(CNN) - Staring down the near-certainty of running next year against a Democrat whose campaign will feature a sweeping vision for health care, President Donald Trump is rolling out the latest in a series of isolated health care policies that his team hopes will stack up to a plan he can run on.
That effort included an event Thursday in Florida, where Trump signed an executive order that underscores the benefits of preserving the status quo for Medicare, in particular Medicare Advantage plans offered by private insurers.
In a raucous campaign-style event, Trump claimed Medicare is "under siege" and that Democrats want to destroy it.
"These people on the other side, these people are crazy. They want to take it away, give you lousy health care," he said. "We are making your Medicare even better and we're not letting anyone, it will never be taken away from you."
Trump's piecemeal approach risks leaving him -- and, perhaps more crucially, vulnerable down-ballot Republicans -- without a coherent alternative in a race that could center largely on competing ideas for health care.
Nothing is likely to move on Capitol Hill as the White House and Congress focus on the impeachment inquiry engulfing Trump's presidency. However, even before the House began those proceedings, the administration had little in the way of an overarching design for health care.
The White House had planned to start pumping out health-related initiatives on a near-weekly basis over the summer, aides said, but mass shootings, travel and other events have scrambled those plans. Now, Trump's team has laid out a blueprint for a series of announcements through the fall, with upcoming rollouts planned for an Oval Office event and a speech on the road in the weeks ahead, a senior administration official said.
Aides and allies point to what the President has already done to lower drug prices, combat opioid addiction and offer lower-cost alternatives to the Affordable Care Act.
Lack of vision
Since the start of Trump's presidency, Republicans have struggled and failed to agree on a unified vision for health care to offer up as a substitute for the landmark health reform law they've vowed to destroy, though Trump has said Republicans will be "the party of health care." And Democrats, emboldened by the midterm gains they achieved largely by focusing on health care, are eager to contrast their ideas for universal health coverage with a Trump approach to health care that has felt piecemeal at best and nonexistent at worst.
What's more, the political calculations for Trump could change again later this year if an administration-backed lawsuit seeking to invalidate the Affordable Care Act succeeds. In that case, a patchwork quilt of proposals may not be enough to convince voters Trump and Republicans are prepared to fix a newly collapsed system.
Back-to-back mass shootings in El Paso, Texas, and Dayton, Ohio, in August forced the White House to postpone Trump's first planned trip to The Villages for a Medicare speech -- which aides said needed to be retooled before a redo of the policy announcement. Trump will deliver that speech Thursday at an official event with a distinctly political title: "Protecting Medicare from Socialist Destruction."
The order will highlight the benefits of Medicare Advantage, which the Trump administration has been heavily promoting since 2017. It aims to give insurers more flexibility to offer telehealth and supplemental benefits, as well as to make it easier for seniors to sign up for these plans, which are offered by private insurers and have been growing in popularity. It will also allow Medicare Advantage enrollees to receive cash rebates to push them to receive high-value care.
Notably, the administration wants to make sure that traditional Medicare "is not advantaged or promoted over Medicare Advantage," said Health and Human Services Secretary Alex Azar.
Administration officials have been touting Medicare Advantage, which has about 22 million enrollees or one-third of the total eligible for Medicare -- ahead of open enrollment starting in mid-October. Premiums are declining for 2020, while plan choices and benefits are increasing.
A senior official said Trump holds regular meetings with policy staff who brief him on the progress of his various health initiatives. The President asked his team to put together proposals he can tout on the campaign trail, and the senior administration official said Trump "raises health care on his own, every week."
Led by Joe Grogan, head of the Domestic Policy Council, top aides -- including Seema Verma, head of the Centers for Medicare and Medicaid Services, and Azar -- have worked to develop initiatives Trump could pursue through executive action. Some are still in the works heading into 2020. Others already announced include a controversial proposal to require hospitals post the prices they negotiate privately with insurers and one that seeks to transform kidney care for the more than 37 million Americans with kidney disease.
Prospects for a legislative solution to health care before the election are increasingly dim, however. Trump tried unsuccessfully in March to rally Republicans behind devising an Obamacare replacement that few lawmakers wanted to touch, given how costly the GOP's failure to pass one the first time was at the polls.
Some Republicans on Capitol Hill are optimistic that legislation addressing prescription drug pricing and "surprise" medical bills could see some movement before the election, given bipartisan support for addressing both problems. The President has urged Congress to address both issues, and the White House backs the policies behind both bills.
Lawmakers on both sides of the aisle have proposed legislation that would protect patients from getting hefty surprise bills if they unwittingly go to out-of-network doctors, particularly in emergency situations, but momentum has slowed amid heavy lobbying by both insurers and medical providers. While both chambers are also looking at drug price bills, that effort will likely be overshadowed by House Speaker Nancy Pelosi's recent proposal that calls for allowing the federal government to negotiate prices on some drugs -- a non-starter for Republicans.
Running on fundamental change, however, is not a strategy typically employed by sitting presidents, who do their best to persuade voters not to change the status quo.
"I can't think of the last time an incumbent President campaigned on a specific comprehensive overhaul of anything, much less health care," said Josh Holmes, former chief of staff to Senate Majority Leader Mitch McConnell. "I also think the new reality of health care politics is that anybody who has a plan that would disrupt coverage for current beneficiaries is playing with fire."
Many of the Democrats leading in the race to take on Trump next year have advocated either for a national health insurance system, such as "Medicare for All," or at a minimum for adding a government-backed public option to the Obamacare exchanges. The Trump campaign has seized on some of the most controversial elements of the progressive plans to bolster its overarching theme -- that Democrats are too far left -- but has otherwise done little in the way of promoting a health care alternative. Campaign advisers say they've heard little talk of positive messaging on the issue, despite how dominant the topic is on the other side of the aisle.
Trump's aides and allies remain confident their negative messaging on Democratic health care plans will resonate. Most are hopeful Democrats' shift toward what conservatives have described as a government takeover of health care will serve as a fruitful line of attack for Trump.
The shift was evident in a briefing call administration officials held with reporters ahead of the order. Grogan stressed that the President's vision for a healthier America goes beyond the Affordable Care Act, "which at the end of the day is not that many people."
He sought to contrast what steps Trump has taken with the Democratic candidates' push for Medicare for All, evoking a familiar attack that it would lead to Medicare for none.
"While President Trump has expanded health care choices and decreased costs, not to mention lowered prescription drug prices and increased transparency in the industry, 2020 Democrats want to go far beyond Obamacare," said Daniel Bucheli, a Trump campaign spokesman. "The 2020 Democrat field is embracing a government takeover of health care under the 'Medicare-for-all' banner that would eliminate private insurance, increase wait times, and decrease the quality of medical care."
While polls show that Americans want elected officials to lower health care costs, many are not ready to embrace a national health plan such as Medicare for All. Nearly 69% of the public favor a public option, which would compete with private plans, while 53% support Medicare for All, according to a September Kaiser Family Foundation poll.
Democratic candidates have repeatedly attacked Trump for hurting Americans' health care, and experts say the President is seeking to show what he has accomplished amid those accusations.
"The President is really focused on making his mark on health care," said Chiquita Brooks-LaSure, managing director at Manatt Health, a professional services firm, who worked in the Obama administration to implement the Affordable Care Act. "It's not surprising that, as the election is starting to ramp up, we're seeing a lot of efforts from the administration to show movement and progress on some of these priorities, given that repeal and replace really stalled."
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