(Bloomberg Opinion) -- President Donald Trump looks safe from impeachment, but still needs to get reelected. He has a few things going for him on that score — including roaring markets and a resilient economy — but he also has one huge obstacle: Voters don’t trust him on health care, an issue they consistently rate as more important than anything else.
The president tried to tout his record and ambitions in this area at Tuesday's State of the Union address. His actions speak far louder than his often misleading words. America has seen three years of Trump-style health care. It’s been dismal, and voters are right to doubt him on a topic that may be pivotal to the election.
Trump began the health section of his speech with a lie, saying "we will always protect patients with pre-existing conditions." The reality is, he came close to replacing the Affordable Care Act in 2017 with policies that would have gutted consumer safeguards for sick people and cut coverage for millions. The president continues to support a lawsuit that could eliminate the ACA, this time without even bothering to say how he'd replace it.
Trump also touted affordable alternative insurance he's made available. These new plans are cheaper precisely because they don't protect people with pre-existing conditions. Pushing weaker coverage is one of several acts of sabotage by the administration that have boosted costs in the individual insurance market. The word "Medicaid" was completely absent from the speech, even though it covers more than 70 million low-income and vulnerable Americans. That's probably because the administration has devoted itself to cutting the growing and popular program.
Any of the president's potential opponents in the coming election offer a significant contrast. Pete Buttigieg and Bernie Sanders, currently in the lead from the wreckage of the Iowa caucuses, offer different visions for the future of American health care. Both at least aim to boost coverage, a goal that Trump is incapable of or uninterested in accomplishing. Buttigieg, a relative moderate on the issue, has a plan that would immediately extend low-cost insurance to millions of people who should be eligible for Medicaid. There are questions of cost around the single-payer Medicare for All health plan proposed by Sanders, but access to free care is certainly a powerful message and an improvement for people with chronic ailments.
Trump also continued to highlight his efforts to combat high drug prices, an issue prioritized by both sides of the aisle. It's another area where his record is weak and his rhetoric diverges from reality.
The administration has rolled out many pricing initiatives, including reforms to Medicare's drug benefit and an attempt to shame drugmakers via price disclosures in TV ads. None but increasing generic drug approvals was mentioned in a speech that claimed the administration is "taking on the big pharmaceutical companies" because those that haven't been outright abandoned are terminally delayed.
Again, the reality is, there's been little palpable change for patients, and the president's claim that drug prices have dropped under his watch relies on flawed data. Drug spending has grown by many other metrics, Americans continue to ration costly drugs, and the most expensive medicines in history have launched undeterred.
Trump's proposed international pricing index, which would tie reimbursement for certain drugs paid for by Medicare to lower prices in other countries, is one of his only proposals that could help. The plan was rolled out in 2018 and got prominent billing in last year's State of the Union. It's gone nowhere in the face of industry opposition and went unmentioned Tuesday. It's the best he's come up with, and may be dead in the water.
House Democrats, on the other hand, passed a bill last year that would produce bigger price cuts for more people. As Democrats chanted the name of the legislation (“HR 3”), Trump seemed to tepidly endorse a weaker Senate proposal that his party won't unite behind. Each of the major Democratic presidential primary candidates supports reforms that are at least as robust as the House legislation; several want to go quite a bit further.
Given his record, the president's best bet on health care may be to keep quiet. His opponents won't give him that opportunity.
To contact the editor responsible for this story: Beth Williams at bewilliams@bloomberg.net
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.
Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.
©2020 Bloomberg L.P.