The Republican pollster Gene Ulm told me that easing those doubts about his handling of health-care issues is crucial for Trump’s reelection prospects. “No president would be in the game without people believing the economy is getting better than it was,” Ulm said. But for “the next cluster of voters” beyond those immediately drawn to him, “it’s the cost of health care, prescription drugs, and the whole cluster of premiums, co-pays, [and] out-of-pocket expenses” that matter most.
And on those fronts, the best measure of Trump’s anxiety was his mendacity in describing his record on Tuesday night.
Trump, not for the first time, flatly lied about his efforts to revoke the ACA’s protections for those with preexisting conditions. Not only is his administration currently in federal court seeking to invalidate the entire ACA, but in 2017 he endorsed Republican proposals in Congress to effectively erase those protections by allowing insurance companies to charge people who have greater health needs more. “It’s notable that the president feels the need to say he’s protecting people with preexisting conditions,” Levitt says, “but the facts just don’t back that up.”
On prescription drugs, the gap between Trump’s words and actions isn’t quite as stark. Kenneth Thorpe, a health economist at Emory University who served in President Bill Clinton’s administration, told me Trump was correct when he said that federal data showed a decline in overall prescription-drug costs last year. The problem is that prices for some high-profile drugs (such as insulin) are still rising, and the overall cost has stabilized at a level that is unaffordable for many Americans. An added concern, Thorpe said, is that more insurance plans are including prescription drugs in their total deductibles—meaning that patients must spend more out of pocket until they reach that threshold. “What people care about is what they pay, not what the overall cost of the medication is,” he told me.
Trump has talked about confronting prescription-drug costs since his 2016 campaign, when he embraced the long-standing Democratic idea of allowing Medicare to negotiate for lower prices with drug companies. But amid opposition from the pharmaceutical industry, and Republicans leery of an aggressive federal role in health care, he renounced that proposal.
Democrats, meanwhile, have picked up the mantle, putting it at the center of the H.R. 3 legislation that the House passed in December. (That was the bill House Democrats were alluding to when a group of them rose to chant “H.R. 3” during Trump’s State of the Union address.)
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The GOP-led Senate hasn’t taken up the bill, but the public’s intense focus on drug costs makes it possible that Trump will offer some proposals on the issue before Election Day. That’s why it’s so essential for Democrats to more sharply define the terms of debate right now. “It is really important for Democrats to set the bar on the drug-pricing issue at whether someone supports or opposes giving Medicare the power to negotiate,” Garin warns.