An executive order signed by President Trump to expand Medicare Advantage is being criticized for expanding the scope of Medicare plans contracted out to private companies.

President Trump signed an executive order on Thursday in an effort to expand private Medicare plans and slam Democrats for putting “Medicare under threat like never before.” Trump delivered a campaign-style rally at the country’s largest retirement community in Florida in a largely conservative part of the swing-state.

“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience.

Critics point to the Trump administration’s budget proposal, which would cut $845 billion from Medicare over 10 years, as evidence of the hollowness of the president’s pledge to protect the healthcare program. Others note that his administration has failed to end the ban on Medicare negotiating lower drug costs for prescriptions.

The Trump administration, meanwhile, argues it has taken steps to push for more generic drug approvals, import some drugs from Canada, and increase price transparency from hospitals negotiating with insurers.

“Medicare is under threat like never before,” Trump told the crowd. “These people on the other side—these people are crazy by the way, they’re totally crazy—they want to take it away and give you lousy healthcare,” Trump said of Medicare for All supporters. “They want to raid Medicare to fund a thing called ‘socialism.'”

Medicare, Healthcare to Weigh Heavily in 2020 Election

While all of the Democratic candidates support expanding public coverage, Sen. Bernie Sanders’ plan is the only one that would put all Americans under a single health insurance policy. Supporters of Sanders’ plan point to studies like a Political Economy Research Institute (Peri) at the University of Amherst analysis showing that Medicare-for-All would save trillions over a decade.

Medicare-for-All proponents note that spending on healthcare in the US is currently more than twice the average of the world’s 35 advanced economies, yet Americans have worse outcomes in life expectancy and infant mortality than other developed countries with universal healthcare. They argue the profit-driven model in the US has allowed for price-gouging in hospitals, drug prices and ambulances, bloated administrative costs, wasted funds on drug advertising, and weaker coverage by insurance companies.

Progressives argue these factors inhibit Americans from going to the doctor when they are sick, which can increase costs when their illnesses grow more severe, and claim the dependence on employer-provided health insurance hurts workers and stymies entrepreneurship.

Analysts view Trump’s executive order as an effort to carve his 2020 campaign’s lane in the healthcare debate, where he has so far failed to deliver on his 2016 campaign promise to lower drug costs and repeal and replace Obamacare.

The executive order was originally called “Protecting Medicare From Socialist Destruction,” but changed to “Protecting and Improving Medicare for Our Nation’s Seniors” before Mr. Trump’s speech.

Executive Order Condemned for Expanding Medicare Privatization

Critics, like journalist David Dayen, view it more as “backdoor privatization of Medicare while nobody was paying attention.” The plan would expand Medicare Advantage, which are the plans offered by private companies who contract with Medicare. Trump’s order also called for reducing fraud and lowering costs in the Advantage programs, which currently covers around a third of the 60 million seniors who use Medicare.

“Medicare Advantage is stealth privatization intended to undermine traditional Medicare, which is an effective, popular government program and therefore loathed by Republican ideologues,” said Social Security Works President Nancy Altman, as per Common Dreams. “Today’s executive order is yet another giveaway to the corporations that run Medicare Advantage plans.”

“Ironically,” Altman continued, “the Trump administration is framing the executive order as an attack on Medicare for All. In fact, the massive flaws of Medicare Advantage epitomize the need to get for-profit greed out of health care by improving Medicare and expanding it to cover all Americans.”

Trump Medicare Announcement: White House or Campaign Event?

Trump used the White House event to call the Democratic presidential candidates “maniacs,” and said the “radical left” was “consumed by rage and radicalism and insatiable lust.” He said that House Democrats had initiated impeachment proceedings because “they know they can’t beat us fairly,” and alluded to the pharmaceutical industry as a potential supporter of his impeachment, because of his avowed commitment to lowering drug costs.

Critics argue that the speech, which was billed as a White House event rather than a Trump campaign rally and therefore paid for with taxpayer funds, should not be used to campaign against rivals like “Sleepy Joe” Biden and “Pocahontas,” what the president calls Sen. Elizabeth Warren.

“In a free and open democracy, the government doesn’t use taxpayer resources to keep itself in power,” Jordan Libowitz, communications director for Citizens for Responsibility and Ethics in Washington (CREW) told Vox in reference to a Trump speech at a Pennsylvania Shell plant in August. “That’s what authoritarian dictatorships do.”