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Joe Biden’s health care plan includes an option for people to buy into government managed health care.
Biden favors allowing immigrants illegally in the country to buy health insurance in the ACA marketplace, but without financial help from the government.
A TV ad by President Donald Trump’s campaign portrays Joe Biden’s health care plan as a disaster for seniors’ access to health care.
"Let’s turn off the noise and look at the facts about Joe Biden and Kamala Harrs’ government-run health care plan," states the narrator, a senior citizen, in the ad. "Their plan could lead to hospitals being closed, put Medicare coverage at risk, and give benefits to illegal immigrants. Their plan is just too dangerous for seniors like us."
Point by point, the ad misleads about Biden’s health care plan.
This is misleading. Biden hasn’t called for only a government plan-run plan.
The ad cited a July 2019 NBC story about Biden’s health care agenda. Biden does not support Medicare for All; his plan instead builds upon the Affordable Care Act. He supports allowing Americans to buy into a public option for government-managed health insurance. The public option would be offered alongside other private health insurance plans on the marketplace.
The ad also cited an article by the conservative Heritage Foundation which analyzed several plans in Congress and concluded that the public option would lead to a "single government-controlled health care system." But that’s not in line with what Biden has proposed.
This assertion hinges in part on the false premise that Biden is proposing Medicare for All. Again, he isn’t. Biden’s plan calls for taking steps to keep rural hospitals open, including supporting a bipartisan bill in Congress to save rural hospitals in part by increasing payments to Medicare providers.
The ad cites as evidence a New York Times article in April 2019 that states that if Medicare for All abolished private insurance and reduced rates some hospitals, especially in struggling rural centers, "would close virtually overnight."
The Trump campaign also pointed to an August 2019 study conducted by Navigant, a consulting firm, that predicted rural hospitals are in danger of closing under a public option. The study was commissioned by the Partnership for America’s Healthcare Future, a health industry coalition that opposes Medicare for All and a public option.
The study modeled what would happen to rural hospitals, which are already at risk of closing, if three separate public option approaches were implemented — but it didn’t mention Biden’s plan. It found that a public option could lead to 28% to 55% of rural hospitals being at high risk of closure. The study reached these findings by assuming that the hospitals would be paid at Medicare rates.
Some health policy experts argue that a public option would actually help rural hospitals by increasing the number of people in rural areas who have health insurance. This would "benefit rural hospitals, since getting virtually nothing from uninsured patients is worse than getting a reasonably good rate from the public option," Gerard Anderson, a professor of health policy and management at Johns Hopkins University in Baltimore, previously told us.
It’s too early to say how Medicare could be affected by Biden’s plan to add a public option. The ad cited the same Heritage Foundation research that argues broadly that the public option would eventually lead to the end of private alternatives and that doctors who don’t sign up for the public option could be forbidden from participating in Medicare. It also raises concerns about government-set payment rates. But, again, it doesn’t specifically zero in on Biden’s proposal.
The Trump campaign pointed to a September article by the Partnership for America’s Healthcare Future that cites articles — including by PolitiFact — that show a public option could disrupt private insurance offerings. A new public option, the partnership says, would strain government financing when Medicare is already at risk.
The Trump campaign also pointed to comments by Sherry Glied, the dean of New York University’s Wagner Graduate School of Public Service and a former health official in the Obama administration, in the New York Times. Glied said that it was possible that linking public-option coverage to Medicare could cause some doctors to stop accepting Medicare patients.
Parts of Biden’s plan suggest he is comparing the public option and Medicare, the Trump campaign said. For example, Biden’s plan says both programs will negotiate prices with providers and that a board will recommend a reasonable price for new specialty drugs.
But two experts we interviewed said Biden’s health care plan lacks enough detail to lend itself to the conclusion that it will put Medicare coverage at risk.
"There's not really enough detail in the Biden plan yet to say one way or another," said Sabrina Corlette, a professor and expert on health insurance at Georgetown University. "There's nothing inherent in what Biden has proposed that would put traditional Medicare at risk."
If Biden is elected, he would have to write detailed legislation that would explain how the public option would interact with other health insurance, including Medicare.
Practically speaking, candidates running for president know not to propose a harmful Medicare plan, said Joe Antos, a scholar at the conservative American Enterprise Institute.
This goes too far. Biden’s plan doesn’t automatically "give benefits" to immigrants in the country illegally. Biden favors allowing immigrants illegally in the country to buy health care plans under the Affordable Care Act marketplace, but without financial help from the government.
For evidence, the ad cites the June 27, 2019, Democratic primary debate where all of the candidates were asked to "raise your hand if your government plan would provide coverage for undocumented immigrants." All raised their hands, including Biden.
The Democrats were asked whether their health care plans would cover immigrants here illegally. They were not, however, directly asked if that coverage would be free.
When moderator Savannah Guthrie asked Biden to elaborate, he said: "You cannot let people who are sick, no matter where they come from, no matter what their status, go uncovered." He didn’t get into the specifics about paying for the coverage, although he said that immigrants in the U.S. illegally pay the Social Security tax.
Trump’s TV ad said, "Joe Biden and Kamala Harrs’ government-run health care plan … could lead to hospitals being closed, put Medicare coverage at risk, and give benefits to illegal immigrants."
Biden has not called for only a government-run plan. He has called for a voluntary public option alongside private options.
The ad leaps to conclusions about how Biden’s plan would impact hospitals and Medicare coverage, relying largely on articles by groups that oppose the public option. Experts said Biden’s plan doesn’t include enough specifics to reach conclusions, but it’s a stretch to conclude that he would put Medicare coverage at risk. The study the campaign cited about the public option leading to rural hospital closures cites a huge range and makes some assumptions and also acknowledges that rural hospitals are already closing.
The only kernel here is that Biden’s plan allows immigrants here illegally to pay for health insurance, but it’s misleading to state that he would "give" them the benefits.
We rate this claim Mostly False.
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President Donald Trump campaign, TV ad Noise, Oct. 28, 2020
New York Times, Hospitals Stand to Lose Billions Under ‘Medicare for All,’ April 21, 2019
Heritage Foundation, The "Public Option": Government-Run Health Care on the Installment Plan, Feb. 12, 2020
i9 Fact Checker, Republican ad goes after Biden’s support for a public option health care plan, Oct. 30, 2020
Navigant, New Analysis Shows Worsening Situation for Rural Hospitals, Residents, February 2019
NBC, Biden health care plan, July 15, 2019
New York Times, Why the Less Disruptive Health Care Option Could Be Plenty Disruptive, Dec. 3, 2019
PolitiFact, Did Trump confuse the public option with Medicare for All? Oct. 23, 2020
PolitiFact, Trump ad distorts Biden’s record on Social Security and Medicare, policy for immigrants, Sept. 24, 2020
PolitiFact, Medicare for All defines one end of the Democratic presidential debate, April 11, 2019
PolitiFact, Past as prologue: Questioning Buttigieg’s claim about keeping your health care, Feb. 25, 2020
PolitiFact, GOP Senate ad misrepresents Montana governor’s stance on rural hospitals, public option, Aug. 17, 2020
PolitiFact, Fact-checking Trump ad on Democrats, health care for immigrants illegally in the country, Aug. 1, 2019
Email interview, Zach Parkinson, spokesperson for Donald Trump campaign, Nov. 1, 2020
Email interview, Rosemary Boeglin, spokesperson for Joe Biden campaign, Nov. 1, 2020
Email interview, Sabrina Corlette, research professor, founder, and co-director of the Center on Health Insurance Reforms (CHIR) at Georgetown University’s McCourt School of Public Policy, Nov. 1, 2020
Telephone interview, Joe Antos, Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute, Nov. 1, 2020
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