WASHINGTON — When Donald J. Trump first ran for the White House, he promised to “come up with a great health plan,” one that would repeal the Affordable Care Act but replace it with something better, something that would maintain its biggest selling point: protecting people with pre-existing medical conditions.
Once elected, he swore he had a “wonderful plan” and would be “putting it in fairly soon.”
On Tuesday night, President Trump was at it again, during a town-hall-style meeting broadcast on ABC, where he was schooled by Ellesia Blaque, an assistant professor of Africana and Ethnic Literatures at Kutztown University in Pennsylvania. She told him she had a congenital illness, demanded to known what he would do to keep “people like me who work hard” insured — and cut him off when he tried to interrupt her.
“We’re going to be doing a health care plan very strongly, and protect people with pre-existing conditions,” Mr. Trump told her, adding, “I have it all ready, and it’s a much better plan for you, and it’s a much better plan.”
After four years, during the worst health crisis in a century, the unkept promise may be catching up to Mr. Trump. There still does not seem to be any plan, because other than abolishing the Affordable Care Act — which requires insurers to cover pre-existing conditions and which the White House is asking the Supreme Court to overturn — the Republican Party cannot agree on one.
And with tens of thousands of Americans losing their health insurance to a coronavirus-induced recession, fears of inadequate or nonexistent health care coverage have never been greater.
“What the public wants to know is, ‘Where am I going to get health insurance and how much is it going to cost me,’ and that plan didn’t really provide any kind of direction for getting answers to that,” said James C. Capretta, a resident fellow at the American Enterprise Institute who advised President George W. Bush on health policy, referring to a 2018 report on health care overhaul by the Department of Health and Human Services.
Mr. Trump’s health care positions in 2016 separated him from the Republican pack. Yes, he would repeal the Affordable Care Act, he said, but its replacement would be even more generous. He would not cut Medicare, and he would allow the federal government to negotiate for much lower prescription drug costs, a key plank of the Democrats.
But his claim on Tuesday that his administration finally has a secret health care plan “all ready” may be feeling shopworn to a weary electorate. He is running for re-election in the thick of a pandemic, when an estimated 5.4 million American workers had already lost their health insurance between February and May, according to the nonpartisan advocacy group Families USA.
And voters may hold him accountable for his failure to produce.
“The truth is he has no plan and he never will,” Douglas Emhoff, the husband of the Democratic vice-presidential nominee, Kamala Harris, quipped at an event Wednesday.
The question of how to protect people with pre-existing medical conditions will be a central feature of the presidential and congressional campaigns in the next six weeks. And after Mr. Trump’s exchange with Dr. Blaque went viral on Tuesday, Democrats did not waste the moment.
“He just keeps promising his magic healthcare plan is right around the corner. The truth: he has no plan,” Senator Chuck Schumer of New York, the Democratic leader, wrote on Twitter, posting a video that ran through the president’s many unfulfilled promises.
Joel White, a Republican strategist with expertise in health policy, said Congress, not the administration, was at fault for refusing to work with Mr. Trump.
“These are the core issues that face us as a country — cost and quality and access,” he said, “and you can’t just get that done through one guy or one administration. It needs bipartisan support in Congress and the administration, coming together around a workable idea.”
But the White House has not made it easy. When House Republicans finally passed a bill to repeal and replace the Affordable Care Act in 2017, Mr. Trump first celebrated, and then called it “mean.” With little guidance from Mr. Trump and no plan, the Senate failed to pass anything.
That is not to say that Mr. Trump has done nothing to address Americans’ health care concerns.
Every once in a while, his administration wades in, changing policy through regulations or presidential directives. One executive order in 2018 expanded the sale of “short-term” insurance policies — good for up to three years — that do not have to cover pre-existing conditions.
Over the weekend, he issued an executive order aimed at tying the price of prescription drugs to those paid in Europe and other developed nations. Experts say the order will almost certainly be challenged in court. Mr. White says that while the move “may be smart politics, it’s bad policy,” and violates the Constitution. And it cannot go into effect during the president’s first term.
Mr. Trump’s pronouncements on health care have tended to adhere to a pattern: first a superlative (“great,” “terrific,” “fantastic”) followed by a vague deadline. To say they are light on details would be an understatement.
“There’s a great plan, and this will be great health care,” he declared four months into his presidency, in April 2017. “It’s uh, evolving.”
In May 2018, he boasted about “the plans we have coming out, literally over the next four weeks.” Twenty-four weeks later — having announced nothing — he said, “We are working many plans for health care.”
At the beginning of last year, the president hedged on the timing of a health care plan, saying: “When the plan comes out, which we’ll be showing you at the appropriate time, it’s much better than Obamacare. So when the plan comes out, you’ll see it.”
More than two months later, in June 2019, Mr. Trump told George Stephanopoulos of ABC that “we already have the concept of the plan,” and said he would “be announcing that in about two months — maybe less.”
That is essentially what he again told Mr. Stephanopoulos on Tuesday night, as Dr. Blaque firmly stood her ground. She told him she was born with sarcoidosis, an inflammatory disease that attacks multiple organs, “and from the day I was born, I was considered uninsurable.” When she asked if the Affordable Care Act’s pre-existing conditions provision should “be removed,” Mr. Trump tried to answer.
“Please stop and let me finish my question sir,” she cut in.
Mr. Trump then repeated that he would not “hurt pre-existing conditions,” and turned the conversation to Democrats and President Barack Obama: “He said, you can have your doctor. You can have your plan. And that turned out to be a lie, and he said it 28 different times at least.”
The exchange went viral. The sight of a Black academic with a Ph.D. confronting the president thrilled liberal Twitter. But the Fox News host Laura Ingraham, a staunch Trump backer, said he had been “ambushed” in the town hall event, and called the forum a “total set up.”
In an interview Wednesday evening, Dr. Blaque, 57, said that while she relied on Medicaid as a younger woman, she was now insured by the state of Pennsylvania, her employer. She has long been a Trump critic, but had been undecided about whether to vote at all, because she has not seen improvements in the lives of Black people under either party.
She said she “broke down and cried” after the event, and returned home determined to cast her ballot for the president’s opponent, former Vice President Joseph R. Biden Jr. Mr. Trump’s answer, she said, did not satisfy her.
“He used one term from my question and then went on a rant about Obamacare, his typical redundant rant about how it’s a disaster, it’s too expensive, it’s too this and it’s too that,” she said. “So he never answered my question, and I just stood there like a fool and felt like soot on the bottom of his shoe.”
Michael D. Shear contributed reporting.