WASHINGTON — President Donald Trump bragged about a mission accomplished in veterans’ health care that has not been achieved. He threatened to end health insurers’ “bailouts” that actually help consumers. And he cited “tremendous” costs to taxpayers from providing health services to transgender troops without providing evidence of that expense.
Over a week dominated by internal strife in the administration, a potty-mouthed tirade from the new communications chief and the collapse of health care legislation, policy was aired on a number of fronts as well. Some of it was factually challenged or just plain wrong.
A look at a sampling of statements from last week.
TRUMP: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” — tweet Saturday.
THE FACTS: If you think of a bailout as an infusion of government money to keep an industry in business, that’s not what is going on here. He’s talking about federal payments to insurance companies that are used to reduce deductibles and co-payments for consumers with modest incomes. Trump has only guaranteed those payments will continue through July.
Analysts have said that without the payments, more insurers might drop out of the system, limiting options for consumers and clearing the way for the insurers that stay to charge more for coverage.
Trump’s threat to end “bailouts” to members of Congress is something of a mystery. What is clear is that he is upset they did not pass the Republican health care bill and wants them to think he will punish them if they don’t get rid of Obamacare.
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TRUMP: “We’ve begun to process seamlessly transferring veterans’ medical records. Horrible situation. You couldn’t get your medical records. And now it’s so easy and so good. And the system is fixed, finally, after all of these years.”
THE FACTS: That IT system is not fixed. The multiyear effort has barely begun. The costs are not even accounted for in Trump’s proposed 2018 budget. The VA expects its outmoded scheduling system to remain for several more years.
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TRUMP: “We have Choice. … We have nearly doubled the number of veterans given approvals to see the doctor of their choice.”
THE FACTS: He’s exaggerating the progress on this front. Trump is referring to the VA’s Choice program, which offers federally paid medical care outside the VA. Put in place after a 2014 wait-time scandal at the Phoenix VA, the program allows veterans to see outside doctors if they must wait more than 30 days for an appointment or drive more than 40 miles to a VA facility.
The department’s approvals to veterans to use Choice have grown under Trump, but they haven’t nearly doubled. VA Secretary David Shulkin wrote in a recent USA Today editorial that outside care programs for the first half of the year increased 26 percent over the same period last year. The program is also running out of money and will need an emergency replenishment by Congress to head off disruptions in care.
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TRUMP: “We’ve published wait times at every VA facility. I used to go around and talk about the veterans and they’d stand on line for nine days, seven days, four days … 15 days. People that could have been given a prescription and been better right away end up dying waiting on line. That’s not happening anymore.”
THE FACTS: Problems of delay or substandard care at some of the VA facilities have not disappeared. On access, the VA reported recently that veterans have been waiting more than 60 days for new appointments at about 30 VA facilities nationwide.
On quality of care, the VA’s inspector general issued urgent action reports in April and May warning that patients at Washington’s VA medical center were being put at unnecessary risk of harm due to bad inventory practices, like potentially dirty syringes and medical supply shortages.
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TRUMP: “We’ve delivered same-day mental health services at every VA medical center.”
THE FACTS: This may be the case, but it happened before Trump took office. By late 2016, the department’s blog announced that the goal of providing same-day primary and mental-health care when medically necessary would be achieved at every VA medical center by year’s end. Shulkin told Congress in late January the services already were fully in place.
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TRUMP: “Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.” — tweet Wednesday saying transgender troops would be banned from the armed forces.
THE FACTS: He’s offered no substantiation for the assertion that transgender military members represent tremendous medical costs and disruption. A Rand Corp. study found otherwise.
It estimates that out of about 1.3 million active-duty military personnel, 2,450 are transgender. Only a subset would seek transition-related care, such as hormone therapy and sex-reassignment surgery. Based on private insurance data, the study estimates a minimal increase in costs from such care for the active-duty armed forces — no more than 0.13 percent, or $8.4 million annually.
As for disruption, members representing less than 0.1 percent of the total force would seek transition-related care that could affect their deployments, the study says.
The Pentagon says it is allowing transgender troops to remain in uniform and not changing its policy otherwise until Defense Secretary Jim Mattis receives an authoritative directive on what to do.
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TRUMP: “As I said from the beginning, let ObamaCare implode, then deal.” — tweet Friday.
THE FACTS: He didn’t say that from the beginning. During the 2016 campaign, he promised to “immediately repeal and replace” Barack Obama’s health care law, as he put it on one tweet from last year. He did not propose to let the law fail, then follow up with a new package.
