Andy Slavitt

Opinion columnist

President Donald Trump is going to spend the year trying to get reelected by dodging the bullets of his horrible health care record. He asked the Supreme Court for an assist in the matter and this week, the court granted his wish. Will Democrats let him get away with it? This will be perhaps the most important 2020 test of their political capabilities and whether they can make the case that their policies line up best with voters’ needs.

Here’s the background. Last year, the Trump administration joined a lawsuit brought by 20 Republican-led states to throw out the Affordable Care Act.

The grounds were always considered specious, but instead of protecting the tens of millions of Americans with preexisting conditions who were guaranteed insurance by the ACA, let alone the 20 million who gained health insurance because of it, Trump instructed the Justice Department to side with the Republican states.

Legal experts call the move rare and possibly unprecedented.

The lawsuit became a hot potato. Conservative courts in Texas and New Orleans backed it, but stayed their verdicts and passed the case along. The most recent ruling came Dec. 18, which happened to be the day we were distracted by the House vote to impeach Trump. Democratic state attorneys general, left to defend the people in this case, quickly asked the Supreme Court to review it so justice could be done. The court gave Trump what he wanted on Tuesday, which happened to be the day we were distracted by the start of the Senate impeachment trial. Fishy?

2020 ruling would put Trump in a bind

A Trump-backed Supreme Court case repealing the entire ACA in an election year would be inconvenient to say the least for a president who absurdly claimed as recently as last week to be the savior of insurance protections for preexisting conditions. So the Trump administration asked the Supreme Court not to hear the case, and the justices obliged.

Trump’s ability to run his campaign rests on his ability to get away with lying. Since becoming president, he has made false or misleading health care claims over 900 times, according to a Washington Post database. From taking credit for an Obama-era law on veterans health care, to his promises to preserve Medicare and Medicaid, both of which Trump guts in his budget proposals (and plans to continue doing), to his hollow promises to reduce teen vaping and take on drug companies, Trump lies because he could never run on the facts.

But Trump’s boldest lie — a claim made 73 times, according to The Post — is that he’s a champion for protecting people with preexisting conditions, one of the most prominent rights he aims to eliminate. Others include allowing insurance companies to reinstate lifetime limits and to exclude benefits like prescription drugs and mental health coverage.

Trump’s ACA repeal would also raise drug costs for millions of seniors by expanding the “doughnut hole” (a temporary coverage gap) in the Medicare prescription drug benefit.

So while Trump benefits from delaying the ruling until after the election, the Democrat who stands against him this fall, and the Democrats who run for House and Senate seats, can’t let him get away with it. It would be political malpractice of the highest order.

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Fighting fair against a president who is always prepared to dodge the truth and play dirty is no easy matter. But this is what Democrats face. And the sooner they accept it and act accordingly, the better.

So far, the Democratic presidential candidates are acting like they’re running in a vacuum. They are occupied with debating how to make universal coverage happen in the most ideal way. While this is an interesting and even important debate in other times, it’s a far remove from the brass-knuckled, rough-and-tumble politics they will face. More important, it lets Trump off the hook. And it’s only an intellectual exercise until they beat Trump and take the Senate.

2020 Dems aren't running in a vacuum

The 2018 Democratic congressional candidates did the simple job in front of them: Shove Republicans' actual voting records in front of voters, and call them out for being hell-bent on repealing the ACA and their attempts to lie about it.

This paid off with the House majority and a lot of Trump districts going blue. But those lies will be amateur hour compared with what the Democratic standard-bearer will confront in Trump. Getting in the mud never works with him. But Democrats who try to stay too far above the fray on health care by painting their own picture will miss the opportunity to hold Trump to account with voters.

The Democrats have the facts (and the truth) on their side. That only matters if they lay them out right. People don’t like to have their intelligence continually insulted, and they feel rightfully insecure and angry about having their health care taken from them by Washington.

The Democrats' message should sound like this: “Trump and his Washington cronies have spent four years trying to take away your health care and then lying to your face. I will protect your ability to care for your family. I will never lie to you about something as important as this.”

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Democrats need to make the simple case that Trump and the Republicans have the radical Washington plan that serves special interests at our expense, while the Democrats' own first priority is to protect people's care, expand the ACA and continue to make care more affordable.

The truth is that anything beyond that wouldn’t be on a first-term agenda anyway. Win in 2020, then earn the right to push for more far-reaching change.

If the Democrats fail, in his second term Trump will get the ACA repeal case to the high court after he has perhaps added another justice or two — and when there won’t be any opportunity to make him pay for his lies.

Andy Slavitt, board chair of United States of Care and a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt