2小时前 / 美国有线电视新闻网（CNN）
作者：亚当·坎克林
发布时间：2026年2月19日，美国东部时间上午5:00
唐纳德·特朗普 处方药 医疗保健政策
尽管民调显示支持率低迷，且部分高级顾问对将这一长期被证明对共和党极具灾难性的议题推到台前心存疑虑，总统唐纳德·特朗普正准备将医疗保健作为其中期选举竞选的核心焦点。
据多名政府官员及知情人士透露，特朗普及其高级助手制定的策略旨在突出他们认为具有广泛选民吸引力的关键优先事项，如降低药品价格，同时试图先发制人，应对民主党可能针对医疗成本上升发起的猛烈攻击。
“多年来我们在这方面做得很糟糕，我们不谈论医疗保健，即便谈论，也只是在被迫的时候才说，”一位参与讨论的特朗普顾问表示，“特朗普正在做一些好事，我们需要在这方面更积极主动。”
策略带来的困扰
这一策略已引发一些争议。
近几周，特朗普政府官员向共和党议员推销了一项几乎不可能实现的目标：在11月中期选举前推动重大医疗立法，尽管国会对这类立法几乎没有兴趣。在政府内部，白宫助手正在策划对特朗普政府卫生部门的大规模重组，试图解决其信息传达工作中的问题，并将重点从疫苗等更具争议性的话题上转移开。
对医疗保健日益强调的背后，是白宫最新的努力——试图解决因生活成本上升而拖累特朗普支持率的问题，并缓解共和党内部对中期选举惨败的担忧。周四，总统将前往佐治亚州发表新一轮以经济成就为重点的演讲，强调经济可负担性。
然而，民调显示，这一信息迄今为止并未在选民中引起广泛共鸣。尽管有人希望转向医疗保健能帮助政府获得更多支持，但几位参与该议题的共和党盟友私下将这一做法描述为政府在选举日前九个月面临的巨大挑战的象征。
“他们实际上能做的事情不多，无法改变共和党多数派的命运，”一位接近白宫的共和党人士表示，“显然，他们正处于一个艰难的境地。”
失败的历史
十多年来，共和党一直难以制定出一套能赢得选举的医疗保健政策平台，最显著的失败是在特朗普第一任期内多次试图废除并取代奥巴马医改（Obamacare）均告失败。2017年的这一事件疏远了选民，并将该议题的政治走向彻底转向民主党，预示着次年共和党失去众议院控制权的40个席位摇摆。
此后，民主党候选人在医疗保健议题上的民调优势持续扩大。尽管特朗普通过支持“让美国再次健康”运动（Make America Healthy Again）并在药品价格问题上采取更民粹主义的立场，试图重塑共和党的议程，但几乎没有证据表明他缩小了差距。
一位白宫官员辩称，特朗普仍有可能打破共和党在医疗保健议题上的历史困境，并坚称政府致力于以此为竞选重点。该官员表示，总统的医疗保健议程中的主要部分，如降低药品价格，得到了广泛支持，可作为政府解决民众可负担性担忧的切实证据。
“总统并非传统意义上的共和党人，我们所做的许多事情并不符合传统共和党模式，”该官员称，“他已经在这里建立了一些东西。”
但在最近关于中期选举策略的简报中，特朗普的政治顾问给出了更直接的理由——他们别无选择。
据两名知情人士透露，白宫办公厅副主任詹姆斯·布莱尔和顶级特朗普民调专家托尼·法布里齐奥私下警告共和党人，民主党可能会将竞选攻击的重点集中在可负担性和医疗保健问题上。这一点在特朗普去年未能就延长某些奥巴马医改补贴达成协议后变得尤为明显，导致数百万参保人面临价格上涨。
医疗保健成本也一直是美国人最关心的可负担性问题之一，使其成为中期选举中一个潜在的关键议题，官员们预计此次选举将主要由选民的经济观点塑造。
在这样的背景下，特朗普团队认为必须主动出击。
“我认为他们不希望只因为医疗保健成本上涨而受到攻击，”长期从事共和党工作的亚历克斯·科南特表示，“特朗普希望定义自己，而不是让民主党定义共和党的立场。”
信息传达的转变
周二晚上，在布莱尔和办公厅主任苏西·怀尔斯主持的中期选举策略会议上，特朗普团队强调了将中期选举描绘为选民在政府取得的进展与回到一年前他们投票反对的状况之间进行选择的重要性。据在场人士向CNN透露，尽管特朗普政府官员承认美国人对此持怀疑态度，甚至感到不满，但他们仍持积极态度，认为仍有可能围绕这些挑战进行有效沟通。
这一新的重点反映了特朗普本人对竞选其医疗保健议程部分内容日益高涨的热情。总统尤其自豪于他的“最惠国”（Most Favored Nation）计划，该计划为美国人在某些药物上争取到谈判折扣。他本月早些时候坚称，“仅靠这一点，共和党就应该能够赢得中期选举。”
他同样大力推崇所谓的“伟大医疗计划”——一个以直接向个人提供补贴为核心的松散框架，他已敦促国会议员优先考虑这一计划，尽管在选举年对如此复杂的议题通过重大立法几乎没有共识。
与此同时，白宫已采取措施加强其医疗信息传达工作的关键部分。据两名知情人士透露，1月底，怀尔斯秘密指派一位受信任的特朗普高级官员评估美国卫生与公众服务部（HHS）的内部运作，此前数月部门内部冲突和公开失误已使白宫感到沮丧，并阻碍了其议程的执行。
该官员布拉德·史密斯提交的评估报告成为了白宫与卫生与公众服务部部长小罗伯特·F·肯尼迪协调的部门高层重组的基础。此次重组导致肯尼迪的两名高级助手被解除其经参议院确认的职务，另有四人被提拔。《华盛顿邮报》率先报道了史密斯的参与。
仍有更多变动在考虑中：知情人士称，由于对肯尼迪的亲密助手斯蒂芬妮·斯皮尔在卫生与公众服务部活动和信息传达工作中的表现不满，特朗普官员正考虑让她靠边站。
新提拔的团队（包括两名在特朗普药品定价计划中密切合作的工作人员）将接管该部门的大部分日常运作，以更好地与白宫协调工作，并避免过去一年中卫生与公众服务部多次陷入的负面新闻。具体而言，该部门预计将不再重点推进肯尼迪颇具争议的全国疫苗政策改革。
相反，特朗普官员推动肯尼迪更频繁地出行，宣传健康饮食等更具广泛吸引力的理念，希望能吸引那些在2024年支持特朗普联盟的“让美国再次健康”（MAHA）运动支持者。卫生与公众服务部部长是未来几个月内几位计划外出拉票的内阁成员之一，特朗普助手周二敦促他们随时准备回应任何议员的请求——最重要的是，保持坚定的信息传达。
“关键在于，哪些是中期选举的制胜议题？”一位知情人士表示，“这才是最重要的。”
争议与怀疑
然而，这一调整仍在进行中。上周，美国食品药品监督管理局（FDA）突然拒绝审查制药商莫德纳（Moderna）开发的新型流感疫苗，引发制药行业警报，最终这一意外举动的投诉传到了特朗普耳中。
两名知情人士向CNN透露，总统对此反应愤怒，斥责FDA专员马蒂·马卡里做出这一决定。此后，FDA表示，在莫德纳提交修订提案后，将重新审查该流感疫苗。
特朗普还必须应对对其医疗议程的广泛质疑，包括一些他指望支持其优先事项的共和党议员的疑虑。尽管特朗普迫使制药商降低部分药品价格的举动备受瞩目，但保守派对将这一首先由伯尼·桑德斯等著名进步派提出的方法法典化仍心存犹豫。
总统的“伟大医疗计划”面临的挑战更大。共和党在众议院仅占微弱多数，参议院对再次推动重大立法的热情也在下降，尽管特朗普极力推动，在选举前最后阶段围绕这一曾多次让他们受挫的议题达成统一支持的可能性微乎其微。
“特朗普明白这是个问题，他需要谈论它，但他面临的问题与我们传统上遇到的相同，”资深共和党策略师道格·海耶表示，“我们从未真正能够展示我们的立场。”
克里斯汀·福尔摩斯对本文亦有贡献。
唐纳德·特朗普 处方药 医疗保健政策
Trump wants to focus on health care in the midterms, creating headaches for the GOP
2 hr ago / CNN
By Adam Cancryn
PUBLISHED Feb 19, 2026, 5:00 AM ET
Donald Trump Prescription drugs Health care policy
President Donald Trump is preparing to make health care a central focus of his midterm sales pitch, despite weak polling and misgivings among some of his own advisers about elevating an issue that’s long proved disastrous for the Republican Party.
The approach developed by Trump and his senior aides aims to spotlight key priorities that they believe carry broad voter appeal, like lower drug prices, while seeking to preempt an expected barrage of Democratic attacks over rising health costs, according to more than a half-dozen administration officials and others familiar with the matter.
“We’ve done a bad job over the years in that we don’t talk about health care, and when we do, it’s only when we’re forced to,” said a Trump adviser involved in the discussions. “There’s good stuff that Trump’s trying to do, and we need to get more aggressive on it.”
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The strategy has already created some headaches.
Trump officials in recent weeks have pitched GOP lawmakers on mounting a longshot bid to pass major health legislation ahead of November’s midterm elections, despite little congressional appetite to do so. And inside the administration, White House aides are orchestrating an extraordinary shakeup of Trump’s health department in an attempt to remedy concerns about its messaging operation and move its focus away from more divisive topics like vaccines.
The intensifying emphasis on health care marks the White House’s latest bid to solve the cost-of-living woes dragging down Trump’s approval ratings and deepening fears within the GOP of a midterm rout. On Thursday, the president will travel to Georgia to deliver the latest in a set of affordability-focused speeches touting his economic accomplishments.
That message hasn’t resonated widely with voters so far, polling shows. While there’s hope that shifting toward health care will help the administration gain traction, several Republican allies working on the issue privately characterized the approach as a sign of the sheer depth of the challenge facing the administration nine months out from Election Day.
“There truly are not many things they will be able to do that will alter the fate of the Republican majority,” said one Republican close to the White House. “That’s obviously a tough place for them to be.”
History of failure
Republicans have struggled for more than a decade to formulate a winning health care platform, most notably failing repeatedly during Trump’s first term to repeal and replace Obamacare. That 2017 episode alienated voters and shifted the politics of the issue decisively toward Democrats, presaging a 40-seat swing that cost Republicans control of the House the following year.
Since then, Democratic candidates have enjoyed a sustained polling advantage on health care. And despite Trump’s efforts to revamp the GOP’s agenda by embracing the Make America Healthy Again movement and staking out a more populist position on drug prices, there’s little evidence he’s managed to significantly narrow the gap.
A White House official argued that Trump could still defy the party’s history on health care and insisted that the administration is committed to campaigning on the issue. Major parts of the president’s health agenda, such as cutting drug prices, are broadly popular, the official said, and can serve as tangible evidence that the administration is addressing affordability concerns.
“POTUS isn’t the traditional Republican, and many of the things we do don’t fit in the traditional Republican mode,” the official said. “He’s already built something here.”
But in recent briefings on midterm strategy, Trump’s political advisers offered a blunter motivation for leaning in on health care: They have no other choice.
James Blair, the White House deputy chief of staff, and top Trump pollster Tony Fabrizio have privately warned Republicans that Democrats are likely to focus their campaign attacks overwhelmingly on affordability and health care issues, according to two people familiar with their message. That became especially obvious after Trump failed to strike a deal last year to extend certain Obamacare subsidies, triggering price increases for millions of enrollees.
Health care costs also consistently rank among Americans’ top affordability concerns, making it a potent issue in a midterm landscape officials expect will be shaped primarily by voters’ economic views.
Against that backdrop, Trump’s team has argued that it needs to go on offense.
“I don’t think they just want to be attacked for letting health care costs go up,” said Alex Conant, a longtime GOP operative. “Trump wants to define himself, rather than letting Democrats define the Republican position.”
Shifting the message
In a meeting on midterm strategy Tuesday night led by Blair and chief of staff Susie Wiles, Trump’s team stressed the importance of portraying the midterms as a choice for voters between the progress the administration’s made or going back to a situation they voted against just a year ago, a source present told CNN. Though Trump officials acknowledged that Americans are skeptical and, in some cases, unhappy, they struck a positive tone, contending that it’s still possible to message around those challenges.
The new focus has mirrored Trump’s own rising enthusiasm for campaigning on parts of his health care agenda. The president has taken particular pride in his “Most Favored Nation” initiative, which offers Americans negotiated discounts on certain medicines. He insisted earlier this month that “the Republican Party should be able to win the midterms on that alone.”
He’s similarly talked up the potential of his so-called Great Healthcare Plan — a loosely constructed framework for tackling health costs centered on funneling subsidies directly to individuals that he’s pressed lawmakers to prioritize on Capitol Hill, despite little appetite for passing major legislation on a complicated topic in an election year.
The White House in the meantime has taken steps to shore up key elements of its health messaging operation. In late January, Wiles quietly tasked a trusted senior Trump official with evaluating the US Health and Human Services Department’s inner workings, following months of internal clashes and public missteps that had frustrated the White House and complicated efforts to execute on its agenda, two people familiar with the matter said.
The conclusions submitted by the official, Brad Smith, formed the basis of a shakeup of the department’s senior ranks coordinated between the White House and HHS Secretary Robert F. Kennedy Jr. The overhaul resulted in the ouster of two top Kennedy aides from their Senate-confirmed roles and elevated four others. The Washington Post first reported Smith’s involvement.
Still more changes are under consideration: Trump officials are weighing a move to effectively sideline Kennedy’s close aide, Stefanie Spear, amid dissatisfaction over her handling of HHS’ activities and messaging efforts, the people familiar said.
The newly elevated group, which includes two staffers who worked closely on Trump’s drug pricing initiative, will instead take over much of the department’s day-to-day operations, in a bid to more closely coordinate its work with the White House and avoid the negative headlines that plagued HHS at times over the past year. Specifically, the department is expected to pivot away from Kennedy’s polarizing efforts to revamp the nation’s vaccine policies.
Trump officials have instead pushed for Kennedy to travel more frequently to promote broader-appeal ideas like healthy eating, in hopes of turning out the MAHA devotees who bolstered Trump’s coalition in 2024. The HHS secretary is one of several Cabinet members expected to hit the road in the coming months, with Trump aides on Tuesday urging them to make themselves available for any lawmakers who request their presence — and above all, to stay militantly on message.
“It’s all about, what are the winning issues for the midterms?” said one of the people. “That’s all that matters.”
Dustups and skepticism
Still, the recalibration remains a work in progress. After the Food and Drug Administration last week abruptly refused to review a new flu vaccine developed by the drugmaker Moderna, setting off alarms across the pharmaceutical industry, complaints about the surprise move eventually reached Trump.
The president responded angrily, berating FDA Commissioner Marty Makary over the decision, two people familiar with the episode told CNN. The FDA has subsequently said it will now review the flu shot, after Moderna submitted a revised proposal.
Trump must also contend with broader skepticism of his health agenda, including among some of the Republican lawmakers he’s counting on to line up behind his priorities. Despite the fanfare surrounding Trump’s ability to strong-arm drugmakers into lowering some prices, there’s still hesitation among conservatives about trying to codify an approach first popularized by prominent progressives like Sen. Bernie Sanders.
The president’s Great Healthcare Plan faces even longer odds. Republicans have only a narrow majority in the House, dwindling enthusiasm in the Senate for another big legislative push and, despite Trump’s urging, little unified support for spending the last stretch before the midterms on a topic that’s burned them numerous times before.
“Trump gets that it’s a problem and he needs to talk about it, but he has the same problem we’ve traditionally had,” said veteran Republican strategist Doug Heye. “We’ve never been able to really demonstrate what we’re for.”
Kristen Holmes contributed to this report.
Donald Trump Prescription drugs Health care policy