If the Affordable Care Act were repealed, “it would mean more than a hundred million Americans would lose coverage for pre-existing conditions.”
President Joe Biden in a campaign ad, May 8
President Joe Biden’s reelection campaign wants voters to compare his record on healthcare policy to that of his predecessor. In May, Biden’s campaign began airing a month-long, $14 million ad campaign targeting swing-state voters and minority groups with spots on TV, digital and radio.
In the ad, titled “SackedBiden attacked former President Donald Trump for his past promises to dismantle the Affordable Care Act, also known as Obamacare. Biden also warned of the potential impact if Trump returned to office and attempted a repeal again.
“This would mean that more than a hundred million Americans would lose protections for pre-existing conditions,” Biden said in the ad.
With less than six months left before election day, The surveys show Trump is leading Biden by a narrow margin in most swing states. And voters believe that Trump will handle issues like inflation, crime and the economy better.
One ABC News/Ipsos poll A poll of about 2,200 adults released in early May shows that the key policy issues on which Biden scored higher than Trump were health care and access to abortion. So, it’s no surprise that the campaign is emphasizing that Biden scored higher than Trump on these issues. those topics central Reacting to the message Biden was sending voters, he said, “This is a huge mistake. This is a huge mistake.”
So, we did a thorough fact-check of Biden’s claim.
Calculating a Pre-Existing Condition
The idea that 100 million Americans are living with one or more pre-existing conditions is not new. It was a topic of debate between then-candidate Biden and then-President Trump during their last election in 2020. Biden cited that statistic in an article. Presidential debates”There aren’t 100 million people who are already suffering from some disease,” Trump responded.
KFF Health News/PolitiFact health check up Biden’s claim was considered “mostly true” at the time, with estimates of the number of Americans with pre-existing conditions ranging considerably larger — from 54 million to 135 million. Estimates on the lower end consider “pre-existing conditions” to be more serious chronic conditions like cancer or cystic fibrosis. Estimates on the higher end of the spectrum include people with more common health problems like asthma and obesity, and behavioral health disorders like substance use disorder or depression.
Biden’s May ad focused on how many people would be left vulnerable if protections for people with pre-existing conditions were eliminated. This is a subject of some debate. To understand this, we need to separate the protections put in place by the ACA from those that exist separately.
Before and after
Before the ACA’s pre-existing condition protections went into effect in 2014, insurers Individual Marketplace — people buying coverage for themselves or their families — can charge higher premiums to people with certain conditions, restrict coverage of specific procedures or drugs, set annual and lifetime coverage limits on benefits, or refuse coverage to people at all.
“Insurance companies use a variety of practices to protect themselves from the costs associated with already sick people,” he said. Sabrina CorlettCo-director of the Center for Health Insurance Reform at Georgetown University and an expert on health insurance markets.
Insurance companies that provide coverage to large employers may impose long waiting periods before employees’ benefits begin. And although employer-sponsored plans cannot discriminate against individual employees based on their health conditions, small-group plans for businesses with fewer than 50 employees can raise costs for everyone if a large number of employees at a company have such conditions. This may lead some employers to stop offering coverage.
“The insurer would say, ‘Because you have three people with cancer, we’re going to increase your premiums dramatically,’ and so it becomes difficult for the small employer to continue to provide coverage to their employees because the coverage is simply not affordable,” he recalls. Edwin ParksA research professor at Georgetown University’s McCourt School of Public Policy who researches public health insurance markets.
As a result, many people with pre-existing medical conditions experienced what some researchers call “Job LockPeople felt trapped in their jobs because they feared they wouldn’t be able to find health insurance anywhere else.
Some basic pre-existing condition protections exist independently of the ACA. Health Insurance Portability and Accountability ActFor example, it restricted how insurers could limit coverage and mandated that employer-sponsored group plans could not refuse to cover a person because of his or her health status. Medicare and Medicaid similarly cannot deny coverage based on health background, although age- and income-based eligibility requirements mean many Americans are not eligible for that coverage.
Once the ACA’s pre-existing condition protections went into effect, plans sold in the individual market had to offer a comprehensive package of benefits to all buyers, regardless of their health status.
Still, some conservatives say Biden’s claim overstates how many people are affected by Obamacare protections.
He said that if you consider even the broadest definition of the number of Americans living with such conditions, “there’s no way you can prove that 100 million people would lose coverage without ACA protections.” Theo MerkelWho was a health policy adviser to the Trump administration and is now a senior research fellow at the Paragon Health Institute and a senior fellow at the Manhattan Institute for Policy Research, a conservative think tank.
Joseph Antos, a senior fellow at the conservative think tank American Enterprise Institute, called the ad’s pre-existing conditions claim “the usual sham.” To reach the 100 million people affected, “you have to assume that a large number of people will lose coverage.” And that’s unlikely to happen, he said.
That’s because most people – about 55% of Americans according to the latest survey – Government Data — get health insurance through their employers. As such, they are protected by Health Insurance Portability and Accountability Act rules, and their plans won’t change if the ACA expires, at least in the short term.
Antos said major insurance companies, which have been operating under the ACA for more than a decade, would maintain the status quo even without such protections. “The negative publicity would be staggering,” he said.
He said that those who lose their jobs will become insecure.
But Corlett argued that losing ACA protections could lead to Americans being priced out of their plans, as health insurers would again begin offering medical insurance in the individual market.
Many businesses may also slowly be priced out of their policies, Park predicted.
“Companies that have older, less healthy workers will see their premiums increase compared to other smaller employers,” he told KFF Health News.
Plus, Park said, every time people lose their job or change jobs, they risk losing their insurance, and going back to the old days of staying on the job.
“In any given year, the number [of people affected] “The number will be much less than 100 million, but all of those 100 million people will be at risk of being discriminated against because of their pre-existing conditions,” Park said.
Our Decision
We previously debunked Biden’s claim that 100 million Americans already have pre-existing conditions At the ballparkAnd there is nothing to suggest that this has changed. Depending on the definition, the number may be lower, but it could be even higher and has likely increased since 2014.
Although Biden’s claim about how many people would be affected if these protections were eliminated seems accurate, it’s unclear what a return to the pre-ACA status quo would look like.
While campaigning this year, Trump promised — as he has many times in the past — that Change the health law With something better. But he never laid out a replacement plan. Biden’s claim should not be judged by his lack of specificity.
We rate Biden’s claim as Mostly True.
Our Sources
ABC News/Ipsos poll, “Six months later, the presidential race remains tight with clashes between issues and characteristicsMay 5, 2024
Avalere, “Repealing the ACA’s pre-existing condition protections could affect the health security of more than 100 million peopleOctober 23, 2018
Biden-Harris 2024 campaign email, “New ad: Biden-Harris 2024 launches ‘Terminate’ criticizing Trump for attacks on healthcare,” May 8, 2024
Center for American Progress,”Number of Americans with pre-existing diseases by district for the 116th Congress2 October 2019
census Bureau, “Health Insurance Coverage in the United States: 2022,” September 2023
CNN, “Trump administration gives states new power to undermine ObamacareOctober 22, 2018
Department of Health and Human Services, “Health insurance coverage for Americans with pre-existing conditions: The impact of the Affordable Care ActJanuary 5, 2017
Department of Health and Human Services, “Health Insurance Portability and Accountability Act (HIPAA) 1996 Useful Tipsaccessed 15 May 2024
Email exchange with Biden-Harris 2024 campaign official, May 13-15, 2024
Email exchange with Trump 2024 campaign national press secretary Caroline Levitt, May 13, 2024
KFF,”KFF Health Tracking Poll: Public Views on the ACA15 May 2024
KFF,”Recent trends in mental health and substance abuse concerns among adolescentsFebruary 6, 2024
KFF Health News,”Dipping into the ‘high risk insurance pool’ – $18,000 a yearFebruary 27, 2017
KFF Health News and PolitiFact,”Biden is divided on how many people have pre-existing conditionsOctober 1, 2020
the new York Times, “Trump leads in 5 key states, while young and black voters express dissatisfaction with Biden13 May 2024
Phone interviews and email exchanges Theo MerkelSenior Fellow at the Manhattan Institute and Director of the Private Health Reform Initiative at the Paragon Health Institute, May 14-15, 2024
Phone Interview Edwin ParksResearch Professor at Georgetown University’s McCourt School of Public Policy, May 22, 2024
Phone Interview Sabrina CorlettCo-Director of the Center for Health Insurance Reform at Georgetown University, May 14, 2024
Truthsocial.com, Posted by @realDonaldTrumpNovember 25, 2023
The Wall Street Journal, “Healthcare.gov will be closed for maintenance during the enrollment periodSeptember 23, 2017
Work, Aging and Retirement,”Job lock, work, and psychological well-being in the United StatesFebruary 19, 2016
YouTube.com/@CSPAN, “First presidential debate of 2020 between Donald Trump and Joe BidenSeptember 29, 2020
YouTube.com/@JoeBiden,”Sacked” Campaign ad, May 10, 2024
Phone interview with Joseph Antos, senior fellow at the American Enterprise Institute, June 5, 2024
Health Matters, What does it mean to cover pre-existing conditions11 September 2020
KFF, Pre-existing conditions and medical underwriting in the individual insurance market before the ACADecember 12, 2016
PolitiFact,”Does Trump want to repeal the ACA, as Biden says? Take a look at his changing stance over the years3 June 2024
bidens-on-target-about-what-repealing-aca-would-mean-for-preexisting-condition-protections-kff-health-news
