his former vice president, Joe Biden, to win the White House, former President Barack Obama sought to contrast the 2020 platforms of Democrats and Republicans on a critical plank: their stance on the Affordable Care Act. It鈥檚 a difference, he argued, that has assumed newfound urgency.
鈥淭he Republicans occupying the White House and running the Senate 鈥� have shown themselves willing to cut millions off their health insurance and eliminate preexisting condition protections for millions more, even in the middle of this public health crisis,鈥� Obama said.
Obama was referring to a couple of GOP policies, the former president鈥檚 senior adviser Eric Schultz told KHN. The first: a pending Supreme Court case, Texas v. Azar, in which the Trump administration has argued the 2010 health law should be struck down. Schultz also highlighted the White House鈥檚 refusal to provide a special open enrollment period for the ACA health exchanges in the midst of the coronavirus pandemic.
奥别鈥檝别 previously checked claims about President Donald Trump鈥檚 stance on the law鈥檚 preexisting condition protections 鈥� arguably its most popular component 鈥� and his position on the Texas v. Azar lawsuit.
But COVID-19 adds new relevance, because of both the virus鈥檚 devastating health implications and bludgeoning impact on the American economy. Indeed, the Trump administration鈥檚 handling of the virus crisis is shaping up to be a defining issue in the run-up to November. Meanwhile, Biden made the health care law a signature component of his presidential platform and has been a vocal critic of the administration鈥檚 pandemic response.
With that in mind, we decided to take another look.
The Republican Agenda
Obama is correct: The Republican Party has opposed the ACA for years. In 2016, then-candidate Trump campaigned on its repeal. Since then, the White House and congressional Republicans have pursued an agenda that would dismantle the law鈥檚 preexisting condition protections. Republicans haven鈥檛 united behind an alternative plan, either.
First: the lawsuit. Texas v. Azar stems from the 2017 Tax Cuts and Jobs Act. That measure took the teeth out of the health law鈥檚 individual mandate, which required that all Americans have health insurance or pay a penalty. The tax law, pushed by Republicans and signed by Trump, set that penalty to $0.
A collection of Republican states鈥� attorneys general now argue that, without the penalty, the rest of the health law doesn鈥檛 work and should be struck down.
Killing the ACA would eliminate the stipulation that insurance plans cannot charge people more if they have a preexisting condition, get rid of the subsidies it provides for people to buy insurance on the exchanges and gut the Medicaid expansion that, in six years, to more than 13 million people. The Supreme Court has agreed to hear the case, although it won鈥檛 rule until after the November election.
The Trump administration, while technically in the position that would defend the law in court, has declined to support it 鈥� a move legal experts say is almost unprecedented.聽 In fact, the administration with the states arguing that it should be struck down. Neither the White House nor Senate Republicans have put forth a replacement bill that would maintain the ACA鈥檚 protections in the event the high court rules against the law.
We asked the White House if the administration had changed its stance in the wake of the pandemic. Trump鈥檚 staff redirected us to the Department of Justice, the federal government鈥檚 legal arm. The DOJ did not respond to emailed requests for comment. As recently as the , though, Trump told reporters he still wanted the law 鈥渢erminated.鈥�
Senate Democrats the administration to change its position on the lawsuit. But Republicans, who hold the Senate majority, , a position that hasn鈥檛 changed even since COVID-19 effectively shut down large swaths of the country.
In some ways, the Republican stance isn鈥檛 important, argued Thomas Miller, a resident fellow at the , a public policy think tank. It鈥檚 hard to imagine the Supreme Court voting to get rid of the health law, especially in the midst of COVID-19, he said.
Still, that doesn鈥檛 change the facts of what Trump is arguing.
And the lawsuit is also only one part of the equation. Another, is healthcare.gov.
Americans who have lost their jobs 鈥� and, often, the insurance that came with it 鈥� are eligible to buy insurance on the federal exchange, since job loss is a鈥渜ualifying life event鈥� that gets you special access. Those who otherwise lack coverage would normally have to wait until the regular open enrollment period, which takes place at the end of the year. But the threat of COVID-19 has changed the risk for many of these potential shoppers.
In response, 11 states have independently reopened their state-run health exchanges for a special sign-up period. But the administration has declined to take such steps for the national marketplace.
鈥淚f you have been uninsured and picked up your newspaper, or turned on your news and realized your health was in much greater risk than you had anticipated, and would like to rush and get health insurance in case you end up on a ventilator 鈥� you鈥檙e out of luck,鈥� said Linda Blumberg, a health policy fellow at the , a nonprofit research organization.
Even before coronavirus, the institute estimated that 32 million Americans were uninsured. About 20 million of them could benefit from a special enrollment period, Blumberg said. Without insurance, coronavirus treatment poses not just a health risk, but also a financial one.
The Trump administration has said it , out of a pool of $100 billion, to cover the cost of treating uninsured people with COVD-19. After treating patients, hospitals would get paid at the Medicare rate.
But the administration鈥檚 policy extends only to covering COVID-19 treatment. Uninsured people with underlying chronic conditions don鈥檛 have a way to pay for health care, noted Robert Berenson, another Urban Institute fellow. If left untreated, those chronic ailments make COVID-19 far more dangerous than it would be for someone able to get preventive treatment earlier on.
Coronavirus And The ACA
President Trump鈥檚 stance raises another question, experts noted. Without the ACA, what kind of impact would COVID-19 have?
Even with the heath law intact, many Americans won鈥檛 be able to find affordable health insurance. That particularly applies to people who can鈥檛 afford the premiums on the individual marketplace, don鈥檛 qualify for federal subsidies or live in one of the 14 states that didn鈥檛 opt into the ACA鈥檚 Medicaid expansion provision.
And the ACA is nowhere near sufficient on its own, Miller noted. Having insurance is part of the picture, but it doesn鈥檛 guarantee access to testing or that a hospital will be able to treat you. 鈥淥n the margins, it does help a little bit to have insurance coverage, but the problem is so much larger than that,鈥� Miller argued.
Still, without the health law, the virus鈥檚 impact would be 鈥渃atastrophic,鈥� said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill.
Striking the individual marketplace and Medicaid expansion would leave almost another 20 million people uninsured 鈥� 鈥渁t risk,鈥� said Larry Levitt, a vice president at the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
Without the ACA, COVID-19 could be considered a preexisting condition. Insurance companies could charge more to cover people who have previously contracted the virus (assuming, of course, those people can get tested and recorded as having had COVID-19). Plus, emerging evidence suggests severe cases of COVID-19 may leave lingering health consequences, that even after recovery would require ongoing medical care, Levitt said.
鈥淭he ACA鈥檚 consumer protections ensure that persons with COVID-19 can obtain insurance without fear of being turned away or charged exorbitant premiums because of their preexisting condition,鈥� Oberlander said.
The health law also imposed strict regulations over what insurance must cover. Without those regulations, plans could 鈥� and likely would 鈥� revert to skimpier coverage, Blumberg said.
That, she said, means plans that perhaps don鈥檛 cover ventilators or branded medicines, or that cap how many days of hospital care they鈥檒l cover, or that require people to pay much more out-of-pocket.
鈥淚nsurers, given the legal ability to do it, would limit their legal liability and protect themselves from high claims,鈥� she said. 鈥淭hey did it before and will do it again.鈥�
Our Ruling
Obama accused the Trump administration and Senate Republicans of being 鈥渨illing to cut millions off their health insurance and eliminate preexisting condition protections for millions more, even in the middle of this public health crisis.鈥�
Evidence indicates that this is an apt characterization. None have put forth a plan that would maintain coverage or consumer protections 鈥� policies that benefit millions of Americans 鈥� if the Supreme Court rules against the ACA. And as Obama asserts, striking down the law without an equivalent replacement could be devastating, especially during the COVID-19 pandemic. We rate this claim True.