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| Trump’s Secret Health Plan Is a Promise Voters Have Heard Before | |
| (about 2 hours later) | |
| WASHINGTON — When Donald J. Trump first ran for the White House, he promised to “come up with a great health plan,” one that would repeal the Affordable Care Act but replace it with something better while maintaining its biggest selling point: protecting people with pre-existing medical conditions. | WASHINGTON — When Donald J. Trump first ran for the White House, he promised to “come up with a great health plan,” one that would repeal the Affordable Care Act but replace it with something better while maintaining its biggest selling point: protecting people with pre-existing medical conditions. |
| Once elected, he swore he had a “wonderful plan” and would be “putting it in fairly soon.” | Once elected, he swore he had a “wonderful plan” and would be “putting it in fairly soon.” |
| On Tuesday night, President Trump was at it again, during a town-hall-style meeting broadcast on ABC, where he was schooled by Ellesia Blaque, an assistant professor of Africana and ethnic literatures at Kutztown University in Pennsylvania. She told him she had a congenital illness, demanded to know what he would do to keep “people like me who work hard” insured — and cut him off when he tried to interrupt her. | On Tuesday night, President Trump was at it again, during a town-hall-style meeting broadcast on ABC, where he was schooled by Ellesia Blaque, an assistant professor of Africana and ethnic literatures at Kutztown University in Pennsylvania. She told him she had a congenital illness, demanded to know what he would do to keep “people like me who work hard” insured — and cut him off when he tried to interrupt her. |
| “We’re going to be doing a health care plan very strongly, and protect people with pre-existing conditions,” Mr. Trump told her, adding, “I have it all ready, and it’s a much better plan for you.” | “We’re going to be doing a health care plan very strongly, and protect people with pre-existing conditions,” Mr. Trump told her, adding, “I have it all ready, and it’s a much better plan for you.” |
| After four years, during the worst health crisis in a century, the unkept promise may be catching up to Mr. Trump. There still does not seem to be any plan, because other than abolishing the Affordable Care Act — which requires insurers to cover pre-existing conditions and which the White House is asking the Supreme Court to overturn — the Republican Party cannot agree on one. | After four years, during the worst health crisis in a century, the unkept promise may be catching up to Mr. Trump. There still does not seem to be any plan, because other than abolishing the Affordable Care Act — which requires insurers to cover pre-existing conditions and which the White House is asking the Supreme Court to overturn — the Republican Party cannot agree on one. |
| And with tens of thousands of Americans losing their health insurance to a coronavirus-induced recession, fears of inadequate or nonexistent health care coverage have never been greater. | And with tens of thousands of Americans losing their health insurance to a coronavirus-induced recession, fears of inadequate or nonexistent health care coverage have never been greater. |
| “What the public wants to know is, ‘Where am I going to get health insurance and how much is it going to cost me?’” said James C. Capretta, a resident fellow at the American Enterprise Institute who advised President George W. Bush on health policy. | “What the public wants to know is, ‘Where am I going to get health insurance and how much is it going to cost me?’” said James C. Capretta, a resident fellow at the American Enterprise Institute who advised President George W. Bush on health policy. |
| Mr. Trump’s health care positions in 2016 separated him from the Republican pack. Yes, he would repeal the Affordable Care Act, he said, but its replacement would be even more generous. He would not cut Medicare, and he would allow the federal government to negotiate for much lower prescription drug costs, a key plank of the Democrats. | Mr. Trump’s health care positions in 2016 separated him from the Republican pack. Yes, he would repeal the Affordable Care Act, he said, but its replacement would be even more generous. He would not cut Medicare, and he would allow the federal government to negotiate for much lower prescription drug costs, a key plank of the Democrats. |
| But his claim on Tuesday that his administration finally had a secret health care plan “all ready” may be feeling shopworn to a weary electorate. An estimated 12 million workers are likely to lose their employer-based insurance in the pandemic, according to a report released Wednesday by Avalere, a nonpartisan health care consulting firm. While some may have gained coverage in other ways — through a spouse or Medicaid, for example — 35.7 million Americans lacked insurance during the second half of 2019, before the pandemic began, according to the National Center for Health Statistics. | But his claim on Tuesday that his administration finally had a secret health care plan “all ready” may be feeling shopworn to a weary electorate. An estimated 12 million workers are likely to lose their employer-based insurance in the pandemic, according to a report released Wednesday by Avalere, a nonpartisan health care consulting firm. While some may have gained coverage in other ways — through a spouse or Medicaid, for example — 35.7 million Americans lacked insurance during the second half of 2019, before the pandemic began, according to the National Center for Health Statistics. |
| And anxiety in the electorate is running high. | And anxiety in the electorate is running high. |
| “The projected collapse of American health insurance is well underway,” the nonpartisan advocacy group Families U.S.A. warned last month. | “The projected collapse of American health insurance is well underway,” the nonpartisan advocacy group Families U.S.A. warned last month. |
| The question of how to protect people with pre-existing medical conditions will be a central feature of the presidential and congressional campaigns in the next six weeks. The Supreme Court has scheduled oral arguments for Nov. 10 on a lawsuit filed by Republican attorneys general and backed by the Trump administration that seeks to overturn the Affordable Care Act. Should the court invalidate the law, more than 20 million Americans stand to lose coverage. | The question of how to protect people with pre-existing medical conditions will be a central feature of the presidential and congressional campaigns in the next six weeks. The Supreme Court has scheduled oral arguments for Nov. 10 on a lawsuit filed by Republican attorneys general and backed by the Trump administration that seeks to overturn the Affordable Care Act. Should the court invalidate the law, more than 20 million Americans stand to lose coverage. |
| And the health effects of the coronavirus will only make things worse, said Chris Jennings, a Democratic health policy expert who is advising the party’s presidential nominee, Joseph R. Biden Jr. | And the health effects of the coronavirus will only make things worse, said Chris Jennings, a Democratic health policy expert who is advising the party’s presidential nominee, Joseph R. Biden Jr. |
| “If you’re going to invalidate the Affordable Care Act, that would mean that the long-term effects of Covid-19 would become a pre-existing condition,” he said. | “If you’re going to invalidate the Affordable Care Act, that would mean that the long-term effects of Covid-19 would become a pre-existing condition,” he said. |
| Though the Affordable Care Act already blocks insurers from rejecting customers with pre-existing conditions, the president said last month that he was considering an executive order extending that requirement, though it is unclear if he has the authority to do so. | Though the Affordable Care Act already blocks insurers from rejecting customers with pre-existing conditions, the president said last month that he was considering an executive order extending that requirement, though it is unclear if he has the authority to do so. |
| At the White House on Wednesday, Mark Meadows, the chief of staff, told reporters that Mr. Trump’s health plan would be “an executive action with a legislative component,” adding: “It’s ready. We’ve been making a number of tweaks and modifications.” | At the White House on Wednesday, Mark Meadows, the chief of staff, told reporters that Mr. Trump’s health plan would be “an executive action with a legislative component,” adding: “It’s ready. We’ve been making a number of tweaks and modifications.” |
| Such assurances may not get Mr. Trump far. After Mr. Trump’s exchange with Dr. Blaque went viral on Tuesday, Democrats did not waste the moment. | Such assurances may not get Mr. Trump far. After Mr. Trump’s exchange with Dr. Blaque went viral on Tuesday, Democrats did not waste the moment. |
| “He just keeps promising his magic healthcare plan is right around the corner. The truth: he has no plan,” Senator Chuck Schumer of New York, the Democratic leader, wrote on Twitter, posting a video that ran through the president’s many unfulfilled promises. | “He just keeps promising his magic healthcare plan is right around the corner. The truth: he has no plan,” Senator Chuck Schumer of New York, the Democratic leader, wrote on Twitter, posting a video that ran through the president’s many unfulfilled promises. |
| Joel White, a Republican strategist with expertise in health policy, said Congress, not the administration, was at fault for refusing to work with Mr. Trump. | Joel White, a Republican strategist with expertise in health policy, said Congress, not the administration, was at fault for refusing to work with Mr. Trump. |
| “These are the core issues that face us as a country — cost and quality and access,” he said, “and you can’t just get that done through one guy or one administration. It needs bipartisan support in Congress and the administration, coming together around a workable idea.” | “These are the core issues that face us as a country — cost and quality and access,” he said, “and you can’t just get that done through one guy or one administration. It needs bipartisan support in Congress and the administration, coming together around a workable idea.” |
| But the White House has not made it easy. When House Republicans finally passed a bill to repeal and replace the Affordable Care Act in 2017, Mr. Trump first celebrated, and then called it “mean.” With little guidance from the president and no plan, the Senate failed to pass anything. | But the White House has not made it easy. When House Republicans finally passed a bill to repeal and replace the Affordable Care Act in 2017, Mr. Trump first celebrated, and then called it “mean.” With little guidance from the president and no plan, the Senate failed to pass anything. |
| That is not to say that Mr. Trump has done nothing to address Americans’ health care concerns. | That is not to say that Mr. Trump has done nothing to address Americans’ health care concerns. |
| But rather than expand coverage for people with pre-existing conditions, he has weakened it. One executive order in 2018 increased the sale of “short-term” insurance policies — good for up to three years — that do not have to cover pre-existing conditions. Another, that same year, made it easier for small businesses to band together and offer plans that escape some of the requirements of the Affordable Care Act, such as mental health coverage and maternity care, though that rule barred insurers from discriminating based on any “health factor.” | But rather than expand coverage for people with pre-existing conditions, he has weakened it. One executive order in 2018 increased the sale of “short-term” insurance policies — good for up to three years — that do not have to cover pre-existing conditions. Another, that same year, made it easier for small businesses to band together and offer plans that escape some of the requirements of the Affordable Care Act, such as mental health coverage and maternity care, though that rule barred insurers from discriminating based on any “health factor.” |
| Over the weekend, he issued an executive order aimed at tying the price of Medicare prescription drugs to those paid in Europe and other developed nations. Experts say the order will almost certainly be challenged in court. Many Republicans oppose it, considering it a form of socialism. Mr. White says that while the move “may be smart politics, it’s bad policy” and violates the Constitution’s separation of powers clause because Congress has already passed laws governing Medicare. And in any event, it cannot go into effect during the president’s first term. | Over the weekend, he issued an executive order aimed at tying the price of Medicare prescription drugs to those paid in Europe and other developed nations. Experts say the order will almost certainly be challenged in court. Many Republicans oppose it, considering it a form of socialism. Mr. White says that while the move “may be smart politics, it’s bad policy” and violates the Constitution’s separation of powers clause because Congress has already passed laws governing Medicare. And in any event, it cannot go into effect during the president’s first term. |
| Mr. Trump’s pronouncements on health care have tended to adhere to a pattern: first a superlative (“great,” “terrific,” “fantastic”) followed by a vague deadline. To say they are light on details would be an understatement. | Mr. Trump’s pronouncements on health care have tended to adhere to a pattern: first a superlative (“great,” “terrific,” “fantastic”) followed by a vague deadline. To say they are light on details would be an understatement. |
| “There’s a great plan, and this will be great health care,” he declared three months into his presidency. “It’s uh, evolving.” | “There’s a great plan, and this will be great health care,” he declared three months into his presidency. “It’s uh, evolving.” |
| In May 2018, he boasted about “the plans we have coming out, literally over the next four weeks.” Twenty-four weeks later — having announced nothing — he said, “We are working many plans for health care.” | In May 2018, he boasted about “the plans we have coming out, literally over the next four weeks.” Twenty-four weeks later — having announced nothing — he said, “We are working many plans for health care.” |
| Last year, the president hedged on the timing of a health care plan, saying: “When the plan comes out, which we’ll be showing you at the appropriate time, it’s much better than Obamacare. So when the plan comes out, you’ll see it.” | Last year, the president hedged on the timing of a health care plan, saying: “When the plan comes out, which we’ll be showing you at the appropriate time, it’s much better than Obamacare. So when the plan comes out, you’ll see it.” |
| More than two months later, in June 2019, Mr. Trump told George Stephanopoulos of ABC that “we already have the concept of the plan” and that he would “be announcing that in about two months — maybe less.” | More than two months later, in June 2019, Mr. Trump told George Stephanopoulos of ABC that “we already have the concept of the plan” and that he would “be announcing that in about two months — maybe less.” |
| That is essentially what he again told Mr. Stephanopoulos on Tuesday night, as Dr. Blaque firmly stood her ground. She told him she was born with sarcoidosis, an inflammatory disease that attacks multiple organs, “and from the day I was born, I was considered uninsurable.” When she asked if the Affordable Care Act’s pre-existing conditions provision should “be removed,” Mr. Trump tried to answer. | That is essentially what he again told Mr. Stephanopoulos on Tuesday night, as Dr. Blaque firmly stood her ground. She told him she was born with sarcoidosis, an inflammatory disease that attacks multiple organs, “and from the day I was born, I was considered uninsurable.” When she asked if the Affordable Care Act’s pre-existing conditions provision should “be removed,” Mr. Trump tried to answer. |
| “Please stop and let me finish my question, sir,” Dr. Blaque cut in. | “Please stop and let me finish my question, sir,” Dr. Blaque cut in. |
| Mr. Trump then repeated that he would not “hurt pre-existing conditions” and turned the conversation to Democrats and President Barack Obama: “He said, you can have your doctor. You can have your plan. And that turned out to be a lie, and he said it 28 different times at least.” | Mr. Trump then repeated that he would not “hurt pre-existing conditions” and turned the conversation to Democrats and President Barack Obama: “He said, you can have your doctor. You can have your plan. And that turned out to be a lie, and he said it 28 different times at least.” |
| The exchange went viral. The sight of a Black academic with a Ph.D. confronting the president thrilled liberal Twitter. But the Fox News host Laura Ingraham, a staunch Trump backer, said he had been “ambushed” in the town hall event and called the forum a “total set up.” | The exchange went viral. The sight of a Black academic with a Ph.D. confronting the president thrilled liberal Twitter. But the Fox News host Laura Ingraham, a staunch Trump backer, said he had been “ambushed” in the town hall event and called the forum a “total set up.” |
| In an interview Wednesday evening, Dr. Blaque, 57, said that while she relied on Medicaid as a younger woman, she was now insured by the State of Pennsylvania, her employer. She has long been a Trump critic, but had been undecided about whether to vote at all because she has not seen improvements in the lives of Black people under either party. | In an interview Wednesday evening, Dr. Blaque, 57, said that while she relied on Medicaid as a younger woman, she was now insured by the State of Pennsylvania, her employer. She has long been a Trump critic, but had been undecided about whether to vote at all because she has not seen improvements in the lives of Black people under either party. |
| Dr. Blaque said she “broke down and cried” after the event and returned home determined to cast her ballot for Mr. Biden. | Dr. Blaque said she “broke down and cried” after the event and returned home determined to cast her ballot for Mr. Biden. |
| Mr. Trump’s answer, she said, did not satisfy her. | Mr. Trump’s answer, she said, did not satisfy her. |
| “He used one term from my question and then went on a rant about Obamacare, his typical redundant rant about how it’s a disaster, it’s too expensive, it’s too this and it’s too that,” she said. “So he never answered my question, and I just stood there like a fool and felt like soot on the bottom of his shoe.” | “He used one term from my question and then went on a rant about Obamacare, his typical redundant rant about how it’s a disaster, it’s too expensive, it’s too this and it’s too that,” she said. “So he never answered my question, and I just stood there like a fool and felt like soot on the bottom of his shoe.” |
| Michael D. Shear contributed reporting. | Michael D. Shear contributed reporting. |