An America-First Healthcare Plan

The order directs the Secretaries of Treasury, Labor, and Health and Human Services to maintain and build upon existing actions expanding affordable healthcare choices. It directs HHS and the FDA Commissioner to expand access to affordable medicines, including accelerating generic and biosimilar drug approvals and facilitating safe drug importation. It directs Treasury, Labor, and HHS to continue ensuring consumers have access to meaningful price and quality information before receiving care. On surprise billing, it requires HHS to work with Congress toward a legislative solution by December 31, 2020; if legislation fails, HHS must take administrative action to prevent patients from receiving bills for out-of-pocket costs they could not reasonably have foreseen.

Within 180 days, HHS must update the Medicare.gov Hospital Compare website to display whether hospitals comply with the Hospital Price Transparency Final Rule, whether they give patients itemized receipts upon discharge, and how often they pursue legal action — such as wage garnishment or home liens — to collect patient debts. HHS and VA are directed to maintain and improve care quality for veterans, and HHS is directed to promote medical innovation for COVID-19, Alzheimer's, sickle cell disease, and pediatric cancer. The order does not itself create new legal rights enforceable against the government.

Hospital patients vulnerable to surprise out-of-network bills, Medicare beneficiaries who will see new hospital billing data on Hospital Compare, federal agencies tasked with expanding drug access and price transparency, and hospitals subject to the existing price transparency rule whose compliance will be publicly displayed.

Patients will gain a public tool to check whether their hospital is transparent about prices and aggressive in suing patients over debt. The surprise billing directive creates a firm year-end trigger: if Congress does not act, HHS must act unilaterally, potentially capping what patients can be charged by out-of-network providers.

The surprise billing section has a two-track structure: HHS attempts a legislative fix with Congress through December 31, 2020; if that fails, it must take administrative action — but the order does not specify what form that action must take, leaving HHS substantial discretion. The Hospital Compare update (180-day deadline) works through an existing public-facing CMS website, adding three new data points about hospital billing behavior that patients can consult before choosing care. All directives are expressly conditioned on applicable law and available appropriations, and no new enforceable rights are created.