Jacob Gardenswartz
If the Affordable Care Act have been terminated, “that would mean over a hundred million Americans will lose protections for preexisting conditions.”
President Joe Biden in a marketing campaign commercial, May 8
President Joe Biden’s reelection marketing campaign desires voters to distinction his report on well being care coverage together with his predecessor’s. In May, Biden’s marketing campaign started airing a monthlong, $14 million advert marketing campaign concentrating on swing-state voters and minority teams with spots on TV, digital, and radio.
In the advert, titled “Terminate,” Biden assails former President Donald Trump for his previous guarantees to overturn the Affordable Care Act, also referred to as Obamacare. Biden additionally warns of the potential impact if Trump is returned to workplace and once more pursues repeal.
“That would mean over a hundred million Americans will lose protections for preexisting conditions,” Biden mentioned within the advert.
Less than six months from Election Day, polls show Trump narrowly main Biden in a head-to-head race in most swing states. And voters belief Trump to raised deal with points reminiscent of inflation, crime, and the economic system by important margins.
An ABC News/Ipsos poll of about 2,200 adults, launched in early May, exhibits the one main coverage points on which Biden obtained increased marks than Trump have been well being care and abortion entry. It’s no shock, then, that the marketing campaign is making those topics central to Biden’s pitch to voters.
As such, we dug into the details surrounding Biden’s declare.
Preexisting Condition Calculations
The concept that 100 million Americans live with a number of preexisting circumstances isn’t new. It was the topic of a back-and-forth between then-candidate Biden and then-President Trump throughout their earlier 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 on the time rated Biden’s declare to be “mostly true,” discovering a reasonably large vary of estimates — from 54 million to 135 million — of the variety of Americans with preexisting circumstances. Estimates on the decrease finish have a tendency to contemplate “preexisting conditions” to be extra extreme persistent circumstances reminiscent of most cancers or cystic fibrosis. Estimates on the spectrum’s increased finish embrace individuals with extra widespread well being issues reminiscent of bronchial asthma and weight problems, and behavioral well being issues reminiscent of substance use dysfunction or melancholy.
Biden’s May advert focuses on how many individuals could be susceptible if protections for individuals with preexisting circumstances have been misplaced. This is a matter of some debate. To perceive it, we have to break down the protections put in place by the ACA, and people who exist individually.
Before and After
Before the ACA’s preexisting situation protections took impact in 2014, insurers in the individual market — individuals shopping for protection for themselves or their households — might cost increased premiums to individuals with specific circumstances, prohibit protection of particular procedures or drugs, set annual and lifelong protection limits on advantages, or deny individuals protection.
“There were a number of practices used by insurance companies to essentially protect themselves from the costs associated with people who have preexisting conditions,” mentioned Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University and an knowledgeable on the medical health insurance market.
Insurers offering protection to giant employers might impose lengthy ready durations earlier than workers’ advantages kicked in. And although employer-sponsored plans couldn’t discriminate in opposition to particular person workers primarily based on their well being circumstances, small-group plans for companies with fewer than 50 workers might increase prices throughout the board if giant numbers of workers in a given firm had such circumstances. That might immediate some employers to cease providing protection.
“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 analysis professor at Georgetown University’s McCourt School of Public Policy who researches public medical health insurance markets.
As a end result, many individuals with preexisting circumstances skilled what some researchers dubbed “job lock.” People felt trapped of their jobs as a result of they feared they wouldn’t be capable to get medical health insurance wherever else.
Some primary preexisting situation protections exist unbiased of the ACA. The 1996 Health Insurance Portability and Accountability Act, for instance, restricted how insurers might restrict protection and mandated that employer-sponsored group plans can’t refuse to cowl somebody due to a well being situation. Medicare and Medicaid equally can’t deny protection primarily based on well being background, although age and income-based eligibility necessities imply many Americans don’t qualify for that protection.
Once the ACA’s preexisting situation protections kicked in, plans offered on the person market had to offer a complete package deal of advantages to all purchasers, irrespective of their well being standing.
Still, some conservatives say Biden’s declare overstates how many individuals are affected by Obamacare protections.
Even for those who take into account the broadest definition of the variety of Americans residing with such circumstances, “there is zero way you could justify that 100 million people would lose coverage” with out ACA protections, mentioned Theo Merkel, who was a Trump administration well being coverage adviser and is now a senior analysis fellow with the Paragon Health Institute and a senior fellow on the Manhattan Institute for Policy Research, a conservative assume tank.
Joseph Antos, a senior fellow on the American Enterprise Institute, a conservative assume tank, known as the advert’s preexisting circumstances declare “the usual bluster.” To attain 100 million individuals affected, he mentioned, “you have to assume that a large number of people would lose coverage.” And that’s unlikely to occur, he mentioned.
That’s as a result of most individuals — about 55% of Americans, in keeping with the latest government data — obtain medical health insurance by way of their employers. As such, they’re protected by the Health Insurance Portability and Accountability Act guidelines, and their plans probably wouldn’t change, at the least within the brief time period, if the ACA went away.
Antos mentioned main insurance coverage corporations, which have operated below the ACA for greater than a decade, would probably preserve the established order even with out such protections. “The negative publicity would be amazing,” he mentioned.
People who lose their jobs, he mentioned, could be susceptible.
But Corlette argued that dropping ACA protections might result in Americans being priced out of their plans, as well being insurers once more start medical underwriting within the particular person market.
Park predicted that many companies might additionally regularly discover themselves priced out of their insurance policies.
“For those firms with older, less healthy workers than other small employers, they would see their premiums rise,” he instructed KFF Health News.
Moreover, Park mentioned, anytime individuals misplaced work or switched jobs, they’d threat dropping their insurance coverage, reverting to the previous 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 mentioned.
Our Ruling
We beforehand dominated Biden’s declare that 100 million Americans have preexisting circumstances as in the ballpark, and nothing means that’s modified. Depending on the definition, the quantity might be smaller, nevertheless it additionally might be even better and is prone to have elevated since 2014.
Though Biden’s declare concerning the quantity of people that could be affected if these protections went away appears correct, it’s unclear how a return to the pre-ACA state of affairs would manifest.
On the marketing campaign path this 12 months, Trump has promised — as he did many occasions previously — to replace the health law with one thing higher. But he’s by no means produced a alternative plan. Biden’s declare shouldn’t be judged primarily based on his lack of specificity.
We charge Biden’s declare Mostly True.
our sources
ABC News/Ipsos Poll, “Six Months Out, a Tight Presidential Race With a Battle Between Issues & Attributes,” May 5, 2024
Avalere, “Repeal of ACA’s Pre-Existing Condition Protections Could Affect Health Security of Over 100 Million People,” Oct. 23, 2018
Biden-Harris 2024 marketing campaign e mail, “NEW AD: Biden-Harris 2024 Launches ‘Terminate’ Slamming Trump for Attacks on Health Care,” May 8, 2024
Center for American Progress, “Number of Americans With Preexisting Conditions by District for the 116th Congress,” Oct. 2, 2019
Census Bureau, “Health Insurance Coverage in the United States: 2022,” September 2023
CNN, “Trump Administration Gives States New Power to Weaken Obamacare,” Oct. 22, 2018
Department of Health and Human Services, “Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the Affordable Care Act,” Jan. 5, 2017
Department of Health and Human Services, “The Health Insurance Portability and Accountability Act (HIPAA) of 1996 Helpful Tips,” accessed May 15, 2024
Email exchanges with Biden-Harris 2024 marketing campaign official, May 13-15, 2024
Email change with Karoline Leavitt, Trump 2024 marketing campaign nationwide press secretary, May 13, 2024
KFF, “KFF Health Tracking Poll: The Public’s Views on the ACA,” May 15, 2024
KFF, “Recent Trends in Mental Health and Substance Use Concerns Among Adolescents,” Feb. 6, 2024
KFF Health News, “Drowning in a ‘High-Risk Insurance Pool’ — At $18,000 a Year,” Feb. 27, 2017
KFF Health News and PolitiFact, “Biden’s in the Ballpark on How Many People Have Preexisting Conditions,” Oct. 1, 2020
The New York Times, “Trump Leads in 5 Key States, as Young and Nonwhite Voters Express Discontent With Biden,” May 13, 2024
Phone interview and e mail exchanges with Theo Merkel, a senior fellow on the Manhattan Institute and the director of the Private Health Reform Initiative on the Paragon Health Institute, May 14-15, 2024
Phone interview with Edwin Park, a analysis professor at Georgetown University’s McCourt School of Public Policy, May 22, 2024
Phone interview with Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University, May 14, 2024
Truthsocial.com, post by @realDonaldTrump, Nov. 25, 2023
The Wall Street Journal, “Healthcare.gov to Shut Down During Parts of Enrollment Period for Maintenance,” Sept. 23, 2017
Work, Aging and Retirement, “Job Lock, Work, and Psychological Well-Being in the United States,” Feb. 19, 2016
YouTube.com/@CSPAN, “First 2020 Presidential Debate between Donald Trump and Joe Biden,” Sept. 29, 2020
YouTube.com/@JoeBiden, “Terminate” marketing campaign commercial, May 10, 2024
Phone interview with Joseph Antos, a senior fellow on the American Enterprise Institute, June 5, 2024
Health Affairs, What It Means To Cover Preexisting Conditions, Sept. 11, 2020
KFF, Pre-Existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA, Dec. 12, 2016
PolitiFact, “Does Trump Want To Repeal the ACA, as Biden Says? Tracking His Changing Stance Over the Years,” June 3, 2024
