Trump pro­mot­ing health care ‘vi­sion’ in swing state NC


WASH­ING­TON (AP) — Pres­i­dent Don­ald Trump plans to sign an ex­ec­u­tive or­der on pre­ex­ist­ing med­i­cal con­di­tions Thurs­day, amid a global pan­demic and grow­ing un­cer­tainty about the fu­ture of pro­tec­tions guar­an­teed by the Obama-era health law his ad­min­is­tra­tion is still try­ing to over­turn.

In a visit to swing state North Carolina, the pres­i­dent will sketch out what aides call a “vi­sion” for qual­ity health care at af­ford­able prices, with lower pre­scrip­tion drug costs, more con­sumer choice and greater trans­parency. Aside from pro­tect­ing peo­ple with pre­ex­ist­ing con­di­tions, he’ll sign another ex­ec­u­tive or­der to try to end sur­prise med­i­cal bills.

But while the Trump ad­min­is­tra­tion has made some progress on its health care goals, the sweep­ing changes he promised as a can­di­date in 2016 have eluded him. 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.

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.”

Bill-signing cer­e­monies on pre­scrip­tion drugs and med­i­cal charges were once seen as achiev­able goals for Trump be­fore the elec­tion. No longer.

Health and Hu­man Ser vices Sec­re­tar y Alex Azar said one of Trump’s ex­ec­u­tive or­ders 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 ad­min­is­tra­tion has been un­able to forge a com­pro­mise that steers around de­ter­mined lob­by­ing by a slew of in­ter­est groups af­fected.

Health care con­sul­tant and commentato­r Robert Laszewski said he’s par­tic­u­larly puz­zled by Trump’s or­der on pre­ex­ist­ing con­di­tions.

“For more than twenty years we de­bated ways to pro­tect peo­ple from pre­ex­ist­ing con­di­tions lim­i­ta­tions,” said Laszewski. For­mer Pres­i­dent Barack Obama’s land­mark leg­is­la­tion fi­nally es­tab­lished pro­tec­tions, he con­tin­ued.

“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?”

Health care rep­re­sents a ma­jor piece of un­fin­ished busi­ness for Trump.

Pre­scrip­tion drug in­fla­tion has sta­bi­lized when gener­ics are fac­tored in, but the dra­matic price roll­backs he once teased have not ma­te­ri­al­ized.

And the num­ber of unin­sured Amer­i­cans had started edg­ing up 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. The 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. For­mer Vice Pres­i­dent Joe Bi­den has said he wants to ex­pand the Obama law, and add a new pub­lic pro­gram as an op­tion.

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 was un­veil­ing his agenda in Char­lotte, ahead of a two-day swing to sev­eral bat­tle­ground states, in­clud­ing the all-im­por­tant Florida. There, he will hold a rally in Jack­sonville and later court Latino vot­ers at a round­table in Do­ral on Friday. Then he’ll fly to At­lanta, Ge­or­gia, to de­liver a speech on black eco­nomic em­pow­er­ment. He’ll end the day with another rally in New­port News, Vir­ginia.

The scram­ble to de­liver con­crete ac­com­plish­ments on health care comes as Trump is chaf­ing un­der crit­i­cism that he never cre­ated a Repub­li­can al­ter­na­tive to Oba­macare with 40 days to go be­fore the elec­tion.

Trump has re­peat­edly in­sisted his plan is com­ing.

“We’re signing a health care plan within two weeks,” Trump claimed in a July 19 interview. He told re­porters in Au­gust that it would be in­tro­duced “hope­fully, prior to the end of the month.”

Dur­ing a tele­vised town hall ear­lier this month in Penn­syl­va­nia, Trump again in­sisted he had a plan — but re­fused to share its de­tails or ex­plain why he’d waited more than 3 1/2 years to un­veil it.

“I have it all ready, and it’s a much bet­ter plan for you,” he said.


Pres­i­dent Don­ald Trump de­liv­ers re­marks on health­care at Char­lotte Dou­glas In­ter­na­tional Air­port, Thurs­day, Sept. 24, 2020, in Char­lotte, N.C. (AP Photo/Evan Vucci)

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