Feb 5, 2020 - Health

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

Illustration: Aïda Amer/Axios

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.

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Pelosi rips into Trump for State of the Union

Screenshot: MSNBC

House Speaker Nancy Pelosi laid into President Trump for his State of the Union address during her weekly press conference on Thursday, accusing him of using Congress as a "backdrop for a reality show" and calling out his "appalling" comments about pre-existing conditions.

Why it matters: The tension between Trump and Pelosi continues to grow in the wake of the president's address Tuesday, which culminated in the speaker ripping up a copy of the speech on national television.

Key takeaways from Trump's State of the Union address

Speaker Pelosi reacts to having her handshake snubbed by President Trump, as Vice President Mike Pence looks on. Photo: Mark Wilson/Getty Images

An impeached President Trump struck a defiant and hyperbolic tone in his third State of the Union address on Tuesday night, a day before he's set to be acquitted by the Senate.

Inside the room: Tension permeated the House chamber from the outset. Trump snubbed a handshake from Speaker Nancy Pelosi, only to be met with a retaliatory slight of his own when Pelosi failed to apply the honorific language typically used to introduce presidents at joint sessions of Congress.

40% of Iowa caucusgoers said health care was their top priority

Bernie Sanders at his caucus night party in Des Moines, Iowa. Photo: Alex Wong/Getty Images

Iowa Democrats reported Monday that their biggest priorities were beating President Trump and health care — but the meltdown of their election reporting systems left their presidential choices unresolved.

Why it matters: We've been writing for months that Democrats have a major choice ahead, either picking an advocate of Medicare for All — and siding with the plan that's less popular with the rest of the country — or a public option advocate.