President Trump was not in Washington when the Affordable Care Act passed and established a right to health insurance for Americans with pre-existing health conditions. His first legislative priority as president was a bill that would have repealed key parts of Obamacare and weakened such protections. His Justice Department is arguing in court that the entire law should be overturned.
His tweets Monday morning, describing himself as “the person who saved pre-existing conditions,” contradict this record.
Mini Mike Bloomberg is spending a lot of money on False Advertising. I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate…..
— Donald J. Trump (@realDonaldTrump) January 13, 2020
It is true that Mr. Trump signed a law eliminating the tax penalties for Americans who go without health insurance — the so-called individual mandate. That provision was one of the least popular parts of Obamacare. But that legislative change has not improved protections for Americans with pre-existing health conditions. If anything, it has placed them in jeopardy, by forming the basis of a lawsuit that could erase the Affordable Care Act.
Here’s a brief history of President Trump’s record on pre-existing health conditions.
Did he pass the Affordable Care Act?
No. The president was not in Washington and not in politics when the Affordable Care Act was written, debated and passed in 2009 and 2010. The health law established consumer protections for Americans who buy their insurance, including a rule that health insurers must offer coverage to anyone who wishes to buy it, with prices varying only by region and the age of the customer.
Before Obamacare, some states protected people with pre-existing conditions in this way, but most did not. Americans with prior illnesses like cancer, asthma, even acne, often had trouble buying insurance for themselves and their families. One state that did protect people with pre-existing conditions was New York, where the media executive and presidential candidate Michael Bloomberg currently resides and where Mr. Trump did at the time. (Mr. Bloomberg’s recent television advertisements, which attack Mr. Trump’s health care record, appear to have prompted the tweets.)
The Affordable Care Act was a large and complex law, with many provisions that have proved controversial. But the protections for people with pre-existing conditions enjoy widespread public support.
Has he tried to weaken pre-existing conditions protections as president?
Yes. President Trump’s first legislative priority after his election was to “repeal and replace” the Affordable Care Act. Republicans in Congress voted on several different bills, but each of them had provisions that would have substantially eroded the current protections for Americans with prior health conditions, by weakening the regulations that make such insurance available, affordable and useful.
The bills would have weakened rules that require insurance to cover a standard set of health benefits, for example, and would have established policies that would have raised prices for people with a history of health problems.
Those bills didn’t pass, in part because of public concern about the erosion of these popular protections. The Republican-led Senate was unable to muster a majority to vote for any of several repeal bills.
The president is also responsible for a number of regulatory changes that critics have characterized as “sabotage” of Obamacare. Despite these changes, Obamacare markets have remained fairly stable. But economists and actuaries say that some of the changes, which allow the sale of insurance lacking protections for pre-existing conditions, probably raise insurance prices for sicker customers, if only by a little.
Has he supported a lawsuit to erase pre-existing health protections?
Yes. The Justice Department filed its latest brief in the lawsuit just last week. If the Trump administration wins the case, all of Obamacare would be declared unconstitutional and eliminated.
Such a change would cause many changes and could set off widespread disruption throughout the health system. Among the changes, the protection for pre-existing conditions in Obamacare would go away if the courts agreed with the White House’s legal position.
The basis of this case is the change to the health law that Mr. Trump mentioned in his tweet. By eliminating the tax penalty for people who do not buy insurance, the White House argues that Congress has made all of the health law legally invalid. So far, a Federal District Court judge in Texas has agreed with this argument. An appeals court in New Orleans is waiting for more analysis to decide whether it agrees, but it has signaled openness to the argument.
The president has promised on numerous occasions to release a new health plan, which he presumably would champion should he win in court. But he has never released such a plan or even discussed its broad contours.
His silence on concrete policy preferences makes it hard to assess his statement that this plan will “protect your pre-existing conditions.” His record so far has not been strong.
What about the Democrats?
The party has been consistent and united in defense of Obamacare’s pre-existing conditions protections. Preserving them was a centerpiece of 2018 midterm campaigns. Democratic state officials and the House of Representatives have intervened in the Obamacare lawsuit to defend the law.
Some Democrats support large changes to the health system. “Medicare for all,” a proposal endorsed by more than 100 Democratic House members and two major presidential candidates, would reshape the health system by eliminating private health insurance and replacing it with generous government coverage funded with tax revenues. But by providing identical health coverage for every American, this proposal would do nothing that could plausibly weaken access for people with a history of illness.
What does this have to do with Michael Bloomberg?
It is worth noting that Mr. Bloomberg, who is blanketing airwaves with advertisements on his health care record, also had no role in passing Obamacare. But he has taken no positions that would directly imperil the Affordable Care Act’s pre-existing conditions protections. His campaign’s health care plan, released recently, would tend to expand insurance access and make insurance more affordable for groups that struggle to buy insurance now.