Census figures this week showed 2 million more people were uninsured in 2018 despite a strong economy, the first annual increase in the uninsurance rate since the financial collapse nearly a decade ago and before Obamacare began.
Yet more White House-driven health care policies are coming, and several current and former administration officials described a dual-track effort going into 2020. Keep attacking Obamacare for the base, while carefully constructing a more comforting health care narrative for the center.
The dramatic vaping move was the latest example. Trump on Wednesday abruptly summoned reporters to the Oval Office and announced a sweeping ban on flavored e-cigarettes, amid a growing epidemic of teen vaping. His administration is also preparing to unveil additional efforts this fall on opioids, rural health and health care price transparency, four officials told POLITICO. That may not divert all the attention from the president’s often inflammatory tweets and gibes, but it creates a parallel channel of conversation.
Republicans also believe the Democratic tilt left on health care, particularly the Sen. Bernie Sanders-inspired promises of free “Medicare for All,” will play right into Trump’s hand.
“We don’t have the grandiose leftist, socialist dreams of the Democratic Party. All those fantasy programs would bankrupt the country,” said a senior administration official who’s active on the health care front. By working on specific diseases and health issues, “we’re really building a very strong narrative around this president and this administration.”
Meanwhile, White House officials maintain that the media and health analysts are paying undue attention to the Affordable Care Act — even though Trump himself keeps attacking the law, including lashing out at his late nemesis Sen. John McCain for blocking Obamacare repeal two years ago.
“The frame of reference is all around the ACA — but the individual market is a tiny slice of the full health care marketplace,” the senior official said.
Obamacare — which includes Medicaid expansion, patient protections and health system reforms that affect far many more people than the roughly 10 million people in the law’s individual market — could again dominate the election season. A federal appeals court could strike down part or all of the health care law this fall, as Trump’s Department of Justice has urged it to do.
That could mean the Supreme Court again takes up an Obamacare case during an election year. Trump has repeatedly vowed to have an Obamacare replacement plan ready — though several officials said that won’t happen this month, as Trump had suggested.
Polling analysts told POLITICO that Trump faces an uphill battle on winning swing voters over to his health care agenda.
“Recent polling data has found that health care is not an issue that seems to be working for President Trump for both the overall public and a crucial group of swing voters in the upcoming 2020 election,” said Ashley Kirzinger of Kaiser Family Foundation.
According to Kaiser’s polls, 50 percent of swing voters said that health care makes them more likely to vote for the Democratic candidate in 2020 compared with just 32 percent who said they were more likely to support Trump. Democrats’ 18-point advantage on health care in Kaiser’s polls is ahead of other hot-button issues like immigration, trade and gun policy, where Democrats hold only a narrow advantage or trail the president.
Trump also has repeatedly stepped on his own message with off-script comments that have gone viral and overshadowed the actual initiatives he was announcing. The president in July proclaimed that kidneys have “a very special place in the heart,” contributing to media coverage that Trump publicly grumbled about later that week. His vaping remarks, in which he seemed to describe his teenage son as the first lady’s child, not the first couple’s, didn’t go unnoticed, either. He interjected that 13-year-old Barron was their child “together.”
Trump still has more than a year to polish his health care record before the 2020 election, and senior officials have repeatedly met with Democrats in search of an elusive deal to lower drug prices.
The president already has celebrated what he said was the first decline in U.S. drug prices in around 50 years, although his claim has been largely debunked by fact checkers because it draws on incomplete data that leaves out some of the priciest medications. A forthcoming plan from House Speaker Nancy Pelosi could pressure Trump to either plow ahead with, or retreat from, a campaign pledge to support direct negotiations with drugmakers, a longtime Democratic priority that Republicans have fiercely opposed.
Administration officials also have vowed to combat surprise medical bills, a priority broadly opposed by the health care industry but being considered by multiple congressional committees.
But as the election approaches, Democrats are under some pressure to block some of Trump’s health care initiatives, or at least counter with their own, rather than help burnish his image.
“We’re not enamored with the idea that Democrats should be negotiating with him on prescription drugs,” Woodhouse said. “Can you trust him not to pull the rug out from under you at the end of the day?”