While directing changes to the federal insurance program for older Americans was the specific mission of Thursday’s official visit, Trump’s broader goal was to portray himself as the defender of popular aspects of the nation’s health-care system and vilify Democrats as socialists determined to tear them down.
“With every ounce of strength and every bit of soul, we are going to protect Medicare for you,” the president vowed campaign-style, seizing on the fact that health care is a central concern among voters as he seeks a second term in office.
In Trump’s first trip from Washington since Democrats intensified their impeachment inquiry last week, he visited a welcoming environment. The Villages, a huge retirement community of more than 120,000 senior citizens, has become a reliable bastion for Republican politicians looking to secure votes in one of the country’s largest swing states.
The trip offered a test of whether Trump could continue to focus on the duties of his office as he faces a growing threat. In recent days, Trump has been consumed by the impeachment inquiry, lashing out at a whistleblower who has accused him of presidential misconduct. He has also levied treason charges against House Intelligence Committee Chairman Adam B. Schiff (D-Calif.), who is leading a probe into Trump’s efforts to get Ukraine to investigate former vice president Joe Biden.
While Trump largely kept his remarks in Florida focused on health care, he veered to attack Democrats on immigration, tax policy and their treatment of Supreme Court Justice Brett M. Kavanaugh.
He also briefly talked about House Democrats’ impeachment investigation.
“That’s why they do the impeachment crap, because they know they can’t beat us fairly,” he said. “If they won, it would be a sad, sad day for our country.”
Trump has taken particular interest in the large Democratic primary for the 2020 presidential nomination, handicapping the race and criticizing candidates’ policy proposals, such as Medicare-for-all. On Thursday, he derided progressive Democrats’ plans to build Medicare into a universal, government-financed health system, contending that it would be too expensive and would deprive patients of choice of their own doctors.
The executive order Trump signed Thursday directs federal health officials to make a wide swath of changes to Medicare Advantage, the private managed-care plans currently enrolling 22 million people — one-third of the participants in the federal insurance program for Americans who are 65 and older or have disabilities.
Private health plans, which are paid a fixed monthly fee for each Medicare patient enrolled, are allowed as an alternative to the traditional version of the 1960s-era entitlement program, in which the government reimburses doctors and other providers each time they treat a patient on Medicare. The private version of Medicare, relying on HMOs or preferred provider organizations, has been called Medicare Advantage since the early 2000s.
Over the years, the political parties have sparred over the rationale for managed care within Medicare, with Democrats regarding the private plans as a cost-saving strategy, while Republicans — now including Trump — simply favoring a market-oriented approach of private insurance companies delivering health care. How much the plans have gotten paid has seesawed, depending on which party has been in power when various health-care laws have passed Congress.
The White House made details of the executive order public after Trump’s speech. The changes it directs the Department of Health and Human Services to carry out are intended, in part, to guarantee that Medicare Advantage plans are on equal footing with the original version when people join the program, and permit the private plans to offer a greater array of health-related services, such as adult day care. They also will foster long-distance “telehealth” services that may be especially useful in rural areas.
It also aims to remove a variety of regulations, ranging from billing rules to allowing health-care workers who are not doctors, such as nurse practitioners, to treat patients and get paid at higher rates. Another facet would allow patients in Medicare Advantage plans easier access to creating medical savings accounts.
In a preview for reporters before the president’s remarks, top administration health officials and the White House’s domestic policy director reiterated a central administration talking point that the president is focused on helping all people who need health care and not just the approximately 20 million who have received coverage through the Affordable Care Act, a 2010 law that Trump and other Republicans have been working to dismantle.
The executive order is the fifth relating to health care that Trump has issued since taking office and the third in just over three months. None of the changes envisioned in Thursday’s order will occur immediately, all requiring a period of study by health officials and rewriting federal rules.
In his speech, Trump also reminded his audience that the administration has been developing rules that would enable states to obtain federal permission to import certain drugs from Canada and other countries where pharmaceuticals are sold for lower prices. Florida is the first state that has formally requested such permission, but the federal rules are a work in progress.
Democrats in Florida said Trump’s visit to friendly territory would not be able to mask his sagging poll numbers and the specter of impeachment.
“Donald Trump thinks he can hide in The Villages from his broken promises, his lies, and his corruption,” Florida Democratic Party Chair Terrie Rizzo said in a statement. “But we have a message for Trump — the truth is catching up to you and Florida isn’t fooled.”
The crowd of supporters in The Villages, located mostly in a county where Trump carried almost 69 percent of the vote in 2016, welcomed the president enthusiastically. The community, which is about 97 percent white and almost exclusively over the age of 55, represents a large chunk of the president’s base in a state that will be pivotal in the 2020 race.