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Republican Mike Pence warned during the Oct. 4 vice presidential debate that the Affordable Care Act, commonly known as Obamacare, is only going to get bigger if Democrat Hillary Clinton and her running mate, Tim Kaine, are elected Nov. 8.
"Hillary Clinton and Tim Kaine want to build on Obamacare," Pence said. "They want to expand it into a single-payer program. And for all the world, Hillary Clinton just thinks Obamacare is a good start."
Converting Obamacare to a single-payer program would make it, like Medicare, a federal health insurance program run by the federal government. Currently, Obamacare promotes policies supplied by private insurance companies.
Some Democrats — including, at one time, Barack Obama — pushed for a single-payer system comparable with what other developed countries have. But that turned out to be politically untenable.
The result was the Obamacare patchwork of different commercial insurance plans offered in "marketplaces" by individual states and the federal government.
We contacted the Donald Trump campaign seeking evidence that Clinton and Kaine, in fact, wanted to convert Obamacare into a national health insurance system.
Spokesman Dan Kowalski pointed us to the health care page on Clinton's website.
It indicates "that she supports a 'public option' for Obamacare," Kowalski said. "A 'public option' is a single-payer-like option for health care delivery."
Clinton's website does, indeed, say that she wants a public option. But that would be just one option. Under a single-payer system, the government provides health care for everyone. Clinton's web page makes it clear that there would be other payers as well.
Clinton has consistently said she wants to protect Obamacare from being repealed by the Republicans — and Trump — and expand it by protecting consumers from rising health care costs.
Her expansion would include tax credits, eliminating the out-of-network hospital charges many plans levy, and reducing prescription drug costs by removing the ban that prevents the federal government from negotiating drug prices and allowing Americans to important their drugs from countries where the prices are dramatically lower.
Other parts of her proposal were outlined in a 1,500-word commentary in the Sept. 28 New England Journal of Medicine. Trump declined to submit details on his plans.
We asked the Trump campaign if they had seen any statements from Clinton or Kaine indicating that converting Obamacare into a single-payer system was their eventual goal.
Kowalski responded that "Hillary has committed fully to the public option," and as evidence he directed us to comments Clinton made in 1994 when she was first lady.
At the time, she predicted that if Congress didn't pass health care reform soon, "I believe, and I may be totally off base on this, but I believe that by the year 2000 we will have a single-payer system. I don’t think it’s — I don’t even think it’s a close call politically." She earns no Nostradamus points for that one.
More to the point, later in her answer Clinton says there are three ways to get universal health coverage, only one of which is a single-payer system. The other two: an employer mandate or an individual mandate, which is how Obamacare works.
Pence said Clinton and Kaine "want to expand (Obamacare) into a single-payer program," suggesting that they have proposed such a change. They have not. They have promoted a public option, which would be a government-sponsored insurance plan.
A lot of Democrats, such as Bernie Sanders, would like to go in that direction. But throughout the current campaign, Clinton has consistently resisted that suggestion, saying she would work to prevent the repeal of Obamacare and try to improve on it.
No one would be surprised if Clinton pushed for single payer if it became politically practical, but none of her campaign statements are calling for that.
We rate Pence's statement Mostly False.
The Washington Post, "The Mike Pence vs. Tim Kaine vice-presidential debate transcript, annotated," Oct. 4, 2016
Emails, Dan Kowalski, spokesman, Donald Trump campaign, Oct. 4, 2016
Hillary Clinton campaign website, "Health Care," accessed Oct. 4, 2016
Emails, Josh Schwerin, spokesman, Hillary Clinton campaign, Oct. 4, 2016
PolitiFact, "Obama statements on single-payer have changed a bit," July 16, 2009 and "How much would Bernie Sanders' health care plan cost the middle class?" Jan. 13, 2016
CNN, "What's behind the Clinton-Sanders health care fight?" Jan. 14, 2016
The New England Journal of Medicine, "My Vision for Universal, Quality, Affordable Health Care," Sept. 28, 2016
Physicians for a National Health Program, "Hillary Clinton: 1994 statement on single payer," posted Dec. 31, 2014
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