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The first question Sen. Bernie Sanders faced in a CNN town hall meeting with voters was what he would do to make sure President Donald Trump would be defeated. Sanders began by saying why it was important to unseat Trump.
"It's not only that we have a president who wanted to throw 32 million people off of the health care they had, after promising that he'd provide health care to everybody," said the Vermont Independent Feb. 25. "This president is the first president in the modern history of our country who is trying to divide our people up, based on the color of their skin, the country they were born in, their sexual orientation, their gender, their religion."
In this fact-check, we examine whether Trump wanted 32 million people to lose the health care they had.
Trump has talked about his health care goals in broad sweeping terms, at times even contradicting himself. But ultimately, governing comes down to legislative and executive action. Sanders bases his number on Trump’s ongoing attempts to overturn the Affordable Care Act. We'll put Sanders’ claim into context.
In the Republican presidential primary, Trump offered two pillars of his health care plan.
"We're getting rid of Obamacare," he said at a March 5, 2016 rally. "It's a total disaster that's being replaced. And we'll have great health care at a fraction of the cost."
In general, Trump talked of increasing competition and using the private market to deliver better insurance. He also said his goal was to meet the needs of the poorest.
"There's going to a group of people at the bottom, people that haven't done well," he said Feb. 18, 2016. "We're going to take care of them through, maybe, concepts of Medicare." (Medicare is primarily for seniors, while Medicaid is for the poor, so Trump’s meaning is unclear.)
After the election, with Republicans in control of the White House and Congress, the legislative process began. Trump exhorted Republicans to repeal and replace Obamacare. The first victory came when the House passed the American Health Care Act. House Republicans gathered with Trump at the White House to celebrate. Trump said, "What we have is something very, very incredibly well-crafted."
"This is a great plan," Trump said May 4, 2017. "I actually think it will get even better. And this is, make no mistake, this is a repeal and replace of Obamacare."
The Congressional Budget Office estimated that the House bill would reduce the number of people who would otherwise be insured by 23 million by 2026.
Trump later called the House bill "mean" and said he hoped the Senate version would add more money.
The Senate struggled to pass health care legislation. Trump pressed Republicans to unify around a bill. At a July 24, 2017, White House meeting with senators, he said the Senate version "will deliver truly great health care."
The Congressional Budget Office estimated that under the Senate bill, 15 million people would lose insurance after one year and 22 million by 2026.
With a late night dramatic thumbs-down vote from the late Arizona Sen. John McCain, the measure failed. Trump often voiced regret over that moment.
"We had health care, it was done," he said in an Oct. 17, 2017, radio interview. "And then a hand went up and then the hand was — went up in the wrong direction at two o'clock in the morning, and everybody was shocked by it and disappointed."
One other proposal had been in play in the Senate. It would have repealed large pieces of Obamacare, including the requirement to have insurance, expanded Medicaid and premium subsidies, but it wouldn’t have replaced those with any new programs.
Trump voiced support for that sort of hardball approach.
"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date," he tweeted June 30, 2017.
Two weeks later, he repeated that line.
"Republicans should just REPEAL failing Obamacare now and work on a new health care plan that will start from a clean slate," Trump tweeted July 17, 2017. "Dems will join in!"
The Congressional Budget Office estimated that the repeal bill would lead to 32 million more people without insurance by 2026. The impact wouldn’t come immediately, but it would rise quickly, from 17 million in the first year, to 27 million after three years, then adding another 5 million by the end of the period.
The Sanders campaign pointed to that estimate as proof that Trump wanted to deny 32 million people the health care they otherwise would have.
But some portion of that 32 million would have chosen not to buy insurance due to the end of the individual mandate. The CBO doesn't estimate how many exactly because there are two ways this plays out. Some people wouldn't buy solely because they no longer face a penalty, and others would drop coverage because premiums would rise or insurers would pull out of the markets where they live. (The end of the mandate would encourage healthier people to stop buying, leaving sicker people in the insurance pool, producing higher rates.)
For that unknown fraction of people who could have afforded insurance and simply chose not to buy because they didn't have to, their insurance wasn't taken away. It was something they didn't want.
Ultimately, no health care bill passed.
Sanders said that Trump "wanted to throw 32 million people off of the health care they had." This is based on Trump’s encouraging Senate Republicans to vote for a repeal bill. After three years, the measure would have reduced the ranks of the insured by 27 million, and 32 million after nine years.
Those are government estimates of the future, and not people who would immediately lose insurance, as some might understand Sanders’ words. In addition, the 32 million includes some unknown number of people who would choose not to buy insurance soley due to the end of the individual mandate.
Plus, Trump also supported measures that would reduce the number of insured people by 23 million and 22 million. This makes it more difficult to tie him to a specific reduction in the number of insured.
It is reasonable to say that Trump backed the loss of insurance for tens of milllions of people over time, but not more than that. We rate this claim Half True.
CNN, Town hall with Bernie Sanders, Feb. 25, 2019
Donald Trump, tweet, July 17, 2019
Factbase, Trump statements on health care, accessed Feb. 27, 2019
Washington Post, Senate Republicans’ effort to ‘repeal and replace’ Obamacare all but collapses, July 18, 2017
U.S. Senate Budget Committee, Obamacare Repeal Reconciliation Act of 2017, July 19, 2017
Donald Trump, tweet, June 30, 2017
Washington Post, Don’t sugarcoat this. Trump just called for 32 million people to lose health coverage, June 30, 2017
Congressional Budget Office, How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums, January 2017
Congressional Budget Office, H.R. 1628, the Better Care Reconciliation Act of 2017: An Amendment in the Nature of a Substitute, July 20, 2017
New York Times, G.O.P. Plans Immediate Repeal of Health Law, Then a Delay, Dec. 2, 2016
Congressional Budget Office, Federal subsidies for health insurance coverage for people under age 65: Tables From CBO’s March baseline, March 2016
PolitiFact, Did Donald Trump call the Republican health care plan 'mean'?, Nov. 1, 2018
Email interview, Matthew Fielder, fellow, Center for Health Policy, Brookings Institution, Feb. 26, 2019
Email interview, Christina Eibner, senior economist, RAND, Feb. 26, 2019
Email interview, Josh Orton, adviser, Sanders for President, Feb. 26, 2019
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