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Updated at 4:30 p.m. ET
President Trump gave a speech and signed an executive order on health care Thursday, casting the "Medicare for All" proposals from his Democratic rivals as harmful to seniors.
His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.
His speech was marked by cheers, standing ovations and intermittent chants of "four more years" by an audience of mostly seniors.
Trump spoke extensively about his administration's health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.
The executive order he signed had previously been titled "Protecting Medicare From Socialist Destruction" on the White House schedule but has since been renamed "Protecting and Improving Medicare for Our Nation's Seniors."
"In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens," Trump told the audience. "Today I'll sign a very historic executive order that does exactly that — we are making your Medicare even better, and ... it will never be taken away from you. We're not letting anyone get close."
The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that's administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.
The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.
The order includes a grab bag of proposals, including removing regulations "that create inefficiencies or otherwise undermine patient outcomes"; combating waste, fraud and abuse in the program; and streamlining access to "innovative products" such as new treatments and medical devices.
The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.
"Leading Democrats have pledged to give free health care to illegal immigrants," Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. "I will never allow these politicians to steal your health care and give it away to illegal aliens."
Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first hour hashing out and defending various health care proposals and visions. The major divide is between a Medicare for All system — supported by only two candidates, Sen. Bernie Sanders and Sen. Elizabeth Warren — and a public option supported by the rest of the field.
Trump brushed those distinctions aside. "Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare," he said. "These Democratic policy proposals ... may go by different names, whether it's single payer or the so-called public option, but they're all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism."
Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. "They're very powerful," Trump said. "I wouldn't be surprised if ... it was from some of these industries, like pharmaceuticals, that we take on."
Drawing battle lines through Medicare may be a savvy campaign move on Trump's part.
Medicare is extremely popular. People who have it like it, and people who don't have it think it's a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.
Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.
On Thursday, administration officials emphasized a number of its recent health care policy moves.
"[Trump's] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act," said Joe Grogan, director of the White House's Domestic Policy Council, at a press briefing earlier.
The secretary of health and human services, Alex Azar, said at that briefing that this was "the most comprehensive vision for health care that I can recall any president putting forth."
He highlighted a range of actions that the administration has taken, from a push on price transparency in health care, to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle "impassable health challenges."
Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.
"Today's executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what's broken," Azar said. "Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it."
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