President Trump is pushing advisers to deliver health-care “wins” in the final weeks of the campaign, leading to a frenzied rollout of proposals as polls show the president’s handling of the coronavirus pandemic and health-care policy are two of his biggest vulnerabilities in his reelection bid.
He is expected to mostly avoid speaking about repealing and replacing the Affordable Care Act, something he has long promised to do but a position that is unpopular with voters.
Advisers also expect Trump to sign an executive order promising to protect people with preexisting conditions as part of Thursday’s event, though the administration has not detailed how this objective could be achieved without the safeguards in President Barack Obama’s signature 2010 health-care law, according to another senior administration official. Experts have said such an executive order would amount to little more than a public relations ploy, and the order is not viewed as a substantive policy proposal among many West Wing advisers.
Despite making lowering drug prices and repealing and replacing the Affordable Care Act key planks of his 2016 election bid, Trump has struggled to deliver on many of his health-care promises in his first term. He trails Democratic presidential nominee Joe Biden in polls on health-care issues.
The goal is not necessarily to beat Biden on health care — even some of the most optimistic Trump aides do not see that as possible — but instead to close the polling gap on the issue while touting others on which the president has an advantage, such as the handling of the economy, according to people familiar with the discussions who, like others, spoke on the condition of anonymity to discuss private deliberations.
“In almost every way we can test health care, it continually is at the top of people’s concerns, and it consistently polls to the advantage of Biden and the Democrats down ballot,” said Guy Cecil, who leads Priorities USA, a liberal group that has blanketed the airwaves with advertisements against Trump on health care. “It’s going to take more than repeatedly promising they are going to have a plan in two weeks over and over again.”
The president has signed a flurry of executive orders in recent months and repeatedly promised a “great” health plan that he hopes will help win over seniors, but he has failed to release such a proposal. His aides have also made last-minute pushes for concessions from the pharmaceutical industry, including an attempt to convince drugmakers to give seniors $100 coupons before the election, according to two people familiar with the discussions.
The White House declined to comment on the contents of the president’s Thursday speech. White House press secretary Kayleigh McEnany responded to questions for this article by defending the president’s record on health care and blasting Democrats’ policy plans, claiming they will amount to a “government takeover of health care” and higher taxes.
Trump “will continue to deliver these results and more in a second term,” she said.
Health care had once been a political albatross for Democrats because of early problems with the ACA website, rising premiums on the individual market set up by the law, and Republican complaints that it was enacted in a less than transparent manner, according to strategists in both parties. Trump repeatedly fixates on Obama’s promise that patients could keep their doctors under the ACA, which turned out to be false for some people.
“The turning point in all of the health-care conversations was the attempt by congressional Republicans and Trump to overturn Obamacare,” Cecil said, referring to the failed efforts to scrap the law shortly after Trump took office. “It crystallized for people what was actually at stake. Americans started paying attention to what was actually in Obamacare.”
Cecil added that in recent polls conducted by his group in six battleground states — Wisconsin, Florida, North Carolina, Pennsylvania, Arizona and Michigan — health care and the coronavirus were among voters’ top five concerns, with health care leading among all White women, a key voting bloc. Trump’s perceived attacks on Social Security and insurance for those with preexisting conditions were the No. 1 and No. 2 issues cited by female voters in these states, he said. The president has said he will protect both.
A national Kaiser Family Foundation poll completed after the Democratic and Republican conventions showed Biden with a 13-point advantage when it comes to determining the future of the Affordable Care Act and a 14-point lead on maintaining protections for people with preexisting conditions. But Trump had a slight edge on lowering prescription drug costs; 46 percent of voters said the president had a better approach, while 42 percent favored Biden. Biden had a six-point advantage on lowering the overall cost of health care for individuals.
Republican National Committee and campaign polls have consistently shown Trump trailing Biden on health care among voters in key states. One such poll of battleground states this spring had Biden with a double-digit lead on lowering health-care costs, drug policy and protecting Social Security and Medicare.
The administration’s problems on health care have been exacerbated, officials said, by the president’s handling of the pandemic, which has generally received poor marks from voters.
The president has told advisers that he wants to “fight” on health care, knowing it is a political vulnerability, and advisers have urged him repeatedly to promise that he will maintain protections for those with preexisting conditions. At times, he has berated health-care officials, saying that the issue is hurting him politically, White House officials said.
Trump’s speech Thursday and the pressure on his advisers come as Biden has sought to focus his campaign on Trump’s handling of the pandemic and the future of the ACA, after Supreme Court Justice Ruth Bader Ginsburg’s death last week added fresh uncertainty for the future of the law that extended health insurance to some 20 million Americans. The high court is set to hear oral arguments on the latest bid to strike down the entire law — a suit brought by 18 Republican states that is backed by the Trump administration — on Nov. 10, one week after the election.
Senate Republicans are likely to replace Ginsburg with a conservative justice, changing the balance of the court for years. In previous challenges to the ACA, the court’s four liberal justices and Chief Justice John G. Roberts Jr. upheld the law.
The upcoming Supreme Court decision is the best chance that Trump and the Republican Party have had to fulfill their 10-year promise to repeal the ACA. But it could be a politically perilous victory because Republicans have yet to propose how they would stop millions of Americans from being thrown off their health-care plans if the law is repealed.
Congressional efforts to scrap the law in 2017 were hugely unpopular and brought the ACA’s popularity to record levels, making Trump and Republicans eager to avoid the topic altogether. Trump has privately told advisers that the push, in the beginning of his term, was a mistake.
Democrats were able to take back the House in 2018 on a message of protecting Americans’ access to health care, a strategy Biden and Senate Democrats are working to replicate this year.
Trump has tried to shift voters’ attention to his efforts to lower prescription drug prices — evident earlier this month when he signed two executive orders that the pharmaceutical industry had spent months trying to fend off. Still, experts say it remains highly unlikely that Trump will be able to implement policies that would affect voters before the Nov. 3 election.
“It is difficult to see any of these executive orders actually resulting in lower prices for consumers before the election,” said Chris Meekins, an analyst at financial firm Raymond James and a former official at the Department of Health and Human Services in the Trump administration. “The one area of health care voters trust Trump more than Biden is on lowering drug prices. The Trump campaign wants that to be the main issue for health-care voters — not something like the desire by the Trump administration to kill the ACA at the Supreme Court.”
Trump and White House officials have regularly said over the course of his presidency that a health care plan will be ready in “two weeks,” but have yet to deliver one.
Pressed this week whether such a plan actually exists, McEnany said it does without offering any specifics.
“The president will be laying out some additional health-care steps in the coming, I would say, two weeks,” she told reporters.
There has long been sharp dispute in the administration on what a health-care plan should look like. For several months late last year and early this year, former Domestic Policy Council director Joe Grogan convened regular meetings on health care with White House and agency officials to try to deliver on Trump’s long-promised plan. But no comprehensive plan ever came out of the meetings, which were derailed in February because of the pandemic response.
Meetings were regular, officials said, but too many people with too many different ideas were involved. Some aides wanted to spend more, while others wanted to spend less.
Trump does not have a deep understanding of the health-care system, according to current and former advisers, and the topic does not animate him like some others, such as trade or immigration policy.
White House Chief of Staff Mark Meadows has been a proponent of the prescription drug executive orders, but they have faced some resistance from some conservative members of the administration, who fear they are bad policy.
Currently working on health care initiatives is Theo Merkel, a National Economic Council aide, and staffers on the domestic policy council.
Trump’s most recent action on health care included two executive orders that would tie the prices U.S. consumers pay for some drugs to the lower ones paid in several other countries where governments have the power to set prices — a proposal that is anathema to most congressional Republicans. The administration first rolled out such a proposal that would affect some beneficiaries of Medicare Part B, which applies to drugs administered in doctor’s offices, about two years ago.
Trump expanded the breadth of the orders after growing angry in recent weeks at drug industry ads criticizing him in several swing states, current and former officials said, further driving his push to hit the industry. The second executive order unexpectedly applied the proposal to Medicare’s much larger Part D program, which is used for prescription drugs that patients take at home.
The order took several White House aides by surprise, highlighting the administration’s disorganized approach to health care. Many aides said it was not good policy from a conservative administration.
The proposals are fraught for several reasons, including because they may run afoul of the federal rulemaking process leaving them open to legal challenges.
The administration “talks a big game about drug pricing but doesn’t really do anything, which is what’s been happening for the last three years,” said Rachel Sachs, a law professor at Washington University at St. Louis.
Jeffrey Stein contributed to this report.