President Donald Trump’s recent promise of an executive order on health care makes no sense as policy.
He has said the order, which he first announced during a press conference at his New Jersey golf club last weekend, would protect people with pre-existing conditions. But the Affordable Care Act already prohibits insurers from denying coverage or charging higher premiums based on a person’s medical status. An executive order wouldn’t strengthen that commitment.
But Trump’s vow makes a ton of sense as politics.
He and his Republican allies have spent the last few years trying to take away preexisting condition protections, through legislation to repeal “Obamacare” and a series of executive actions to undermine the law. More recently, Trump has backed a lawsuit urging the Supreme Court to wipe out the Affordable Care Act ― and with it the preexisting condition proviso ― because of a supposed constitutional flaw in the law.
None of this has been popular with voters, which is why Trump is trying desperately to make them forget that record. “Preexisting conditions will be taken care of 100% by Republicans and the Republican party,” he said just a few days ago.
Democrats, meanwhile, are trying just as hard to make sure the voters remember what Trump and his allies actually tried to do on health care. Part of that effort will be a focus on the issue during the Democratic National Convention that begins ― virtually ― on Monday.
All of this adds to the evidence that the politics of the issue have changed, turning a one-time strength for Republicans into a serious liability. And it could have a big impact come November.
The Democratic Spotlight On Health Care
The list of Democratic convention speakers this week includes several people who depend on the Affordable Care Act for insurance. One is Jeff Jeans, an Arizona small business owner who became famous in 2017 for confronting then-House Speaker Paul Ryan (R-Wis.) during a CNN town hall session.
As Jeans explained that night, he had been a lifelong conservative and one of Obamacare’s biggest critics until he got cancer, giving him a preexisting condition that required expensive treatment ― and insurance. “Thanks to the Affordable Care Act, I’m standing here today alive,” he told Ryan.
Another of the speakers is a pastor and cancer survivor, the other a retired educator with a chronic autoimmune disorder. Both will talk about how much the law’s protections for preexisting conditions have meant to them ― a theme Joe Biden almost assuredly will emphasize in his speech accepting the Democratic Party’s nomination for president.
A fourth, newly announced speaker on health care is activist Ady Barkan. Barkan, who suffers from amyotrophic lateral sclerosis ― commonly known as Lou Gehrig’s disease ― endorsed Sen. Elizabeth Warren of Massachusetts in this year’s Democratic presidential race and is perhaps best known as an advocate of Medicare for All. Biden has pointedly declined to support that idea, which envisions a single government plan providing insurance for all Americans. Instead, the soon-to-be official nominee has called for creating a public program that would be open to all but purely voluntary.
The debate between Medicare for All skeptics like Biden and its advocates, especially Sen. Bernie Sanders (I-Vt.), was part of a broader dispute that pitted progressives against moderates, and upstarts versus the establishment, in the 2020 Democratic primaries. It is likely to be a source of even more friction in the future ― especially if Biden wins and the Democrats win control of both chambers of Congress, offering the first real chance in a decade to pass meaningful progressive laws.
But the general election comes first. And with voters facing a choice between a Democrat (Biden) whose agenda would provide coverage to millions and a Republican (Trump) whose agenda ― despite his misleading rhetoric ― would take coverage from millions, the different factions seem willing to play up what they have in common. And that’s a defense of Obamacare and belief in the principle of universal coverage, notwithstanding their differences over how to get there.
When it comes to those broad beliefs, all of the available signs suggest the public is on Democrats’ side.
What The Polls Say About Health Care
Protecting people with preexisting conditions has always been among the Affordable Care Act’s most popular provisions, perhaps because it seems like such a basic principle of fairness: Few people argue that somebody should have to pay higher insurance premiums, or lose access to it altogether, simply because they have a congenital condition, survived cancer or are living with the lingering effects of injury.
But enthusiasm for the Affordable Care Act as a whole has never matched support for the preexisting condition protections and the program’s other popular features. In fact, for much of the decade since Obama signed the law, opponents have slightly outnumbered supporters, according to the Henry J. Kaiser Family Foundation’s monthly tracking surveys.
This was especially true in 2016, on the eve of the last presidential election, following a series of reports about rising premiums and insurers withdrawing from markets because of big financial losses. Although it’s difficult to know what role health care played in the vote’s outcome, promises of repeal figured prominently into Trumps’ campaign rhetoric.
But public opinion shifted once Trump’s victory and Republican control of Congress made repeal a real possibility. For the first time, the debate shifted to the parts of the law voters valued and what Republicans were proposing as an alternative. Nearly every plan the GOP advanced promised to weaken or eliminate altogether Obamacare’s guardrails for people, regardless of their medical status.
The backlash to GOP proposals was a big reason repeal legislation failed to pass in 2017. And in 2018, Republicans lost their House majority. The thrust of the health care debate threatens to prove a similar political drag for Republicans in 2020, especially with the COVID-19 outbreak making the issue such an important one.
That probably explains why Republican candidates around the country are doing precisely what Trump has been doing: Lying about their records.
In Georgia, Sen. David Perdue says in a new advertisement that, “Health insurance should always cover preexisting conditions. For anyone. Period.” But in 2017, Perdue voted “yes” on all three Obamacare repeal bills that came to the Senate floor. And just last month, he told a local television station he supports the Trump-backed Supreme Court lawsuit.
In Arizona, GOP Sen. Martha McSally has made multiple statements along the same lines, including a boast in a campaign ad that, “I will always protect those with preexisting conditions ― always.” This is the same McSally who, as a House member in 2017, famously rallied her colleagues to vote yes on repeal by telling the caucus it was time to get this “fucking thing” done.
McSally, who was also running for the Senate back then, spent the next year denying she’d tried to gut preexisting condition protections. Voters saw through the lie, with a little help from the media, and that’s one reason she ended up losing her 2018 race. The state’s governor ended up appointing her to fill the state’s other seat, which was vacant, and she’s now running in a special election for the remaining two years on the term.
Polls show McSally trailing her Democratic opponent, former astronaut Mark Kelly, who has been pounding away at her record, just as polls show Trump trailing Biden in the White House race.
The record on health care and preexisting conditions is just one reason for the GOP’s political problems and, obviously, a lot can happen between now and November. But 10 years of fighting Obamacare is bound to register with the voters, especially if Democrats have something to say about it.