Where does the Trump administration stand on health care, pre-existing conditions?

With some 82 percent of Americans saying health care is a top issue for them this election cycle, Democrats are hoping to steer the conversation back to what’s covered, what’s not and how much it will cost. In particular, they are sounding the alarms on a move this week by the Trump administration that they say threatens an Obama-era mandate that insurance companies cover pre-existing conditions, even as federal officials insisted Tuesday that those protections remain intact.

Here’s a look at what the Trump administration is doing on health care ahead of the midterm elections:

Pre-existing conditions

The Trump administration on Monday announced a new policy that would allow states to pursue “alternatives” to insurance plans that don’t meet all requirements under the Obama-era law. In Trump’s plan, states could use federal money to subsidize cheaper insurance plans that offer less coverage. Republicans call them “innovative” solutions that will improve competition; critics deride the options as “junk insurance.”

Democrats have swiftly seized on the issue and circulated warnings on social media that such a policy would open the floodgates to insurance plans that deny people coverage based on a previous diagnosis.

“Just weeks before the election, Republicans are once again undermining protections for people with pre-existing conditions and sabotaging our health care system,” said Senate Democratic Leader Chuck Schumer of New York.

Yuri Gripas/Reuters, FILE
Protesters rally during U.S. House voting on the American Health Care Act, which repeals major parts of the 2000 Affordable Care Act know as Obamacare on Capitol Hill in Washington, May 4, 2017.

But Trump administration officials say protections for pre-existing conditions aren’t going anywhere, even though Republicans once sought to eliminate those protections by law with their own “Obamacare” replacement.

Jonathan Monroe, a spokesman for the Centers for Medicare and Medicaid Services, said protections for pre-existing condition “are not waivable provisions under the statute itself.”

“No state waivers that would alter or erode pre-existing conditions protections can or will be approved,” Monroe said in an emailed statement to ABC News.

Still, Democrats hoping to make health care more of an election issue say they believe states will now be allowed to skirt the issue.

What else has Trump done?

After Republicans failed to push through alternative legislation in Congress, the Trump administration opted for regulatory action. The departments of Health and Human Services, Labor and Treasury have finalized rules that allow for the expanded use of short-term insurance plans, as well as association health plans aimed at lowering premiums for self-employed workers who buy insurance as part of a trade group or employment association.

On Tuesday, the Trump administration was expected to propose a regulation that would expand the use of “health reimbursement arrangements,” allowing employers to provide money for employees to cover their medical costs. The Trump administration argues such accounts will attract consumers to the marketplace and lower medical costs overall; critics say the approach could encourage business owners to drop traditional company-sponsored health plans.

The latest proposals are risky politically. While the goal is clearly aimed at reducing premiums for voters, any cost savings wouldn’t likely be seen by voters by November. In the meantime, Democrats have been pushing the message in tight races that Republicans are “sabotaging” the health care system.

Who cares?

Just about everybody. While Trump remains fixated on immigration and the migrant caravan south of the U.S. border, 82 percent of Americans say they consider health care to be a top-tier issue for them this election cycle, according to the latest ABC News/Washington Post poll. That same poll found that by a margin of 53-35, voters say they trust Democrats more on the issue.

That could be why Republican candidates across the country have released ads insisting that they would protect insurance for people with pre-existing conditions in particular. In more than 20 competitive districts from California to Iowa to North Carolina, Republicans in tight federal House and Senate races have released new television and digital ad spots that vow to both protect rules for pre-existing conditions and lower health care premiums. That’s a shift when many of the same Republicans, such as Ohio’s Steve Chabot, who voted on the now-defunct Republican health care bill that would have eliminated premium limits on those with pre-existing conditions.

Still, while health care is a top issue for voters, it’s possible that identify politics will play just as big of a role come Nov. 6. The latest research by the nonpartisan Kaiser Family Foundation found that while health care is a driving issue, a large share of voters will be factoring in Trump himself and party control of Congress as well.

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