How Donald Trump Is Trying to Change His Health Care Record

With nearly 200,000 Americans dead from COVID-19 and millions more who lost their health insurance when they lost their jobs this year, President Donald Trump tried this week—as he has done throughout his presidency—to change the conversation.

On Sunday, the President issued a new executive order aimed at lowering prescription drug prices, an issue dear to many voters, and boasted on Twitter that “prices are coming down FAST.”

The reality is more complicated. Trump’s new executive order, which revokes and replaces a different executive order on drug prices that he signed in July, directs the Secretary of Health and Human Services (HHS) to start testing how it would work to require Medicare to pay the same price for certain prescription drugs as other developed nations, which often pay less for the same medications. In a made-for-2020 twist, the order relies on the HHS secretary invoking an office established under the Affordable Care Act, the bête noire of the Trump Administration.

The President’s new order received immediate pushback from pharmaceutical companies, which will likely challenge it in court and delay any implementation for months or years. Health care experts agreed the order—and especially Trump’s repeated insistence that it will have an immediate impact on drug prices—was largely political posturing. “While this proposal isn’t too big, it is too late to get it done before the election,” says Tricia Neuman, executive director of the nonpartisan Kaiser Family Foundation’s program on Medicare policy.

But if it is all politics, it’s easy to see why Trump might think he needs to chalk up a win among voters who see health care as a top election issue. In a typical election year, health care stands among the most important priorities for voters; this year is similar. After health care was outranked by the economy and immigration in 2016, it rose in importance, and was often the number one issue in 2018. Among older voters, who make up a key segment of Trump’s base, health care has traditionally been a crucial topic.

The coronavirus pandemic has underscored those concerns. Since March, more than 40 million Americans have filed unemployment claims, leaving, experts estimate, as many as 27 million people without their employer-sponsored health insurance. More than 40 states have reported increases in opioid-related deaths in recent months, and older Americans, an important part of Trump’s base, are among the highest risk for severe illness from the coronavirus.

Trump has been trailing former Vice President Joe Biden in national polls for months, and voters’ trust in the President’s ability to handle the COVID-19 pandemic is still underwater, except among registered Republicans. The President has limited health care accomplishments to tout from his four years in office. Even aside from the pandemic, he has proposed cuts to Medicaid and Medicare, seen the rate of uninsured Americans rise, and supported a lawsuit to overturn the Affordable Care Act, which would wipe out health coverage for millions of Americans, without proposing a replacement.

During an ABC News town hall on Tuesday night, Trump promised to protect Americans with pre-existing conditions and swore that he’d release a new health-care plan soon—a vow he has repeated for years, although he has never produced a proposal. The White House chief of staff and press secretary repeated on Wednesday that Trump does have a health care plan on the way.

In the last three and half years, the Trump Administration has pushed to repeal the largely popular ACA and to curtail protections the law offers. It has, for example, refused to defend the law in court, expanded short term insurance policies that do not have to cover pre-existing conditions, limited open enrollment periods, and cut funds to help people sign up for marketplace plans.

Trump’s decision to redirect the conversation to lowering prescription drug prices—a 2016 Trump campaign promise—makes political sense. A recent poll by the nonpartisan Kaiser Family Foundation found that more registered voters say Biden has a better approach than Trump to almost all health care issues with the exception of lowering drug costs, where 46% said Trump had a better approach compared with 42% who favored Biden.

“I can’t think of anything that in this time will look good to people,” Robert Blendon, director of the Harvard Opinion Research Program and a professor of health policy and political analysis at the Harvard Chan School, says of Trump’s health care record. “But at least addressing the high drug prices—there is an anxiety about that.”

Write to Abigail Abrams at abigail.abrams@time.com.