State of the Union previews 2020's pre-existing conditions fight

President Trump claimed last night during the State of the Union that he will "always protect patients with pre-existing conditions" — a statement that's misleading at best.

Why it matters: Pre-existing conditions protections are popular, and both parties are trying to claim credit for them. But only one of the parties has a track record of defending those protections, and it's not the GOP.

Reality check: Republicans' repeal and replace efforts in 2017 wouldn't have preserved the same level of protections the Affordable Care Act provides, nor would any of the plans they've put forward since.

• The Trump administration and Republican state attorneys general are currently fighting in court to strike down the entire ACA — including its pre-existing conditions protections.

The other side: Democratic presidential candidates aren't focused on pre-existing conditions right now.

• Instead, they're duking it out over where the party should go next on health care, and whether that's a public option or Medicare for All.
• Trump seems perfectly happy with this, saying last night that "we will never let socialism destroy American health care" — a preview of how he'll likely attack whichever proposal prevails into the general election.
• In remarks prior to the State of the Union, House Speaker Nancy Pelosi slammed Trump for his support of the ACA lawsuit, for flip-flopping on Medicare drug price negotiations and for the administration's Medicaid block grant proposal.

Between the lines: This sounds much more like Democrats' winning 2018 message than the fight 2020 presidential candidates are having. It also sounds exactly like what we'll probably hear for the rest of the year.

Other SOTU health mentions:

There was no mention of the administration's international pricing index, which would tie the price of some Medicare drugs to what other countries pay and is very controversial among Republicans.

• Instead, Trump called for bipartisan legislation, specifically mentioning a bill by Sens. Chuck Grassley and Ron Wyden.

Trump alluded to expanded short-term health plans, saying that "our new plans are up to 60% less expensive — and better."

• What he didn't say is that these plans aren't required to cover pre-existing conditions or the same benefits that ACA plans are.

He touted the administration's transparency rules, saying that they "will save families massive amounts of money for substantially better care."

• In reality, some experts argue that transparency measures could cause prices to increase, and either way are unlikely to be a silver bullet, even though transparency is a laudable goal.

He repeated the claim that prescription drug prices have gone down for the first time in 51 years — which isn't exactly true, although generics have been driving overall costs down and, as Trump said last night, the administration has approved a record number of generics.

He also slammed Democrats for supporting providing health benefits to undocumented immigrants — another preview of a top 2020 talking point.

Go deeper:

• In photos: Trump delivers State of the Union address
• Key takeaways from Trump's State of the Union address