Representative-elect Alexandria Ocasio-Cortez, a Democrat from New York, smiles after a group photo with the 116th Congress outside the U.S Capitol in Washington, D.C., U.S., on Wednesday, Nov. 14, 2018. Congress returns to work this week with Democrats and Republicans promising to work together to avert a partial government shutdown and pass a handful of other bills, though President Donald Trump's demand to fund his border wall could blow up their plans. Photographer: Andrew Harrer/Bloomberg Rep. Alexandria Ocasio-Cortez (Photo: Andrew Harrer/BB)

President Donald Trump said Republicans “blew it” on health care and will lose the 2020 election if they don’t devise a plan to repeal Obamacare that protects coverage for people with pre-existing conditions.

“We blew it the last time, man I was fed a bill of goods,” Trump said Tuesday in a speech at the National Republican Congressional Committee’s annual spring dinner. “We can’t run away” from health care, he added, saying that if the party doesn’t address the issue: “We’ll lose.”

(Related: Trump May Not Try to Replace ACA Till After 2020 Elections)

Democrats “have health care right now and we need to take that away from them,” Trump said, laying out a strategy for the 2020 campaign. He said that Republicans would win back the House of Representatives if they campaign on a pledge to end Obamacare and replace it in their first vote following the election with a cheaper program that still protects sick people from being denied coverage by insurers.

Republicans have struggled mightily since Obamacare became law to reach consensus on such a plan.

‘Stone-Cold Crazy’

It wasn’t clear if Trump was aware that reporters had been allowed to cover his speech. At one point he said he expected it to be leaked to the press. Later, he said it would be dangerous for Democrats to win the 2020 election, calling them “stone-cold crazy.”

He used the address to stake out positions and potential themes for his own re-election campaign, and to assail and mock potential opponents and critics. The president singled out former Vice President Joe Biden, who’s been contemplating a bid for the Democratic nomination but come under scrutiny over allegations by two women of inappropriate contact. “I was going to say welcome to the world, Joe. You having a good time, Joe?” Trump told the gathering.

Trump also derided Democratic Rep. Alexandria Ocasio-Cortez, a progressive lawmaker from New York who has championed the so-called Green New Deal package of policies for combating climate change.

“The Green New Deal, done by a young bartender, 29 years old,” Trump said, referring to Ocasio-Cortez, who worked in a restaurant before entering politics. He urged Republicans to let Democrats proceed with the Green New Deal so that the GOP could run against it.

The failure by Republicans to overturn the Affordable Care Act has long been a sore point for the president. In recent weeks, however, he has again publicly attacked the late Sen. John McCain, who in 2017 cast the decisive vote against an Affordable Care Act-change bill that branded as a repeal of the health law, President Barack Obama’s signature domestic achievement.

The Affordable Care Act imposed many requirements on issuers of individual major medical insurance and funding for expanding access to Medicaid. It also included many other provisions, including funding for health care professional education programs, efforts to make Medicaid long-term care benefits programs more responsive to patients’ needs, a mechanism for narrowing the Medicare Part D prescription drug plan donut hole.

Both defenders and supporters have often talked about “Obamacare” without defining what parts of the Affordable Care Act they include in the term “Obamacare.”

In 2018, Republicans lost control of the House. Many Democratic campaigns focused voter attention on Obamacare-change legislation the Republican-controlled House had passed that would weaken protections for people with pre-existing conditions.

Trump said late Monday that Republicans would wait until after the 2020 election to vote on a replacement for Obamacare, abruptly halting a push he began just last week and guaranteeing that the issue will take center stage in his re-election campaign.

Surprising Allies

Trump’s announcement, again surprising Republican allies in Congress, ended a week-long scramble by GOP lawmakers to respond to Trump’s demand for an Obamacare alternative after the administration unexpectedly changed its position in a lawsuit, arguing that Obamacare should be entirely struck down by federal courts.

Senate Majority Leader Mitch McConnell, a Kentucky Republican, said Tuesday that he had told Trump in a phone call that the Senate wouldn’t consider another attempt to overhaul the health care system before the 2020 elections.

The administration’s new legal position is a political gift to Democrats who have vowed to defend the Affordable Care Act and its more popular elements, including insurance coverage protections for sick people and the Medicaid expansion program.

Trump has consistently said that the Republican alternative would cover pre-existing conditions, but he has not said what would happen to the price of coverage, or the benefits packages, for people with pre-existing conditions.

— Read Texas ACA Case Could Re-Open Medicare Part D Donut Holeon ThinkAdvisor.

— Connect with ThinkAdvisor Life/Health on LinkedIn and Twitter.

Copyright 2019 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.