President Trump capped his fruitless four-year journey to abolish and replace the Affordable Care Act by signing an executive order Thursday that aims to enshrine the law’s most popular feature while pivoting away from a broader effort to overhaul the nation’s health insurance system.
Trump announced the move during a trip to North Carolina, outlining his “vision” for revamping parts of the nation’s health care. During the speech, which came shortly before a campaign swing to Florida, Trump barely veiled the political nature of his intent.
“The historic action I’m taking today includes the first-ever executive order to affirm it is the official policy of the United States government to protect patients with preexisting conditions,” Trump said, despite the fact such protections are already enshrined in law. “We’re making that official. We’re putting it down in a stamp, because our opponents, the Democrats, like to constantly talk about it.”
The speech and executive order stood as a tacit admission that Trump had failed to keep his 2016 promise to replace his predecessor’s signature achievement with a conservative alternative. For a president who campaigned in 2016 pledging to “repeal and replace” the ACA, Trump’s 2020 signature health-care speech instead expressed a willingness to keep the law largely in place. Unable to repeal the law, Trump appeared open to simply rebranding it.
“Obamacare is no longer Obamacare, as we worked on it and managed it very well,” Trump said of the law that continues to provide coverage for more than 20 million Americans. “What we have now is a much better plan. It is no longer Obamacare because we got rid of the worse part of it — the individual mandate.”
While Trump’s 2017 tax law did eliminate the requirement that virtually all Americans maintain insurance, the ACA remains in place with its expansion of Medicaid and insurance markets covering millions.
The failure to repeal and replace the ACA has not stopped Trump from repeatedly promising a soon-to-come health-care plan in a repetitive cycle of boastful pledges and missed deadlines that intensified in recent weeks ahead of the November election.
Trump’s speech and executive action Thursday constituted his most concrete effort yet to make good on those pledges by spelling out his health-care principles and criticizing his opponents.
“We’ve really become the health-care party — the Republican Party,” Trump said before reading a list of his accomplishments that pointedly did not include replacing the Affordable Care Act.
But even as other Republicans have tried to avoid the issue of health care — with some appearing to defend components of the ACA in political ads — Trump has continued to raise the subject and promise a soon-to-come comprehensive proposal.
Health care, long a top issue for voters, has taken on fresh urgency with less than five weeks to go before the November election.
The ongoing coronavirus pandemic has killed more than 200,000 Americans and caused millions to lose their jobs and health insurance. A pending Supreme Court case over the constitutionality of the ACA is set to be heard in November, and the death of justice Ruth Bader Ginsburg last week has raised the prospect that the law could be invalidated.
Trump said he supported the lawsuit but also claimed he would be fine maintaining the core of Obamacare “if we lose,” the first time he has openly expressed a willingness to abandon his original promise to “completely repeal” President Barack Obama’s most significant domestic achievement.
Democrats have been talking about health care constantly, while Republicans have largely steered clear of the issue, a phenomenon that tracks with public polling showing Americans trust the party responsible for passing the last major health-care legislation over the party that has tried to repeal it without offering an alternative.
Trump has sought to cut into that advantage ahead of the vote, touting his record and signing executive actions just days before he is set to face Democratic presidential nominee Joe Biden in a debate next week.
In addition to the executive action on preexisting conditions, Trump also promised millions of older Americans would receive $200 toward the cost of prescription drugs and signed executive orders he said would somehow prevent unexpected medical bills and protect insurance coverage for preexisting medical problems. The White House released no details of how the $200 program would work, how it would be funded and whether this was a long-term plan or one-time payment to seniors ahead of the election.
Both actions fall short of a comprehensive health-care overhaul. By comparison, the Affordable Care Act revamped much of the nation’s health-care and insurance systems for the first time in decades.
After entering office determined to undo the law and quickly replace it with a conservative alternative, Trump swiftly ran into obstacles.
In 2017, Republicans were repeatedly forced to abandon their proposals to repeal the ACA when they failed to reach a consensus on a replacement despite holding majorities in the House and Senate. Trump has expressed frustration at the late senator John McCain (R-Ariz.) for torpedoing the last GOP attempt to replace the law, but the lack of consensus was widespread in the party.
In the years since, Trump has taken some action on health care using his executive authority, including symbolic executive orders intended to lower drug prices and changes to Medicare billing practices.
But a comprehensive health-care plan has remained elusive, and Trump has instead resorted to making bold claims that he was on the cusp of delivering one.
In June 2018, Trump said he would unveil a health-care plan “in a very short period of time.”
A year later, he said such a plan would be out “over the next four weeks.” A month after that, he said a “phenomenal” plan would arrive “in about two months.”
While no such plan arrived, the pandemic and the upcoming election have only increased the frequency with which Trump has reiterated his promises.
In July, Trump told “Fox News Sunday” anchor Chris Wallace that he would be “signing a health-care plan within two weeks, a full and complete health-care plan.”
Two weeks came and went with no plan. During a town hall that aired on ABC on Sept. 15, Trump was confronted by a voter who told him that she would die if the ACA’s protections for preexisting conditions were eliminated
Again, Trump said his own plan preserving those protections would be out soon.
“We’re going to be doing a health-care plan very strongly and protect people with preexisting conditions,” Trump said.
Pressed by ABC News anchor George Stephanopoulos about the ever-shifting deadline for the plan, Trump claimed to have already formulated it.
“I have it all ready. I have it all ready,” he said.
Democrats and the Biden campaign have seized on health care, highlighting the Trump administration’s decision to back a lawsuit from a group of Republican attorneys general to have the entire ACA declared unconstitutional by the Supreme Court while offering no alternative.
In a memo released Thursday, party leaders including Democratic National Committee Chairman Tom Perez highlighted the wave of Democratic victories in 2018, noting that health care was an animating issue across the country.
The pandemic and the prospect of the ACA’s demise have revived similar sentiments, allowing the party to go on offense even as Republicans struggle to find a unified message, the memo said.
Biden’s campaign criticized Trump on Thursday for so far failing to put forward a full health-care plan just weeks before the election, saying his administration’s attempt to repeal the ACA could leave millions of Americans without coverage during a global pandemic.
In the aftermath of Ginsburg’s death, Biden has opted to avoid questions about potential Democratic court-packing plans and instead focus on how a more solidly conservative court might undermine the ACA.
“I think we should focus on what this is going to mean for health care, what it’s going to mean to once again have to say if you’re pregnant it’s a preexisting condition, to be able to charge women more for the same procedure as men,” Biden told reporters Wednesday when asked about Trump’s potential Supreme Court nominee. Biden has pledged to build on the ACA if elected.
Some of Trump’s allies have been dismissive of health care as a motivating factor in an upcoming election they believe will be determined by the state of the economy and the spread of unrest in communities.
“Health care is way, way, way down on the list,” said one official at a Trump-aligned super PAC, speaking on the condition of anonymity to discuss internal strategy. “It is right up there for Democrats, but we’re not looking at Democrats to take us to 270” electoral votes.
Anne Gearan, Amy Goldstein, Paige Winfield Cunningham, Matt Viser and JM Rieger contributed to this report.
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