“Mini Mike Bloomberg is spending a lot of money on False Advertising. I was the person who saved preexisting 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 and, if Republicans win in court and take back the House of Representatives, your healthcare, that I have now brought to the best place in many years, will become the best ever, by far. I will always protect your Pre-Existing Conditions, the Dems will not!”

— President Trump, remarks in two tweets, Jan. 13, 2020

Nearly 70 times through Dec. 10, President Trump has falsely claimed he has sought to protect patients with preexisting conditions through his various efforts to eliminate the Affordable Care Act, according to our database of Trump’s false or misleading claims. But these tweets are really something — a virtual traffic jam of false claims.

Let’s unravel this mess.

The Facts

“Mini Mike Bloomberg is spending a lot of money on False Advertising.”

Trump appears to be complaining about this Bloomberg ad, which is mostly about the former New York mayor’s health-care proposals but starts out by noting higher health-care costs. A narrator says: “What’s Trump’s plan? Repeal Obamacare, threatening coverage for millions of Americans.” (Update: Trump could also be complaining about this new Bloomberg ad, which argues that Trump’s claim that he is protecting pre-existing conditions is a “broken promise.”)

Well, Trump has repeatedly tried to repeal or weaken the ACA, and independent experts have concluded the various plans he supported would have weakened coverage for Americans, especially those with preexisting conditions. So it’s unclear why Trump would claim it is false advertising.

“I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now …”

False. Trump had nothing to do with the ACA, signed into law by President Barack Obama in 2010.

Before the Affordable Care Act, insurance companies could consider a person’s health status when determining premiums, sometimes making coverage unaffordable or even unavailable if a person was already sick with a problem that required expensive treatment. The ACA prohibited that, in part by requiring everyone to purchase insurance. (That was known as the individual mandate.)

The ACA accomplished this through two provisions: guaranteed issue, which means insurance companies must sell insurance to anyone who wants to buy it, and community rating, which means that people within the same geographic area who buy similar insurance and are the same age pay similar prices. The two together made insurance affordable for people with, say, cancer. Before passage of the ACA, even minor health problems could have led an insurance company to deny coverage.

Trump supported House and Senate bills that would have weakened those protections by allowing states to seek waivers from the law and consider a person’s health status when writing policies in the individual market. The theory was that removing sicker people from the markets and allowing policies with skimpier options would result in lower overall premiums.

But the Congressional Budget Office concluded that states that took advantage of these provisions could perversely end up blowing up their insurance markets, leaving people with preexisting conditions with spiraling costs. About one-sixth of the U.S. population was estimated to live in states that would face this problem.

If the bills had been signed into law, costs for people with existing health conditions almost certainly would have increased.

Moreover, the Trump administration has issued new rules that promote the use of low-quality short-term plans that were prohibited under the ACA. These plans typically don’t have the same protections for people with existing health conditions, allowing insurance companies to deny coverage or charge higher prices. (A number of states, mainly Democratic-leaning, have acted to prohibit or limit these Trump plans.)

“… while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate …”

Technically, the GOP-led Congress did not eliminate the individual mandate. It still exists in the law, but the tax penalty for not having health insurance was reduced to zero. From the perspective of many health-care experts, the penalty was never high enough to encourage compliance; it certainly was unpopular.

But the individual mandate was a key component of the law. The ACA operates on the theory that, in the individual market, costs could be spread among a community of people with insurance. In other words, healthier people help subsidize the costs for sicker people. (People who get insurance from their employer — which is about half of Americans under 65 — already participate in a group that spreads the risk.)

The individual mandate was considered a crucial part of making the law work, along with protections for preexisting conditions and tax subsidies to make the law affordable. Reducing the penalty to zero could weaken the law in the long run, though enrollment in Obamacare basically held steady from 2019 to 2020.

“… if Republicans win in court and take back the House of Representatives, your healthcare, that I have now brought to the best place in many years, will become the best ever, by far.”

The tell here is “win in court.” What is Trump referring to?

The Trump administration has sided with plaintiffs in a court case that would wipe away the entire Affordable Care Act, saying it was unconstitutional. (Yes, the Supreme Court previously said the law was constitutional, but that hinged on the fact the individual mandate was deemed a tax. So the theory, under a lawsuit advanced by Republican-led states, is now that the tax penalty has been eliminated, the basis for saying the law is constitutional has been made null and void.)

It’s impossible to say what would happen if the Trump administration prevails in the case, but it would probably be chaos. The health system has spent a decade evolving under the ACA, but the lawsuit would wipe away the entire law — including protections for preexisting conditions.

“I will always protect your Pre-Existing Conditions, the Dems will not!”

This is lunacy. We’ve shown that Trump has worked hard to weaken these protections.

Meanwhile, the ACA is a law passed with no Republicans votes that enjoys strong support within the Democratic Party. Some presidential candidates want to expand the law, even institute a universal health-care system, but none of those proposals would specifically raise costs for or deny coverage to people with preexisting health conditions.

The Pinocchio Test

This traffic jam of false claims ends up in a crash worthy of Four Pinocchios.

Four Pinocchios

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