Trump promotes health care ‘vision’ but gaps remain
CHARLOTTE,
N.C. (AP) — More than three-and-a-half years into his presidency and 40
days from an election, President Donald Trump on Thursday launched what
aides termed a “vision” for health care heavy on unfulfilled
aspirations.
“This is affirmed, signed, and done, so we can put
that to rest,” Trump said. He signed an executive order on a range of
issues, including protecting people with preexisting medical conditions
from insurance discrimination.
But that right is already guaranteed in the Obama-era health law his administration is asking the Supreme Court to overturn.
House
Speaker Nancy Pelosi dismissively said Trump’s “bogus executive order
on pre-existing conditions isn’t worth the paper it’s signed on.”
Democrats are betting heavily that they have the edge on health care
this election season.
Trump spoke at an airport hangar in
swing-state North Carolina to a crowd that included white-coated,
mask-wearing health care workers. He stood on a podium in front of a
blue background emblazoned with “America First Healthcare Plan.” His
latest health care pitch won accolades from administration officials and
political supporters but failed to impress others.
“Executive
orders issued close to elections are not the same thing as actual
policies,” said Katherine Hempstead, a senior policy adviser with the
nonpartisan Robert Wood Johnson Foundation, which works on a range of
health care issues, from coverage to quality.
Trump’s speech
served up a clear political attack, as he accused Democrats of wanting
to unleash a “socialist nightmare” on the U.S. health care system,
complete with rationing. But Democratic nominee Joe Biden has rejected
calls from his party’s left for a government-run plan for all. Instead,
the former vice president wants to expand the Affordable Care Act, and
add a new public program as an option.
Trump returned to health
care amid disapproval of his administration’s handling of the
coronavirus pandemic and growing uncertainty about the future of the
Obama-era law.
In a rambling speech, he promised quality health
care at affordable prices, lower prescription drug costs, more consumer
choice and greater transparency. His executive order would also to try
to end surprise medical bills.
“’If we win we will have a better
and less expensive plan that will always protect individuals with
preexisting conditions,” Trump declared.
But while his
administration has made some progress on its health care goals, the
sweeping changes Trump promised as a candidate in 2016 have eluded him.
The
clock has all but run out in Congress for major legislation on lowering
drug costs or ending surprise bills, much less replacing the Affordable
Care Act, or “Obamacare.”
Pre-election bill signing ceremonies on
prescription drugs and surprise medical charges were once seen as
achievable — if challenging — goals for the president. No longer.
Trump’s
speech Thursday conflated some of his administration’s achievements
with policies that are in stages of implementation and ones that remain
aspirational.
Democrats are warning Trump would turn back the
clock if given another four years in the White House, and they’re
promising coverage for all and lower drug prices.
Health and Human
Services Secretary Alex Azar said Trump’s executive order would declare
it the policy of the U.S. government to protect people with preexisting
conditions, even if the ACA is declared unconstitutional. However, such
protections are already the law, and Trump would have to go to Congress
to cement a new policy.
On surprise billing, Azar said the
president’s order will direct him to work with Congress on legislation,
and if there’s no progress, move ahead with regulatory action. However,
despite widespread support among lawmakers for ending surprise bills,
the White House has been unable to forge a compromise that steers around
determined lobbying by interest groups affected.
Health care
consultant and commentator Robert Laszewski said he’s particularly
puzzled by Trump’s order on preexisting conditions.
“So, after 20
years of national public policy debate and hard-fought congressional and
presidential approval, how does Trump conclude he can restore these
protections, should the Republican Supreme Court suit overturn them,
with a simple executive order?” asked Laszewski.
The American
Cancer Society Cancer Action Network said the president’s order is not
the equivalent of Obama’s law. “Should the administration succeed in its
case to throw out the law, the executive order will offer no guaranteed
patient protections in its place,” said Lisa Lacasse, the group’s
president.
For Trump, health care represents a major piece of unfinished business.
Prescription
drug inflation has stabilized when generics are factored in, but the
dramatic price rollbacks he once teased have not materialized. In his
speech the president highlighted another executive order directing
Medicare to pay no more than what other nations pay for medications, but
it remains yet to be seen how that policy will work in practice, if it
can overcome fierce opposition from the drug industry.
Trump said
millions of Medicare recipients will soon receive a card in the mail
containing $200 that they can use to help pay for prescription
medications. “I will always take care of our wonderful senior citizens,”
he promised. No detail was immediately available on when seniors would
get such a card or how the cost of the assistance would be paid for.
More
broadly, the number of uninsured Americans started edging up under
Trump even before job losses in the economic shutdown to try to contain
the coronavirus pandemic. Various studies have tried to estimate the
additional coverage losses this year, but the most authoritative
government statistics have a long time lag. Larry Levitt of the
nonpartisan Kaiser Family Foundation says his best guess is “several
million.”
Meanwhile, Trump is pressing the Supreme Court to
invalidate the entire Obama health law, which provides coverage to more
than 20 million people and protects Americans with medical problems from
insurance discrimination. That case will be argued a week after
Election Day.
The death of Supreme Court Justice Ruth Bader
Ginsburg has added another layer of uncertainty. Without Ginsburg,
there’s no longer a majority of five justices who previously had voted
to uphold the ACA.
Democrats, unable to slow the Republican march
to Senate confirmation of a replacement for Ginsburg, are ramping up
their election-year health care messaging. It’s a strategy that helped
them win the House in 2018.
A recent Kaiser Foundation poll found
Biden had an edge over Trump among registered voters as the candidate
with the better approach on making sure everyone has access to health
care and insurance, 52% to 40%. The gap narrowed for lowering costs of
health care: 48% named Biden, while 42% picked Trump.
Trump
unveiled his agenda at the start of a two-day swing to several
battleground states, including the all-important Florida. There, he held
a rally in Jacksonville and was to court Latino voters at an event in
Doral on Friday. From there, Trump will court black voters in Atlanta
and attend a fundraiser at his Washington hotel before ending Friday
with another rally in Newport News, Virginia.
The scramble to show
concrete accomplishments on health care comes as Trump is chafing under
criticism that he never delivered a Republican alternative to
Obamacare.
“We’ve really become the healthcare party — the
Republican Party — and nobody knows that,” he said Thursday. “The news
doesn’t talk about it.”