Toluse
Olorunnipa and Amy Goldstein Oct.
3, 2019 at 8:12 a.m. CDT
THE VILLAGES, Fla. —
President Trump blasted his potential Democratic presidential rivals in a
highly political speech here Thursday, telling a group of senior citizens
that “maniac” Democrats would rip away their health care, decimate their
retirement accounts and prioritize undocumented immigrants over U.S. citizens.
“All of the Democrat
plans would devastate our health care system,” Trump said during a visit
to The Villages, where he signed an executive order designed to expand the
private-sector version of Medicare that Republicans favor.
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.
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