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Trump’s Drug-Discount Cards Expected to Reach Medicare Recipients After Election

President Trump’s plan to send 33 million Medicare beneficiaries a card that can be used to help pay for as much as $200 in prescription drug costs won’t be completed until after the election, according to a person familiar with the plan.

The cards will be mailed in phases, with some likely going out later in October but most not until after the Nov. 3 presidential election, the person said. The Centers for Medicare and Medicaid Services is spending an estimated $20 million for administrative costs to print and send letters to Medicare beneficiaries informing them that they will be getting cards, the person said.

Plans for the overall drug-discount program have been sent to the Office for Management and Budget, the person said. It is unclear if or when the office will approve the program, which could cost $8 billion, the person said. The Centers for Medicare and Medicaid Services, which oversees Medicare designed for people 65 and older, is unable to say exactly when the cards will go out because the proposal is still at OMB. Beneficiaries will have two years to use the discount cards, the person said.

Low-income beneficiaries who don’t already get financial assistance for medications would likely get the cards, according to the person familiar with the planning, rather than everyone in Medicare Part D, which helps cover prescription drug costs for people 65 and older.

Mr. Trump surprised his own health-administration leaders on Sept. 24 when he announced the plan to mail out prescription drug cards. The discount cards were proposed by White House chief of staff Mark Meadows, said an administration official.

CMS officials rushed to figure out how the program could be structured and designed, according to two people familiar with the planning.

The proposed plan calls for funding the cards from two Medicare trust funds, according to the administration official. It would run out of a CMS office that tests new models for providing or paying for health care.

The program lets officials waive Medicare’s laws or standards to test if new initiatives increase efficiency and “economy of programs” without adversely affecting quality, according to CMS. These waiver programs have generally been required to show they won’t increase federal spending beyond what would have occurred without the test.

The drug-discount-card plan, for example, could be designed to test if people are more adherent to medications if they are given a discount, according to the administration official.

Democrats and other critics have said providing discounts doesn’t fit with the parameters or goals of the program, and they say it is unwise to tap the Medicare trust funds at the same time one of the funds is facing insolvency concerns.

Medicare is funded by two trust funds held by the U.S. Treasury. The trusts pay for hospital care and to administer the federal health-insurance program for people 65 and older and the disabled. They are funded through payroll taxes, income taxes paid on Social Security benefits and other sources.

The Medicare trust

2016 Presidential Election Led To More Heart Attacks, Strokes, Study Says

KEY POINTS

  • Data shows more heart attacks and stroke hospitalizations in the two days right after the 2016 presidential election
  • Sociopolitical stress may have triggered the cardiovascular events, researchers say
  • According to a recent survey, many people see the political climate of the country as a “significant source of stress”

Can political events trigger heart ailments? A new study found that more people were hospitalized with acute cardiovascular disease (CVD) in the days immediately following the 2016 presidential election than before it.

For the new study from the Harvard T.H. Chan School of Public Health and Kaiser Permanente, researchers looked at acute myocardial infarction (heart attack) and stroke diagnoses, as well as emergency diagnoses of chest pains and unstable angina among adults in the Kaiser Permanente data, which includes 4.6 million people.

The researchers compared data from the two days right after the election with the same two days in the week prior to it. They found that cardiovascular hospitalizations in the two days immediately after the elections was 1.6 times higher than the previous week. The rate of cardiovascular hospitalizations was 353.75 per 100,000 people in the two days prior to the election and it rose to 573.14 per 100,000 in the next two days.

“Results were similar across sex, age, and race/ethnicity groups,” the researchers wrote in the study report. They said the results could be a result of the sociopolitical stress people experienced at the time.

The risk for cardiovascular events is high after a stressor or trigger event, the researchers said. 

“The risk of onset of acute myocardial infarction (AMI) and stroke is increased within hours to days after psychological triggers, including anger, depression, anxiety, and stress,” the researchers wrote.

This includes major events such as earthquakes and terror attacks. For instance, there was 70% more evaluations of angina and myocardial infarction on the day of the Sept. 11 attacks. In this case, it appears that the “trigger” event may be the presidential election.

In a report published by the American Psychological Association (APA) in July, 77% of Democrats and 62% of Republicans said the political climate in the country is a “significant source of stress.”

In another nationwide survey by the APA, 68% of the adult respondents noted that the 2020 presidential election is a big source of stress. By comparison, the number was lower during the 2016 presidential election with 52%.

“This is a wake-up call for every health professional that we need to pay greater attention to the ways in which stress linked to political campaigns, rhetoric and election outcomes can directly harm health,” corresponding author David Williams, of Harvard T.H. Chan School, said in a news release.

Although the researchers noted that further studies were needed to understand the relationship between cardiovascular events and sociopolitical stress, the results could be a reminder for people to be more aware of their stress levels and take the necessary precautions to care for their cardiovascular health.

The study is published in the Proceedings of

2020 Election Live Updates: Trump Will Hit the Trail as the Barrett Hearings Begin

Here’s what you need to know:

Credit…Erin Schaff/The New York Times

The event that conservatives hoped would reshape the 2020 election is upon us: The Supreme Court confirmation hearings for Judge Amy Coney Barrett begin Monday at 9 a.m. Eastern time and promise to last most of the week. Republicans have regarded her nomination as an opportunity to reinvigorate voters on the right and refocus the broader electorate on matters other than the coronavirus pandemic.

So far, Judge Barrett’s appointment has not worked out that way. The White House event at which President Trump announced her election became a major transmission point for the coronavirus — Dr. Anthony S. Fauci called it a “super-spreader event” — and at least two Republican members of the Senate Judiciary Committee have been infected. Mr. Trump’s bout with the disease, and rising case counts across most of the country, have relegated the Supreme Court fight to the political background for most of the last few weeks.

There is still hope within the G.O.P. that Democrats might fumble the hearings in a way that could be politically useful to them — a concern some Democrats share, given the apparently diminished capacities of Senator Dianne Feinstein of California, the top Democrat on the panel that will screen the nomination. And at the very least, the hearings give Republicans something to talk about besides Mr. Trump and the virus, even if that is where most voters remain focused. That could be no small favor in red states where Senate seats are at stake.

It is unlikely, however, that Mr. Trump will cooperate with efforts to shift the spotlight this week. He is due on Monday to campaign in Florida, making his first in-person appearance outside Washington since he tested positive for the coronavirus. The president’s insistence on returning to the campaign trail while there are still huge unanswered questions about his medical condition, including about the continued presence of the coronavirus in his body and his ability to transmit it to others, has the potential to become a bigger story than the opening stages of the judicial confirmation process.

That may be doubly the case if Mr. Trump and his supporters continue their practice of flouting basic public-health guidelines for large events, as has been their tendency up to this point.

The question for Democrats — not just Joseph R. Biden Jr. but the party’s whole ticket — may be how much time and political capital they will put into making a strenuous public case against Judge Barrett, at a moment when Mr. Trump continues to serve up generous quantities of easier political fodder for the election that is only weeks away.

Credit…Anna Moneymaker for The New York Times

Trump seeks to put COVID-19 behind him, get back to election campaign

By Andrea Shalal

WASHINGTON (Reuters) – Donald Trump is no longer a transmission risk for COVID-19, his doctor said late on Saturday, as the U.S. president seeks to put his bout with coronavirus behind him and return to the campaign fray.

Trump, trailing his Democratic challenger Joe Biden in opinion polls, addressed supporters from a White House balcony on Saturday afternoon. He urged a crowd of hundreds of largely Black and Latino supporters to help get out the vote in the Nov. 3 election.

His physician Sean Conley said in a statement later that Trump had taken a test on Saturday showing he was no longer “a transmission risk to others,” and there was no longer evidence “of actively replicating virus.”

The White House had no immediate comment on whether Conley’s statement meant Trump had actually tested negative for the coronavirus.

Trump first revealed that he had tested positive on Oct. 2, and spent three days in hospital. The White House has not disclosed when Trump last tested negative.

Trump is eager to get back on the campaign trail after an absence of more than a week. He plans to travel to the key battleground state of Florida on Monday, followed by rallies in Pennsylvania and Iowa on Tuesday and Wednesday, respectively.

“I’m feeling great,” he told the crowd.

The president’s illness has cast a spotlight on the pandemic, which has infected nearly 7.7 million people in the United States and killed over 213,000. His administration has faced criticism for its handling of the crisis, and for its lax approach to mask-wearing and social distancing in the White House. At least 11 close Trump aides have tested positive for coronavirus.

Speaking firmly and with no sign of the raspy throat evident in recent interviews, Trump delivered a shorter-than-usual campaign speech.

He attacked Democrats as pursuing a “socialist” or even “Communist” agenda, and hailed his own record in fighting crime and boosting the U.S. economy, while flag-waving supporters cheered and chanted, “We love you.”

Democrats and some commentators criticized Saturday’s event for potentially exposing a new batch of supporters to the virus and for using a federal building as an election prop.

Asked about it in New Castle, Delaware, Biden said he hoped the president and his supporters were taking precautions.

“They should be socially distant and wearing masks,” he said. “It’s the only responsible thing to do.”

Trump standing alone at the event, was not wearing a mask as he spoke. In the crowd, most were wearing masks but not following social distancing guidelines.

Trump repeated past calls for states to reopen their economies even as new cases hit a two-month high on Friday. A Reuters analysis showed more than 58,000 infections were reported and hospitalizations in the Midwest hit a record for a fifth successive day.

Opinion polls show Biden with a substantial lead nationally, although with a narrower advantage in some of the states that may decide the election outcome.

(Reporting by Andrea Shalal and Jason

The Hill’s Campaign Report: Trump campaigns on Rush Limbaugh show l Democrats question Trump’s mental fitness l Coronavirus stimulus in doubt before election

Welcome to The Hill’s Campaign Report, your daily rundown on all the latest news in the 2020 presidential, Senate and House races. Did someone forward this to you? Click here to subscribe.

We’re Julia Manchester, Max Greenwood and Jonathan Easley. Here’s what we’re watching today on the campaign trail:

LEADING THE DAY:

Happy Friday! From talk of invoking the 25th Amendment to President TrumpDonald John TrumpBiden campaign raises over M on day of VP debate Trump chastises Whitmer for calling him ‘complicit’ in extremism associated with kidnapping scheme Trump says he hopes to hold rally Saturday despite recent COVID-19 diagnosis MORE’s two-hour call into the Rush Limbaugh show, it’s been another chaotic day in Washington to say the least.

Let’s get you up to speed.

The day kicked off with Democrats rolling out legislation that would establish a panel to examine a sitting president’s ability to perform their duties, and potentially to remove the commander in chief from office if they are found to be debilitated.

The legislation would invoke the 25th Amendment, which empowers Congress to create “a body” which, working with the vice president, can remove a president deemed “unable to discharge the powers and duties of his office.”

To be clear, any panel created by the legislation would apply to future administrations, but it’s a hit at Trump, who is facing questions from Democrats over his mental acuity in the wake of his coronavirus treatments. Speaker Nancy PelosiNancy PelosiOn The Money: Trump says talks on COVID-19 aid are now ‘working out’ | Pelosi shoots down piecemeal approach | Democrats raise questions about Trump tax audits Trump retweets reporter saying 25th Amendment is not equivalent to a ‘coup’ Trump responds to Pelosi bringing up 25th Amendment: ‘Crazy Nancy is the one who should be under observation’ MORE (D-Calif.), who unveiled the legislation, has openly questioned whether Trump’s COVID-19 treatments have impacted his decisionmaking skills.

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellOvernight Health Care: Regeneron asks for emergency authorization of coronavirus treatment Trump received | McConnell says he hasn’t visited White House in two months due to coronavirus | Employer-sponsored health insurance premiums rise 4 percent McConnell says he hasn’t visited White House in two months due to coronavirus Human Rights Campaign unveils its congressional scorecard ahead of election MORE (R-Ky.) blasted the legislation as “absolutely absurd.” The bill has no chance of being enacted this session, with Congress on recess and the Senate and White House currently controlled by Republicans.

Meanwhile, sources told The Hill that Trump and his aides offered Pelosi a $1.8 trillion coronavirus relief package. The latest figure is a jump from their last offer of $1.6 trillion. However, we don’t know yet if Pelosi will be willing to move down from her demand for a $2.2 trillion package.

Trump made news on the issue while he was on Limbaugh’s show this afternoon, saying he wanted a larger package than either Democrats or Republicans have offered. The comments

Trump campaigns on Rush Limbaugh show l Democrats question Trump’s mental fitness l Coronavirus stimulus in doubt before election

Welcome to The Hill’s Campaign Report, your daily rundown on all the latest news in the 2020 presidential, Senate and House races. Did someone forward this to you? Click here to subscribe.



a man wearing a suit and tie: The Hill's Campaign Report: Trump campaigns on Rush Limbaugh show l Democrats question Trump's mental fitness l Coronavirus stimulus in doubt before election


© Getty Images
The Hill’s Campaign Report: Trump campaigns on Rush Limbaugh show l Democrats question Trump’s mental fitness l Coronavirus stimulus in doubt before election

We’re Julia Manchester, Max Greenwood and Jonathan Easley. Here’s what we’re watching today on the campaign trail:

LEADING THE DAY:

Happy Friday! From talk of invoking the 25th Amendment to President Trump’s two-hour call into the Rush Limbaugh show, it’s been another chaotic day in Washington to say the least.

Let’s get you up to speed.

The day kicked off with Democrats rolling out legislation that would establish a panel to examine a sitting president’s ability to perform their duties, and potentially to remove the commander in chief from office if they are found to be debilitated.

The legislation would invoke the 25th Amendment, which empowers Congress to create “a body” which, working with the vice president, can remove a president deemed “unable to discharge the powers and duties of his office.”

To be clear, any panel created by the legislation would apply to future administrations, but it’s a hit at Trump, who is facing questions from Democrats over his mental acuity in the wake of his coronavirus treatments. Speaker Nancy Pelosi (D-Calif.), who unveiled the legislation, has openly questioned whether Trump’s COVID-19 treatments have impacted his decisionmaking skills.

Senate Majority Leader Mitch McConnell (R-Ky.) blasted the legislation as “absolutely absurd.” The bill has no chance of being enacted this session, with Congress on recess and the Senate and White House currently controlled by Republicans.

Meanwhile, sources told The Hill that Trump and his aides offered Pelosi a $1.8 trillion coronavirus relief package. The latest figure is a jump from their last offer of $1.6 trillion. However, we don’t know yet if Pelosi will be willing to move down from her demand for a $2.2 trillion package.

Trump made news on the issue while he was on Limbaugh’s show this afternoon, saying he wanted a larger package than either Democrats or Republicans have offered. The comments are a break with what his own White House is currently offering leaders on Capitol Hill.

McConnell said he does not expect the White House and Congress to reach a deal on a coronavirus spending package prior to Election Day.

And speaking of Trump’s call into Limbaugh’s show … the president spent a whopping two hours on the conservative talk radio program, in what the president’s reelection campaign dubbed the “largest radio rally in history.”

Trump spent the call lashing out as his usual targets, including the news media, Black Lives Matter and Democrats.

“To be with you two hours, you have no idea. It’s a great honor,” Trump told Limbaugh.

READ MORE:

Democrats unveil bill creating panel to gauge president’s ‘capacity,’ by Mike Lillis

Trump and allies try to reframe 25th Amendment

Democrats Zero In on President’s Fitness for Office as Election Looms

WASHINGTON — Speaker Nancy Pelosi, amplifying questions about President Trump’s fitness for office less than a month before the election, introduced legislation on Friday that would create a standing bipartisan group of outside experts tasked with evaluating the president’s mental and physical health and advising Congress on whether the commander in chief’s powers should be forcibly removed under the 25th Amendment.

The measure is certain to die at the end of the year, given that it would need a presidential signature to be enacted. But Democrats’ decision to promote it now — after the president’s coronavirus diagnosis and as Ms. Pelosi has suggested that his treatment might be affecting his judgment — was an unmistakable dig at the sitting president’s capacity to govern, just weeks before voters go to the polls.

“A president’s fitness for office must be determined by science and facts,” Ms. Pelosi said at a news conference on Capitol Hill, where she insisted that the bill, a version of which was introduced before Mr. Trump was hospitalized with the virus, had nothing to do with him. “This legislation applies to future presidents, but we are reminded of the necessity of action by the health of the current president.”

The measure, sponsored by Representative Jamie Raskin, Democrat of Maryland, would create a bipartisan commission of health experts, doctors and former senior executive branch officials, such as a former president, selected by top congressional leaders, to report to Congress on the president’s competence.

Mr. Trump has raged against the idea, calling Ms. Pelosi “Crazy Nancy” and accusing her of staging a coup, and on Friday suggested that Democrats had proposed the measure because they were concerned not about his competence, but about that of former Vice President Joseph R. Biden Jr., his Democratic rival.

“Crazy Nancy Pelosi is looking at the 25th Amendment in order to replace Joe Biden with Kamala Harris,” Mr. Trump said on Twitter. “The Dems want that to happen fast because Sleepy Joe is out of it!!!”

Republicans blasted the legislation as an attempt to overturn the results of the 2016 election.

“Right here in this last three weeks before the election, I think those kinds of wild comments should be largely discounted,” Senator Mitch McConnell, the majority leader, told reporters in his home state of Kentucky.

Congress has never invoked the 25th Amendment to assemble a group like the one being proposed. The amendment was ratified in 1967, in the wake of President John F. Kennedy’s assassination, to prepare the country for an immediate transfer of power because of an emergency or illness. It directs the vice president to work with a commission to determine whether the president is “unable to discharge the powers and duties of his office,” and could forcibly transfer those powers to the vice president until the president recovered.

Mr. Raskin argued on Friday that the saliency of convening such a commission had been underscored by the pandemic, and said that he wished Congress had set up the panel

New England Journal Of Medicine Takes Stance On Presidential Election For First Time

If you had a nickel for every time you’ve heard the phrase “unprecedented times” this year, you’d probably have a lot of nickels. Well, here’s another thing that’s truly been unprecedented: major scientific journals telling you to not vote for one of the major candidates in an upcoming U.S. Presidential election. For the first times in their long histories, The Lancet and Scientific American have clearly urged people to not re-elect current U.S. President Donald Trump this November 3. Scientific American went one step further by endorsing Democratic challenger and former Vice President Joe Biden for President, as Tommy Beer described for Forbes. And now a third prestigious scientific journal, The New England Journal of Medicine (NEJM), has taken a stance with an editorial entitled, “Dying in a Leadership Vacuum.” Take a wild guess from the title as to what they may think of the Trump administration.

Yep, “Dying in a Leadership Vacuum,” may sound like the life and times of a dust ball and how an encounter with a vacuum cleaner really sucks. But in this case, it summarized what the Editors for NEJM wrote about the Trump administration’s continuing response to the current Covid-19 coronavirus pandemic. And spoiler alert, it was not positive, unless you count positively scathing as positive. They described the pandemic as a “test of leadership” and “here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.”

In the immortal words of Tag Team, whoomp! There it is. It’s really the first time since since its founding in 1812 that the esteemed medical journal has taken a clear position on a U.S. presidential election. That was a streak of about 208 years, which is approximately 7592 Scaramuccis, that has now been broken. This is by no means small news in the scientific and medical communities. Some scientists and physicians avoid discussing Presidential politics like a radioactive piece of Shoofly pie covered in sludge. But as many prominent scientists have recently point out, the upcoming election is no longer about “partisanship.” When major scientific journals have to take such a stance, you know the upcoming election is not your typical election.

The editorial went on to state that “the magnitude of this failure is astonishing,” and point out how the U.S. “had ample warning,” but was “incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care

Trudeau prepares for possible ‘disruptions’ after U.S. election outcome; Edmonton faces new voluntary restrictions

On Thursday, Oct. 8, Prime Minister Justin Trudeau said that Canada needs to be ready for “all outcomes” of the U.S. presidential election, such as if there are any “disruptions” following the result.

Trudeau shared his thoughts on the controversy in the U.S., after announcing a $295 million investment from the federal government into a Ford Motor Co. assembly complex in Ontario. The investment, which was matched by Premier Doug Ford’s provincial government, will make it a global hub for battery electric vehicle production.

In Alberta, a record-high spike of 364 new daily cases was announced. Dr. Deena Hinshaw said that a worrisome trend may have developed in its epicentre of Edmonton — where new voluntary restrictions have been introduced — because some people will only follow public health recommendations if they’ve been “personally impacted” by COVID-19.

In Prince Edward Island, the province’s top doctor raised concern about the current “Atlantic bubble,” after an outbreak was reported in New Brunswick, where there are now more active cases than the rest of the Atlantic provinces combined. In New Brunswick, officials announced new mandatory mask restrictions on Thursday, while they also suspended non-essential travel between itself and a Quebec border community.

For more on today’s top stories and the spread of the novel coronavirus across the country, please refer to our live updates below, as well as our COVID-19 news hub.

Trudeau’s focus on Canada’s COVID-19 response, not U.S. election debates

Prime Minister Justin Trudeau was asked repeatedly to share his thoughts regarding the U.S. presidential election, especially on Canada’s response if Donald Trump doesn’t accept Nov. 3’s results.

It’s a rumour that has gained traction with Trump and U.S. Vice President Mike Pence not providing clear answers as to how they would respond to potential defeat in the 2020 election, such as if there will be a peaceful transfer of power.

The prime minister on Thursday said that he’s watched “clips” from both the U.S. presidential and vice-presidential debates, but “my focus right now needs to be on keeping Canadians safe and working with premiers across this country to engage in everything we need to do to control this second wave.”

“Of course what happens in the United States is going to be impacting Canada after the election. But our job is to be ready for all outcomes.”

Trudeau was then pressured to elaborate on what “all outcomes” could mean. 

“Well I think we’re certainly all hoping for a smooth transition or a clear result from the election, like many people are around the world,” said Trudeau. “If it is less clear, there may be some disruptions and we need to be ready for any outcomes, and I think that’s what Canadians would expect of their government, and we’re certainly reflecting on that.”

The prime minister said that he doesn’t comment or weigh in on American political processes.

Trump has repeatedly questioned the integrity of the upcoming U.S. election due to the significant amount of Americans who will be

Verma, Meadows push to finalize $200 drug-card plan for seniors by Election Day

Caught by surprise by President Donald Trump’s promise to deliver drug-discount cards to seniors, health officials are scrambling to get the nearly $8 billion plan done by Election Day, according to five officials and draft documents obtained by POLITICO.



a person posing for the camera: Seema Verma, administrator of the Centers for Medicare and Medicaid Services.


© Tasos Katopodis/Getty Images
Seema Verma, administrator of the Centers for Medicare and Medicaid Services.

The taxpayer-funded plan, which was only announced two weeks ago and is being justified inside the White House and the health department as a test of the Medicare program, is being driven by Centers for Medicare and Medicaid Services Administrator Seema Verma and White House chief of staff Mark Meadows, the officials said. The administration is seeking to finalize the plan as soon as Friday and send letters to 39 million Medicare beneficiaries next week, informing seniors of Trump’s new effort to lower their drug costs, although many seniors would not receive the actual cards until after the election.

The $200 cards — which would resemble credit cards, would need to be used at pharmacies and could be branded with a reference to Trump himself — would be paid for by tapping Medicare’s trust fund.

“The goal is to begin the test by distributing cards starting in October 2020,” according to a draft proposal circulated within the White House last week and obtained by POLITICO.

Career civil servants have raised concerns about the hasty plan and whether it is politically motivated, particularly after Verma pushed Medicare officials to finalize the plan before the Nov. 3 election, said two officials.

The plan to lower seniors’ drug costs comes as administration officials grapple with Trump’s falling support among older Americans, a significant threat to his re-election. Trump is currently lagging challenger Joe Biden by as much as 27 points in recent polls among Americans ages 65 and older, a major reversal from the 2016 campaign, with seniors now voicing concerns about Trump’s handling of the coronavirus pandemic and his chaotic leadership style.

“This has nothing to do with politics. It’s good policy and demonstrates the president is continuing to deliver on his promises to our nation’s seniors,” said Judd Deere, a White House spokesperson. The White House did not make Meadows available for an interview.

CMS did not make Verma available for interviews and declined comment.

Democrats have dismissed the cards as a “gimmick” that will do little to achieve Trump’s 2016 campaign pledge of lowering drug prices.

“It’s a shameless stunt that steals billions from Medicare in order to fund a legally dubious scheme that’s clearly intended to benefit President Trump’s campaign right before Election Day,” said Rep. Frank Pallone, the chairman of the House Energy and Commerce committee.

The administration previously ordered that Trump’s name appear on millions of stimulus checks sent out by the IRS this spring, which Democrats have alleged was an effort for the president to take credit for a congressional relief package.

Trump abruptly announced the drug-discount cards on Sept. 24, a last-minute decision that surprised even some of his own