President Joe Biden’s reelection campaign wants voters to contrast his record on health care policy with his predecessor’s. In May, Biden’s campaign began airing a monthlong, $14 million ad campaign targeting swing-state voters and minority groups with spots on TV, digital, and radio.
In the ad, titled “Terminate,” Biden assails former President Donald Trump for his past promises to overturn the Affordable Care Act, also known as Obamacare. Biden also warns of the potential effect if Trump is returned to office and again pursues repeal.
“That would mean over a hundred million Americans will lose protections for preexisting conditions,” Biden said in the ad.
Less than six months from Election Day, polls show Trump narrowly leading Biden in a head-to-head race in most swing states. And voters trust Trump to better handle issues such as inflation, crime, and the economy by significant margins.
An ABC News/Ipsos poll of about 2,200 adults, released in early May, shows the only major policy issues on which Biden received higher marks than Trump were health care and abortion access. It’s no surprise, then, that the campaign is making those topics central to Biden’s pitch to voters.
As such, we dug into the facts surrounding Biden’s claim.
Preexisting Condition Calculations
The idea that 100 million Americans are living with one or more preexisting conditions is not new. It was the subject of a back-and-forth between then-candidate Biden and then-President Trump during their previous race, in 2020. After Biden cited that statistic in a presidential debate, Trump responded, “There aren’t a hundred million people with preexisting conditions.”
A KFF Health News/PolitiFact HealthCheck at the time rated Biden’s claim to be “mostly true,” finding a fairly large range of estimates — from 54 million to 135 million — of the number of Americans with preexisting conditions. Estimates on the lower end tend to consider “preexisting conditions” to be more severe chronic conditions such as cancer or cystic fibrosis. Estimates at the spectrum’s higher end include people with more common health problems such as asthma and obesity, and behavioral health disorders such as substance use disorder or depression.
Biden’s May ad focuses on how many people would be vulnerable if protections for people with preexisting conditions were lost. This is a matter of some debate. To understand it, we need to break down the protections put in place by the ACA, and those that exist separately.
Before and After
Before the ACA’s preexisting condition protections took effect in 2014, insurers in the individual market — people buying coverage for themselves or their families — could charge higher premiums to people with particular conditions, restrict coverage of specific procedures or medications, set annual and lifetime coverage limits on benefits, or deny people coverage.
“There were a number of practices used by insurance companies to essentially protect themselves from the costs associated with people who have preexisting conditions,” said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University and an expert on the health insurance marketplace.
Insurers providing coverage to large employers could impose long waiting periods before employees’ benefits kicked in. And though employer-sponsored plans couldn’t discriminate against individual employees based on their health conditions, small-group plans for businesses with fewer than 50 employees could raise costs across the board if large numbers of employees in a given company had such conditions. That could prompt some employers to stop offering coverage.
“The insurer would say, ‘Well, because you have three people with cancer, we are going to raise your premium dramatically,’ and therefore make it hard for the small employer to continue to offer coverage to its workers because the coverage is simply unaffordable,” recalled Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy who researches public health insurance markets.
As a result, many people with preexisting conditions experienced what some researchers dubbed “job lock.” People felt trapped in their jobs because they feared they wouldn’t be able to get health insurance anywhere else.
Some basic preexisting condition protections exist independent of the ACA. The 1996 Health Insurance Portability and Accountability Act, for example, restricted how insurers could limit coverage and mandated that employer-sponsored group plans can’t refuse to cover someone because of a health condition. Medicare and Medicaid similarly can’t deny coverage based on health background, though age and income-based eligibility requirements mean many Americans don’t qualify for that coverage.
Once the ACA’s preexisting condition protections kicked in, plans sold on the individual market had to provide a comprehensive package of benefits to all purchasers, no matter their health status.
Still, some conservatives say Biden’s claim overstates how many people are affected by Obamacare protections.
Even if you consider the broadest definition of the number of Americans living with such conditions, “there is zero way you could justify that 100 million people would lose coverage” without ACA protections, said Theo Merkel, who was a Trump administration health policy adviser and is now a senior research fellow with 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 American Enterprise Institute, a conservative think tank, called the ad’s preexisting conditions claim “the usual bluster.” To reach 100 million people affected, he said, “you have to assume that a large number of people would lose coverage.” And that’s unlikely to happen, he said.
That’s because most people — about 55% of Americans, according to the most recent government data — receive health insurance through their employers. As such, they’re protected by the Health Insurance Portability and Accountability Act rules, and their plans likely wouldn’t change, at least in the short term, if the ACA went away.
Antos said major insurance companies, which have operated under the ACA for more than a decade, would likely maintain the status quo even without such protections. “The negative publicity would be amazing,” he said.
People who lose their jobs, he said, would be vulnerable.
But Corlette argued that losing ACA protections could lead to Americans being priced out of their plans, as health insurers again begin medical underwriting in the individual market.
Park predicted that many businesses could also gradually find themselves priced out of their policies.
“For those firms with older, less healthy workers than other small employers, they would see their premiums rise,” he told KFF Health News.
Moreover, Park said, anytime people lost work or switched jobs, they’d risk losing their insurance, reverting to the old days of job lock.
“In any given year, the number [of people affected] will be much smaller than the 100 million, but all of those 100 million would be at risk of being discriminated against because of their preexisting condition,” Park said.
Our Ruling
We previously ruled Biden’s claim that 100 million Americans have preexisting conditions as in the ballpark, and nothing suggests that’s changed. Depending on the definition, the number could be smaller, but it also could be even greater and is likely to have increased since 2014.
Though Biden’s claim about the number of people who would be affected if those protections went away seems accurate, it is unclear how a return to the pre-ACA situation would manifest.
On the campaign trail this year, Trump has promised — as he did many times in the past — to replace the health law with something better. But he’s never produced a replacement plan. Biden’s claim shouldn’t be judged based on his lack of specificity.
We rate Biden’s claim Mostly True.
–Jacob Gardenswartz, Politifact and Kaiser Health News
Laurel says
All the claims Trump said he would do, didn’t happen the four years he was President. I have no idea why people think he would do any of it now, if in office again. No logic. Well, he did give the rich a major tax break.
Man, is he gonna mess things up if he gets in! I mean, c’mon, as a businessman, he screwed up vodka! How do you screw up vodka?
Pogo says
@As stated
https://www.google.com/search?q=2000+nh+presidential+vote
And
https://www.google.com/search?q=2000+fl+presidential+vote
If only…
Thanks, Ralph.
Jackson says
The Republican “health care plan” was always to repeal the Affordable Care Act taking health insurance away from 20 million Americans. Period. No other proposal was ever offered. Helping the average working family is apparently way too complicated for Repubs.
Joe D says
Laurel:
I’m FAIRLY sure that former president TRUMP TRIED to repeal the Affordable Care Act. With a Democratic majority in Congress at the time, he didn’t have the VOTES to do it ( it’s not a law you can REVERSE by just “saying so”). He couldn’t do it by presidential decree.
As a Clinical Nurse Therapist and a Certified Nurse Case Manager (now retired) at a major East Coast University teaching hospital, I can tell you that Trump shortened the OPEN enrollment period for coverage to the shortest time period EVER! I can also tell you he SLASHED the Federal advertising budget to let citizens know they were eligible for coverage, and that the enrollment restriction was EXTREMELY short during his tenure as president.
As far as the 100 million people who could lose coverage, if the ACA provisions for “pre-existing conditions statistic, I can’t verify that number personally.
What can vouch for is the WIDE RANGE of conditions which could be used to deny insurance coverage, if you quit your job, get fired, take a promotion at another job. EACH of those working status changes could result in your NEW job’s insurance company saying they won’t cover you.
Conditions such as Diabetes /HISTORY of Cancer ( you don’t even have to have active cancer NOW)/ heart disease/ HIGH BLOOD PRESSURE/ PREGNANCY (oh yes!)/ Obesity (defined by a BMI-Body Mass Index over 25…Google the calculation for finding yours…you might be surprised)! Drug/alcohol treatment/ chronic mental illness ( like depression/bipolar/ ADHD/Anxiety). The pre-existing condition doesn’t even have to be YOURS …it can be your child’s or covered partner’s condition.
I would be quite surprised if the total number of US citizens with pre-existing conditions WOULDN’T be at least ClOSE to 100 million. Believe me, the major INSURANCE companies have a fairly accurate tally of who would fall under the coverage exclusions…NOTICE they are GENERALLY remaining SILENT on this issue…because it would be in their BEST FINANCIAL interests for the Affordable Care Act to go away…think of how it would benefit their bottom line for PROFIT, if they could deny coverage for these “high dollar” patients.
I’m hoping people look at politicians PAST and CURRENT Records of behavior, and not just what they are SAYING to get elected!
Lee says
Trump tried to get rid of the Obama Care but couldn’t do it because of the locked in law but if elected, he & his republicans can now.
The Republicans always wanted to do away with Social security, Medicare and VA.
Trump tried wanted to privatized the Post Office and VA the cut benefits as well.. thank God he ran out it time.
All need to think hard before voting Republican or be ready to lose your earned benefits to live, it’s how they want to Lower the budget so they can give back to Wall-street again
…God Bless America
John Stove says
Where is Trumpos’ “great, beautiful, best, you will get tired of winning” plan? He has spewed BS about it since he was in office but never produced it or discussed it. He is so full of crap and will do anything to get re-elected on the backs of the average hard working American.
He and the Republican’s will forever be remembered as running the longest con game in the history of the USA.
richiesanto says
As a volunteer for SHINE (Serving the Insurance Needs of the Elderly) and someone who counsels seniors and others on Medicare and Medicaid, I am 100% certain of ONE thing: Republicans could care less about the health care needs of the average American.
Florida is a prime example of a state that refused Medicaid expansion and routinely discontinues Medicaid for people that remain eligible. It’s all a dollar’s game for the Desantis administration. The more people they can get off state programs, the more money for the rich to reap, and a win for the GOP.
All we have to do as a Nation is try to forget the low income, underinsured and underpaid residents (which a large portion of are registered Republicans) and let them fend for themselves and we will have a more trump like country. God forbid we become like one of those shit hole nations he rails about.
endangered species says
They represent the highest bidder, so they will preserve profits for insurance companies but your correct could care less if you and your family need care.
Mothersworry says
I believe that during the time trump was in the wh the senate and the house of rep was controlled by the repubs. Blame them.
coyote says
“Trump tried to get rid of the Obama Care but couldn’t do it because of the locked in law but if elected, he & his republicans can now.”
How quickly we forget !! :(
2017 – Trump and his posse Republicans DID indeed try to eliminate the ACA – even after it was established law – Twice.
Maybe you don’t recall the reason that Trump hated John McCain so much that the Navy had to hide a warship named the “John McCain” from his sight – John McCain was the one vote we needed to KEEP the act in place – and his reason for voting to retain it resounds throughout EVERY thing Trump and the current brand of TRRINOs (The REAL Republicans in Name Only – i.e. Trumpeteers) want to demolish or eliminate. Eliminate with no comparable replacement/correction.
McCain didn’t vote to keep it – twice – because he wanted it – Instead, he stated clearly the first time that he was voting to keep the ACA act in place because Trump and the Republicans did NOT HAVE any viable replacement plans.
QUOTE from John McCain :
“While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.”
(https://finance.yahoo.com/news/john-mccain-heres-why-voted-080525553.html)
And the second time – later in 2017 – When Trump and gang wanted to essentially take the money Washington now spends on Obamacare and send it back to states to set up whatever health insurance schemes they liked while gradually throttling that spending over time.
McCain voted against this bill because : “I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate, and amendment,” McCain said in a written statement. “But that has not been the case. Instead, the specter of September 30th budget reconciliation deadline has hung over this entire process.”
(https://slate.com/business/2018/08/john-mccains-health-care-legacy-did-he-really-save-obamacare.html)
So don’t go thinking that this is a new specter on the horizon – Trump has had the ACA act in his sights since he found out he can use it for political points on sooooo many levels (Democratic effort, socialistic, Black (gasp!) President, etc etc.) If he gets office again you bet he’ll be back at it.
Oh and by the way, I guarantee you that if the ACA was a Trump accomplishment, there would be BILLIONS of people on it, not just 100 million.
Nancy N. says
The only reason that Trump didn’t get rid of the ACA last time was John McCain…and Trump has never forgiven him for it. Since then, the Trump and his sycophants have successfully run out of the party anyone capable of having an independent, humanitarian, or empathetic thought. This time, if he’s given the chance to try, he will succeed. And my family, and many others like us, will be left with no insurance.
Laurel says
Nancy N.: You are absolutely correct, it was John McCain who saved the ACA, a Republican! Republicans need to take their party back from the MAGA cult. As a country, we need balance. The good Republicans, like Jeff Flake and Adam Kinzinger are run out of office and it is the extremist voters who are at fault. The Grand Old Party no longer exists. The Trump cult has arisen.
The middle class is kept busy trying to make a living, paying off that truck, trying to raise a family, trying to enjoy life a little, but it is easier to control an otherwise hard to control group if preached to (lied to) by Fox Entertainment, Newsmax and social media. Keep ’em overwhelmed and in debt. Believe me, folks, it’s intentional.
Meanwhile, people like DeSantis and Trump are doing their best to keep people in the dark and take away their freedoms in the name of freedom.
endangered species says
remember when the gop fought to remove the public option in the ACA (price control) and promised guaranteed profits for insurance companies…..You can look back at a lot of these things and see the gop sabatoge of programs, take unemployment, Medicare, social security, child protection laws, sick time, paid leave, minimum wage increases, and we could go on and on. anything that helps everyday americans the gop is avidly against. Dont forget the treason come vote time cause you know the orange convict is declaring victory on election night no matter the outcome.