…which would place Jindal near the center of the policy universe, at least for the first year or two of Trump’s presidential term.
If you’re the Secretary of the Department of Health and Human Services for Trump, you’re going to have to manage the unspooling of Obamacare.
What you’ll see a lot of in the local reports on Jindal as a potential cabinet member is a recitation of the critical things the former Louisiana governor said about Trump in the beginning of the presidential campaign, when both were running for the Republican nomination – that Trump was an “egomaniac” and a “carnival act,” and that Trump’s hair “looks like he’s got a squirrel on his head.”
All of which has little to do with what Jindal at HHS would mean for the millions of Americans facing the prospect of health insurance they can no longer afford, of course, but it’s an easy way to fill space.
More interesting is a comparison between Jindal’s plan to replace Obamacare, released through his America Next policy shop in 2014, and Trump’s Obamacare replacement plan released earlier this year. There is overlap between the two, which could make Jindal an attractive choice for a Trump administration regardless of political rhetoric he may have offered over a year ago.
Trump’s website had a seven-point plan to replace Obamacare – though it didn’t contain a great amount of specificity. That’s not a criticism; any presidential campaign policy statement which does go very far into the specifics is by definition a fraud, because beyond the basic elements it’s unlikely such a plan would survive the legislative process intact.
The seven elements were…
- A complete root-and-stem repeal of Obamacare;
- Making health insurance plans available across state lines (it’s a safe bet that this will absolutely become law next year);
- Tax deductibility of individual health insurance plans;
- Health Savings Accounts;
- Price transparency from doctors and hospitals;
- Block-granting Medicaid to the states, so state Medicaid programs could be little laboratories for experimentation without Washington’s control; and
- Streamlining the FDA approval process and getting new drugs to the market more cheaply and quickly, which one would expect might lower the cost of those drugs.
Jindal’s America Next Obamacare plan had several key elements, some of which could fit nicely into a Trump Obamacare re-do…
- “Tax equity” between individual and employer-based health insurance, which is found in Trump’s plan, together with a government subsidy offered by states with federal funding so lower-income consumers can buy an individual plan (that’s an expansion of Jindal’s Bayou Health idea for Medicaid, which created a market for private insurers to offer competitive products for Medicaid enrollees in Louisiana);
- Health Savings Accounts, which it seems fairly clear will come roaring back into American health-care policy next year;
- A major crackdown on Medicaid and Medicare fraud;
- Price – and quality – transparency;
- Guaranteed access for pre-existing conditions;
- Changing Medicare into a premium support plan, which is something House Speaker Paul Ryan likes but Trump has never shown a lot of enthusiasm for (one way to square this circle might be that Medicare enrollees could opt for a premium support plan, or not);
- A “global grant” approach to Medicaid, which is the same thing as Trump’s block-grant idea;
- Reforms by states to expand access to health care, such as relaxation of “certificate of need” requirements restricting the construction of hospitals and clinics and other licensing requirements;
- Portability reform;
- Making health insurance plans available across state lines;
- Pooling mechanisms – meaning promoting the availability of group health insurance outside the employment realm, so that you could buy group health insurance through your church, alumni association, Kiwanis Club, college sorority or any other common-interest group;
- Tort reform to lessen the cost of medical malpractice insurance for doctors; and
- Allowing Medicare patients to purchase healthcare outside of the system on a cash basis if they choose, which would encourage more doctors to treat Medicare patients.
The overlapping elements in the two plans are in bold above.
It’s clear Jindal, who ran Louisiana’s health-and-hospitals department before becoming an elected official and had a role in a healthcare reform task force in Washington, has a better grasp of detail where it comes to those issues. The Wall Street Journal report also named Ben Carson as a potential HHS secretary, but Jindal might seem to make more sense given his experience in health policy.