Meeting in an auditorium at Case Western University and the Cleveland Clinic, the incumbent Republican president and his Democratic challenger constantly answered questions about the economy, race relations and the federal judiciary by concentrating on the nation's most searing health care issues.
The emphasis on health care began almost immediately when the debate's moderator, Fox News' Chris Wallace, asked the candidates to discuss Trump's nomination of Seventh Circuit Judge Amy Coney Barrett to replace the late Justice Ruth Bader Ginsburg on the U.S. Supreme Court.
"What's at stake here is the president's made it clear he wants to get rid of the Affordable Care Act," Biden quickly responded, adding that 20 million people would lose health benefits and 100 million Americans would lose the ACA's protections for people with preexisting conditions.
Trump retorted by asserting that "the 100 million people [figure] is totally wrong." He also tried to turn the tables on Biden by alleging that the former vice president would kowtow to "socialist" lawmakers who want to replace private insurance with a government-run program.
"The bigger problem that you have is that you're going to extinguish 180 million people with their private health care," the president said.
"That is simply not true," Biden replied, noting that his health care agenda calls for larger premium assistance and a public insurance plan as an alternative to private coverage.
Conservatives have warned that a public option would undermine a well-functioning private insurance market.
The conversation swiftly moved on to reproductive rights, with Biden averring that "the president also is opposed to Roe v. Wade, [and] that's on the ballot as well in the [Supreme] Court."
Trump replied, "It's not on the ballot. … You don't know [Barrett's] view on Roe v. Wade."
The fact that health care wound up in the spotlight was not surprising — polls have consistently found that voters rank it among the top issues in the 2020 election, and that they tend to give Biden a modest edge, while modestly favoring Trump on the economy.
Following up on his question about Judge Barrett, Wallace noted that the Supreme Court in November will hear arguments in a case aimed at invalidating the entire ACA. The moderator asked Trump about his failure to release a comprehensive replacement for the ACA if it is struck down.
"The individual mandate was the most unpopular aspect of Obamacare. I got rid of it," Trump replied, referring to GOP legislation that eliminated the mandate's financial penalty for noncompliance.
Trump continued by boldly promising that "drug prices will be coming down 80 or 90%" under his "most favored nation" executive order. The order would cap reimbursement for some drugs in Medicare at the lowest price paid in certain economically comparable countries. Trump released the order only recently after years of failing to deliver on lofty goals of lower drug prices, and experts are skeptical it will be implemented anytime soon, if ever.
Biden countered that Trump "has no plan for health care." That was a theme the former vice president reprised several times on Tuesday, saying that Trump has "no plan" for quickly alleviating the coronavirus pandemic and "no plan" for safely reopening schools and businesses amid ongoing outbreaks.
In an extended back-and-forth over the pandemic, Trump predicted that the nation is "weeks away from a vaccine." It's possible that federal regulators will grant emergency authorization for a vaccine by November, but few observers expect doses to be widely distributed before early next year at the soonest.
"We're for a vaccine. But I don't trust him at all," Biden said, alluding to fears that Trump will pressure the U.S. Food and Drug Administration to prematurely authorize a COVID-19 vaccine before the Nov. 3 election.
A Washington Post column Tuesday authored by a bipartisan group of seven former FDA commissioners — including Trump's first one, Scott Gottlieb — said that the agency's tradition of science-based decision-making is "changing in deeply troubling ways" because of political meddling by the Trump administration. The ex-commissioners warned of "potentially dire" implications for public confidence in a COVID-19 vaccine.
When Trump assured viewers at one point that the government is "all set up" logistically to distribute hundreds of millions of vaccine doses, Biden sought to sow doubts about trusting the current White House occupant, citing several of his eyebrow-raising statements during the coronavirus crisis.
"This is the same man who told you by Easter, this would be gone away," Biden said. "By the warm weather, it'd be gone, miraculous, like a miracle. And by the way, maybe you can inject some bleach in your arm, and that would take care of it."
"That was said sarcastically, and you know that," Trump replied, referring to his strange suggestion in April that injections of disinfectant could do "a tremendous number on the lungs" of COVID-19 patients.
Trump on Tuesday night also attacked Biden's prominent role in responding to the swine flu pandemic that began in 2009, saying, "You didn't do very well on swine flu. H1N1. You were a disaster."
Biden replied by contrasting the swine flu's five-figure death toll with COVID-19's six-figure death toll: "14,000 people died, not 200,000. There was no economic recession."
When Wallace asked about racial unrest stemming from instances of police brutality, Biden again steered the conversation toward health care and the pandemic. He said that "one in 1,000 African Americans has been killed because of the coronavirus," and that Trump "has been disastrous for the African American community."
Trump responded by spotlighting Biden's role in passing anti-crime legislation in the 1990s that has been widely criticized as excessively harsh.
"You have treated the Black community about as bad as anyone in this country," Trump said.
The next debate in the presidential race, set for Oct. 7 in Salt Lake City, will pit Vice President Mike Pence against Biden's running mate, Sen. Kamala Harris of California. Trump and Biden will debate next on Oct. 15 in Miami.
--Editing by Michael Watanabe.
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