bills, Azar said. 

Azar's staff is working on what such a regulatory approach might include but had no details to share Thursday.

"He’s telling them – get your act together, get something passed, or we’ll be coming at it and you’ll get what you get from us," Azar said. 

Also Thursday, Sen. Chris Murphy, D-Conn., introduced legislation that would create "best practices" for hospitals to illnesses don't bankrupt patients. His bill joins several others on surprise billing that have been stalled in Congress, each with its own group of supporters lined up, said Benedic Ippolito, an economist with the free market American Enterprise Institute. 

That makes it much harder for Trump to convince a Congress that's "not interested in new ideas," said Ippolito.

“The reality is Congress has to act in order to ensure patients aren’t caught by surprise medical bills or trapped in a cycle of compounding medical debt," said Murphy. "If Trump wants to make this right, he can work with me on my legislation introduced today."

Trump recently signed an executive order that would set Medicare drug prices to amounts paid by other nations. But the order requires federal rules be implemented before such pricing could be set, a process that can take several months, and pharmaceutical companies would fight such pricing.

Far more is needed to prevent insurance premiums from skyrocketing, however, said Larry Levitt, executive vice president at the nonprofit Kaiser Family Foundation. Levitt, a former HHS official in the Clinton Administration, said “strong regulation of insurance companies” and “some way of encouraging healthy people to sign up” is needed to prevent what’s known as a death spiral in insurance markets.

“President Trump is once again promising to protect people with pre-existing conditions if the Affordable Care Act is overturned, but still doesn’t have an actual plan to back up that promise,” said Levitt. “You can’t just click your heels together three times and make pre-existing condition protections a reality.”

Azar said the "overselling of Obamacare" includes the false notion it's affordable for middle-class Americans who earn too much to get significant subsidies under the health law. "That is an insurance card you can’t actually afford to use to take care of your pre-existing conditions," Azar said. 

Texas and other states challenging the Affordable Care Act argue it became unconstitutional after Congress eliminated the law's individual mandate, a tax people paid if they did not purchase insurance or qualify for an exception. 

The U.S. Justice Department originally sought to strike down only the insurance mandate, but changed its position and urged the Supreme Court to declare the entire law unconstitutional. The case will arrive at  the Supreme Court a week after the November election.

Some analysts questioned how much Trump would be able accomplish on protecting existing medical conditions or surprise billing without Congressional action.

“There’s only so much they can do unilaterally,” said Ippolito. “It’s hard to think through what their options are.”

Telling Congress to resolve the issue by Jan. 1 or Azar will impose regulations to address it is not much of an ultimatum, Ippolito added. 

“What’s the stick?” he said, noting it would take several months or even years.

“This is like many of the situations we’ve seen over the last couple months: It’s probably politics over policy ... (the White House is) under a lot of pressure to deliver, but the challenge is it’s pretty late in the game to do anything. He is talking a big game, but there isn’t action to back up the rhetoric.”