Donald Trump unveils his 'America First' healthcare plan

Donald Trump announced his long-awaited health care plan on Thursday as he seeks to fulfill a campaign promise before the presidential election.

The US president vowed to protect people with pre-existing medical conditions, a key part of the Obama-era healthcare legislation which his administration is attempting to strike down, as well as calling for an end to surprise medical billing.

Mr Trump unveiled his healthcare "vision" during a speech in Charlotte, North Carolina, a key swing state in this year's race, saying his "America First healthcare plan" would deliver quality health care at a "much lower cost" to the public.

Mr Trump has repeatedly attacked the Affordable Care Act, the signature healthcare policy signed into law by President Barack Obama, and promised to repeal and replace it with an alternative healthcare plan during his first term.

But while the administration has made some progress on its health care goals, the sweeping changes he promised as a candidate in 2016 have eluded him.

Democrats have seen healthcare as a winning issue during the 2020 campaign, with polls suggesting handling of the coronavirus pandemic and healthcare policies are Mr Trump's two biggest vulnerabilities.

Joe Biden, Mr Trump's Democratic opponent, has said if he is elected he will build on the Affordable Care Act, which extended health coverage to millions of Americans, promising to make coverage available to all Americans.

During his event on Thursday, Mr Trump signed an executive order which declared it is "the policy of the United States" that people with pre-existing health conditions should not be denied coverage by health insurance companies.

However, constitutional experts expressed doubts over whether the order held any legal weight. Nicholas Bagley, a professor at University of Michigan's law school, said: "Unless there's a law that prohibits the conduct in question, or unless the president is exercising a power that's been delegated to him by Congress, his statements have no more legal weight than a tweet."

Mr Trump's health secretary, Alex Azar, said the administration would also sign a second executive order asking Congress to pass legislation banning surprise healthcare bills by the beginning of next year, and explore executive action to address the goal if the legislative bid fails.

"What the president is saying is that all the relevant players - hospitals, doctors, insurance companies - had better get their act together, and get legislation passed through Congress that protects patients against surprise medical bills," Mr Azar said.

Nancy Pelosi, the Democrat House Speaker, labelled it a "bogus order", as she called on the president to "drop his lawsuit to overturn the Affordable Care Act in the middle of a pandemic".

Mr Trump's scramble to deliver concrete accomplishments on health care follows criticism that he never created a Republican alternative to Obamacare, with 40 days to go before the election.

The issue remains a key concern for Americans during the election campaign, with millions of people thought to have lost their health insurance as unemployment increased during the coronavirus pandemic.

Meanwhile, the Trump administration is pressing the Supreme Court to scrap the entire Affordable Care Act, often referred to as "Obama Care", which provides coverage to more than 20 million people and protects Americans with medical problems from insurance discrimination. The case will be argued a week after Election Day.

The death of Supreme Court Justice Ruth Bader Ginsburg has added another layer of uncertainty. Without Justice Ginsburg, there is no longer a majority of five justices who previously had voted to uphold the ACA.