President
Trump gave a speech and signed an executive order on health care Thursday,
casting the "Medicare for All" proposals from his Democratic rivals
as harmful to seniors.
His
speech, which had been billed as a policy discussion, had the tone of a
campaign rally. Trump spoke from The Villages, a huge retirement community in
Florida outside Orlando, a deep-red part
of a key swing state.
His
speech was marked by cheers, standing ovations and intermittent chants of
"four more years" by an audience of mostly seniors.
Trump
spoke extensively about his administration's health care achievements and
goals, as well as the health policy proposals of Democratic presidential
candidates, which he characterized as socialism.
The
executive order he signed had previously been titled "Protecting Medicare
From Socialist Destruction" on the White House schedule but has since been
renamed "Protecting and Improving Medicare for Our Nation's Seniors."
"In
my campaign for president, I made you a sacred pledge that I would strengthen,
protect and defend Medicare for all of our senior citizens," Trump told
the audience. "Today I'll sign a very historic executive order that does
exactly that — we are making your Medicare even better, and ... it will never
be taken away from you. We're not letting anyone get close."
The
order is intended, in part, to shore up Medicare Advantage, an alternative to
traditional Medicare that's administered by private insurers. That program has
been growing in popularity,
and this year, premiums are down
and plan choices are up.
The executive order
directs the Department of Health and Human Services to develop proposals to
improve several aspects of Medicare, including expanding plan options for
seniors, encouraging innovative plan designs and payment models and improving
the enrollment process to make it easier for seniors to choose plans.
The
order includes a grab bag of proposals, including removing regulations
"that create inefficiencies or otherwise undermine patient outcomes";
combating waste, fraud and abuse in the program; and streamlining access to
"innovative products" such as new treatments and medical devices.
The
president outlined very little specific policy in his speech in Florida.
Instead, he attacked Democratic rivals and portrayed their proposals as
threatening to seniors.
"Leading
Democrats have pledged to give free health care to illegal immigrants,"
Trump said, referring to a moment from the first Democratic presidential debate
in which all the candidates onstage raised their hands in support of health care for
undocumented migrants. "I will never allow these politicians to
steal your health care and give it away to illegal aliens."
Health
care is a major issue for voters and is one that has dominated the presidential
campaign on the Democratic side. In the most recent debate, candidates spent
the first hour hashing out and defending various health care proposals and
visions. The major divide is between a Medicare for All system — supported by
only two candidates, Sen. Bernie Sanders and Sen. Elizabeth Warren — and a
public option supported by the rest of the field.
Trump
brushed those distinctions aside. "Every major Democrat in Washington has
backed a massive government health care takeover that would totally obliterate
Medicare," he said. "These Democratic policy proposals ... may go by
different names, whether it's single payer or the so-called public option, but
they're all based on the totally same terrible idea: They want to raid Medicare
to fund a thing called socialism."
Toward
the end of the speech, he highlighted efforts that his administration has made
to lower drug prices and then suggested that drugmakers were helping with the
impeachment inquiry in the House of Representatives. "They're very
powerful," Trump said. "I wouldn't be surprised if ... it was from
some of these industries, like pharmaceuticals, that we take on."
Drawing
battle lines through Medicare may be a savvy campaign move on Trump's part.
Medicare
is extremely popular. People who have it like it, and people who don't have it
think it's a good thing too. A recent poll by
the Kaiser Family Foundation found that more than 8 in 10 Democrats,
independents and Republicans think of Medicare favorably.
Trump
came into office promising to dismantle the Affordable Care Act and replace it
with something better. Those efforts failed, and the administration has
struggled to get substantive policy changes on health care.
On
Thursday, administration officials emphasized a number of its recent health
care policy moves.
"[Trump's]
vision for a healthier America is much wider than a narrow focus on the
Affordable Care Act," said Joe Grogan, director of the White House's
Domestic Policy Council, at a press briefing earlier.
The
secretary of health and human services, Alex Azar, said at that briefing that
this was "the most comprehensive vision for health care that I can recall
any president putting forth."
He
highlighted a range of actions that the administration has taken, from a push
on price transparency
in health care, to a plan to end the HIV epidemic,
to more generic-drug approvals.
Azar described these things as part of a framework to make health care more
affordable, deliver better value and tackle "impassable health
challenges."
Without
a big health care reform bill, the administration is positioning itself as a
protector of what exists now — particularly Medicare.
"Today's
executive order particularly reflects the importance the president places on
protecting what worked in our system and fixing what's broken," Azar said.
"Sixty million Americans are on traditional Medicare or Medicare
Advantage. They like what they have, so the president is going to protect
it."
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