Millions of poor Americans could get left out of Trump's legally dubious plan to send $200 drug discount cards to Medicare beneficiaries

• Trump's legally dubious pledge to send out $200 cards to Medicare beneficiaries could leave out 13 million low-income Americans receiving federal aid within the program.
• The "Extra Help" program within Medicare provides poor Americans with subsidies that can be used towards prescription drug copays and premiums.
• The administration appears to be focusing on aiding seniors that are not already getting federal assistance.
• "It doesn't mean they're having an easier time affording their medication," healthcare expert Juliette Cubanski said of people enrolled in Extra Help.

President Donald Trump vowed on Thursday to send $200 drug discount cards to 33 million Medicare beneficiaries in a legally dubious gambit aimed at strengthening his political support among seniors.

But that could exclude 13 million low-income Americans enrolled in the program who are receiving federal subsidies to better afford their prescription medications.

During an event in North Carolina, Trump said the cards would be sent in the near future to millions of older Americans.

"Nobody has seen this before. These cards are incredible," he said. "The cards will be mailed out in coming weeks. I will always take care of our wonderful senior citizens."

Other administration officials used the same figure. White House press secretary Kayleigh McEnany wrote on Twitter with an emphasis on it Thursday: "Soon, 33 MILLION Medicare beneficiaries will receive a card in the mail containing $200 they can use towards prescription drug costs."

If the cards are sent out, it could carry a $6.6 billion price tag. The White House did not immediately respond to comment.

Juliette Cubanski, deputy director of the Medicare policy program at the Kaiser Family Foundation, told Business Insider that the administration appeared to be focusing on providing cards to beneficiaries not already receiving government assistance.

Around 13 million low-income Americans in Medicare are enrolled in a federal "Extra Help" program that helps them pay premiums and co-pays. Individuals are eligible for subsidies when their incomes are below 150% of the poverty line, or around $19,000, and own minimal assets.

But that doesn't mean the subsidies are ample enough to cover all their costs. They range from $3 for generic medicines and $9 for brand name drugs, though amounts vary, Cubanski said, and many still face "affordability challenges."

"It doesn't mean they're having an easier time affording their medication," she said. "If you're taking 5-10 medications, your out-of-pocket costs may be significant."

The Trump administration said Thursday the initiative would be approved under a waiver program that gives Medicare room to scrutinize new policy ideas. Cards could be used for copays on prescription drugs, a senior official said.

But it was unclear whether the White House has the legal authority to do it, as the waiver program allows policies to be tested if they are budget neutral. In addition, details on the funding mechanism are scarce. The Wall Street Journal reported money for the cards would be pulled from the Medicare trust fund.

Prominent lobbying groups for the drug industry were in the dark. The Pharmaceutical Research and Manufacturers of America said Thursday it wasn't provided any information about the measure and said it would do little to provide significant help.

The industry previously opposed sending out the cards as part of a deal with the White House to cut drug prices, which ultimately collapsed.

Democrats ripped Trump for attempting to send the discount cards barely six weeks before Americans cast their ballots. Sen. Ron Wyden of Oregon called it a "taxpayer-funded bribe."

"Trump is resorting to gimmicky coupons that hide the fact that he has totally failed to lower drug prices and that Big Pharma is thriving under his watch," Wyden said in a statement Friday. "Drug companies will be paying as much for this gimmick as Mexico is paying for the Wall."