This was a busy week in politics that offered policy wonks clearer insights into issues that are likely to play a role in the 2020 presidential election—and unsurprisingly, health care is one of them.
We kicked off the week with the Iowa Democratic caucuses, and while we're still awaiting final results, entrance and exit polls conducted Monday showed health care was the most important issue for caucusgoers.
President Trump then stepped into the spotlight on Tuesday to deliver his State of the Union address, during which he highlighted five key health care issues and his administration's efforts to address them. But one thing was noticeably absent from Trump's speech: a formal health reform plan that could compete with those being offered by Democrats.
Trump last June said his administration within two months was going to release a plan "to produce phenomenal health care." However, the Washington Post's Paige Winfield Cunningham in September reported that congressional aides and a former White House staffer said they'd been told that the administration was moving away from crafting a health reform plan.
Instead, Trump has largely focused on enacting new policies and regulations to make incremental changes to the Affordable Care Act (ACA) and health care system.
And Trump's approach doesn't appear to be winning over voters: Various media outlets last month reported that Trump was briefed on polling showing voters trust Democrats more than Republicans when it comes to health care issues, and Trump reportedly let HHS Secretary Alex Azar know how frustrated he was about the findings.
But based on Trump's State of the Union speech, his administration appears to be sticking to its current approach—and experts are divided on whether that's the best plan going into the 2020 presidential election.
Could Trump's decision not to release a health plan hurt his re-election chances?
Some industry observers argue that Trump should release a health reform plan, and that failing to do so could hurt his chances of re-election—and diminish his health care legacy.
For instance, John Solomon, an investigative columnist and executive vice president for video at The Hill, in an opinion piece argued that Trump and Republicans "must be on offense to win the battle of health care ideas" in the 2020 election. He writes, "Trump and congressional Republicans must forge a populist free-market plan to counter the left's simplistic 'Medicare for All' mantra."
And Axios' Sam Baker noted that, if Trump isn't re-elected, he'll end his term with little to show for his "big ambitions on health care." Baker argued that, aside from the administration's moves to increase price transparency in health care, many of Trump's major health care efforts—such as approving Medicaid work requirements, expanding access to short-term health plans, and his most recent block grant proposal—could be stopped or overturned by Democratic presidents in the future, if they're not first overturned by courts.
There's also the question of whether the Trump administration will oversee the downfall of the ACA. The Department of Justice is not defending the ACA in court, and instead has filed briefs arguing the entire law should be struck down along with its individual mandate. And several health care observers (including the Daily Briefing's editorial team) have noted the widespread confusion that would accompany any ruling striking down the ACA, which could spell trouble for the Trump administration if officials don't already have a replacement plan in place.
But some say Trump doesn't need a comprehensive plan
However, others argue that Trump doesn't need to release a comprehensive plan—because voters already know his health care priorities.
In regards to the ACA, Azar last month said "there's not really a need" for the administration to release an ACA replacement plan in the near term because there's not likely to be a final ruling in the lawsuit any time soon.
In fact, the American Enterprise Institute's Joe Antos told Kaiser Health News' Julie Appleby that Trump and Republicans might be better off focusing on derailing Democrats' health reform proposals ahead of the elections than putting out a plan of their own.
Appleby explained that "[a] comprehensive plan could be a lightning rod for [Trump's] opponents," and could cause him to lose some of the praise he's won "from both conservatives and liberals for such things as his proposals to require hospitals to post their actual, negotiated prices, and some strategies to lower drug prices."
Similarly, Politico's Dan Diamond and Joanne Kenen wrote that Trump throughout 2019 built a "disease-by-disease [health care] agenda" that has been "aimed at suburban voters who may be put off by the Democrats' left turn on health care." For example, the Trump administration has taken steps to address youth e-cigarette use, combat HIV transmission, end the U.S. opioid epidemic, overhaul kidney care, and tackle childhood cancer. Some of those efforts "have received bipartisan applause and could help millions of people," Diamond wrote. And it's likely no coincidence that those are health care issues that Trump spotlighted in his State of the Union address.
A senior administration official who works on health care told Diamond and Kenen, "We don't have the grandiose leftist, socialist dreams of the Democratic Party. All those fantasy programs would bankrupt the country." Instead, by concentrating on specific health issues, the administration is "really building a very strong narrative around" Trump's health care priorities, the official said.
And, according to John Goodman, president of the Goodman Institute for Public Policy Research and a senior fellow at the Independent Institute, if you've been paying attention to those individual policy updates, then you shouldn't need a comprehensive health reform plan to understand Trump's position.
In a Forbes commentary, Goodman writes, "For the past two years the Trump administration has been pushing the limits of executive authority to make fundamental changes in our health care system," and "for each of its major policy changes, the administration has put out press releases and background documents for all to read."
Is that strategy working?
But based on the recent polling data, that strategy doesn't appear to be resonating with the public—or it's just not having the impact Trump and his team had hoped.
Trump's health care record thus far has been overshadowed by his calls to repeal and replace the ACA and the latest legal case, and has "left many patients and advocates—excited about some of the president's public-health proposals—simultaneously worried about what happens if Obamacare goes away," Diamond wrote.
We'll be watching to see how Trump, his administration, and his campaign team handle health care and health care reform as we get closer to this year's presidential election and more polling data become available. But, as polling from Iowa's caucuses show, one thing is certain: Health care is a major political issue—and that's not likely to change any time soon.