Trump’s strategist argue his health care efforts are meant to reclaim the party’s advantage on the issue, a top concern for swing voters — and one that Democrats owned in the 2018 midterms. Democrats are accusing Republicans of trying to “sabotage” the Affordable Care Act and its insurance protections for preexisting conditions, a theme they will return to in the 2020 elections.

Trump’s advisers have been downplaying the failed effort to repeal Obamacare and they’ve insisted the president is doing big things on health care. Still, Trump showed he’s not ready to let go of that fight. He briefly criticized the late Sen. John McCain’s “thumbs down” vote that derailed the repeal effort — though he didn’t mention his former rival by name this time — and teased yet again the possibility of taking another run at the 2010 health care law after the election.

“If the Republicans take back the House, keep the Senate, keep the presidency — we’re gonna have a fantastic plan,” Trump said.

Trump in the wide-ranging speech praised his administration’s efforts on health care, including efforts to curb opioid overdoses and the new plan to end HIV transmission within a decade. He also touted efforts to take on drug makers and teased his plans to allow “safe and legal importation” of prescription drugs.

Some of the efforts he mentioned, though, have had a limited impact. A law expanding access to experimental medications to terminally ill patients has only helped a few people. And a rule requiring drug makers to disclose list prices in television advertisements has been blocked by a federal judge, though the administration has appealed the ruling.

Federal health officials said Thursday’s executive order is aimed at beefing up Medicare coverage and its rapidly growing offshoot run by private plans, Medicare Advantage. The order calls for bolstering telehealth services – which would reduce the need for visits at the doctor’s office for a frail population – and supplemental benefits Medicare Advantage plans can offer.

Enrollment in Medicare Advantage plans has swelled to more than 20 million, or more than a third of all Medicare beneficiaries, and is expected to keep rising. The Trump administration, with support from Congress in some case, has already expanded the scope of supplemental benefits insurers can offer, such as in-home services, transportation to the grocery store and park passes. Critics have accused the Trump administration of favoring Medicare Advantage over the traditional program, despite concerns that the government overpays insurers and seniors could face limited provider networks.

Trump’s order directed his government to expand Medicare Advantage beneficiaries’ access to tax-advantaged medical savings accounts. It also calls for his health department to propose ways for Medicare Advantage enrollees to receive cash rewards or rebates as a perk for saving the government money when they receive quality care.

The executive order also includes lower-profile initiatives the administration has already pursued, such as reducing the administrative burden on health care providers. The order calls for minimizing the time between FDA approval of a drug and Medicare’s determination of whether to cover the treatment.