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President Donald Trump attempted to take credit for one of the most popular elements of the Affordable Care Act: Its protection for people who have preexisting medical conditions.
"I was the person who saved Pre-Existing Conditions in your healthcare," Trump tweeted on Jan. 13.
The protection for people with medical problems has been a rallying cry for Democrats, and they used the issue to help propel their widespread election victories in 2018.
Trump repeatedly has sought to align himself with this issue – in May, for instance, claiming he would "always protect patients with preexisting conditions." We rated that claim False. His re-election campaign has made similar claims, which experts debunked.
Trump’s recent claim that he "saved" that guarantee of coverage adds a new twist, though. We contacted the White House to find out the basis for this statement.
Judd Deere, a White House spokesman, told us, "President Trump has repeatedly stated his commitment to protect individuals with preexisting conditions and his track record shows that he has consistently done what is necessary to improve care for the vulnerable." Deere also pointed us to a range of other policy initiatives – such as efforts on kidney health, approving generic drugs and loosening restrictions on short-term health plans.
But none of those addressed the basis of Trump’s tweet.
The health policy experts we consulted, however, were unambiguous: The president’s claim has no factual basis and flies in the face of his ongoing policy efforts.
"I feel like we’re being gas-lit," said Linda Blumberg, a health economist at the Urban Institute. "You can’t tell me you’re the savior of people with preexisting conditions when every single thing you’ve said or done is the opposite of that." (Gaslighting means manipulating the telling of events in such a way it leads people to question their recollections.)
This skepticism persisted across the political spectrum.
"That’s a rather extended version of aspirational rhetoric short of any evidence," said Tom Miller, a resident fellow at the conservative American Enterprise Institute.
The preexisting condition protection
Under the Affordable Care Act, or ACA, health insurance plans cannot charge people higher prices because they have a medical condition. This protection has been intact since the law took effect, under then-President Barack Obama.
As a 2016 candidate, Trump promised to repeal and replace the health law. That came to a head in 2017, when the law came within one vote in the Senate of being undone.
"That tweet is part fantasy, part delusion, part politics, and all lie," said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. "The president is lying about preexisting conditions. He supported, and continues to support, efforts to repeal the ACA that would take those consumer protections away."
After that effort, Blumberg said, the president boasted that he had dismantled Obamacare – which is not only untrue, but, she added, confused many consumers.
Since then, the president has maintained his desire to undo the ACA and replace it with something new.
Neither his administration nor congressional Republicans have yet offered a replacement plan. None of the bills they have endorsed would maintain the guarantees of coverage for people with medical problems.
"By supporting repeal of the ACA, they’re supporting repeal of protecting preexisting condition prohibitions," Robert Berenson, another analyst at the Urban Institute, previously told us.
Texas v. Azar
Meanwhile, the Trump administration’s work elsewhere could undo the protection.
A group of Republican-led states are suing to have the entire ACA dismantled. Their argument stems from a law Trump signed: the Tax Cuts and Jobs Act of 2017.
That law gutted the individual mandate – the ACA’s requirement that everyone have coverage or pay a penalty – by reducing the penalty to $0.
In this case, known as Texas vs. Azar, the Republican states are arguing that the individual mandate was central to the ACA, and that without it, the entire law must be taken down. That would include the protections for people with preexisting conditions.
The administration has declined to defend the law in court, a move legal analysts have called almost unprecedented. The case is widely expected to go to the Supreme Court. Since the White House has unveiled no replacement, striking the law would leave a policy vacuum, allowing health plans to revert to discriminating against people with medical issues.
Miller argued that the still-pending court case and previous repeal efforts don’t necessarily mean there’s any imminent threat of the president gutting the ACA’s preexisting condition protections.
"For pure public opinion purposes, you want to say you’re protecting against preexisting condition protections," Miller said. "Does he know how to do it? No. Is he doing anything trying to change it? Not really."
But others noted that the administration’s stance is firmly against maintaining the ACA’s prohibitions.
"The Democrats have correctly said the Trump administration has in fact opposed protections for preexisting conditions by endorsing the lawsuit," Berenson said.
Trump tweeted that he "was the person who saved Pre-Existing Conditions in your healthcare."
The president had nothing to do with the ban on health insurance plans discriminating against people with preexisting conditions. This consumer protection is a core part of the health care law that became law during the Obama presidency. Trump has expressly supported the repeal of this law without offering a replacement that would keep the protection intact.
And to this day, his administration is arguing in court that the law – including this provision – should be undone.
The president’s tweet is not only untrue, but it misrepresents his administration’s efforts to repeal the health care law without offering any replacement that might maintain its core protections. We rate this claim Pants on Fire.
Kaiser Health News, "Federal Appeals Court Strikes Down Portion Of Obamacare," Dec. 18, 2019
Kaiser Health News, "What Would Happen If The ACA Went Away?" Dec. 16, 2019
Kaiser Health News/Politifact, "Team Trump Says Administration’s Action On Health Care ‘Is Working.’ Is It?" Jan. 13, 2020.
Kaiser Health News/Politifact, "Trump’s talk on preexisting conditions doesn’t match his administration’s actions," May 16, 2019.
Email interview with Jonathan Oberlander, professor and chair of social medicine at University of North Carolina-Chapel Hill, Jan. 14, 2020.
Telephone interview with Linda Blumberg, fellow at the Urban Institute Health Policy Center, Jan. 14, 2020.
Telephone interview with Robert Berenson, fellow at the Urban Institute, Jan. 2, 2020.
Telephone interview with Thomas Miller, resident fellow at the American Enterprise Institute, Jan. 14, 2020.
Email interview with Judd Deere, Executive Office of the President, Jan. 14, 2020.
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