Fact check: Biden’s on target about what repealing ACA would mean for preexisting condition protections

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Jacob Gardenswartz | (TNS) KFF Health News

If the Affordable Care Act were terminated, “that would mean over a hundred million Americans will lose protections for preexisting conditions.”

President Joe Biden in a campaign advertisement, May 8

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President Joe Biden’s reelection campaign wants voters to contrast his record on health care policy with his predecessor’s. In May, Biden’s campaign began airing a monthlong, $14 million ad campaign targeting swing-state voters and minority groups with spots on TV, digital and radio.

In the ad, titled “Terminate,” Biden assails former President Donald Trump for his past promises to overturn the Affordable Care Act, also known as Obamacare. Biden also warns of the potential effect if Trump is returned to office and again pursues repeal.

“That would mean over a hundred million Americans will lose protections for preexisting conditions,” Biden said in the ad.

Less than six months from Election Day, polls show Trump narrowly leading Biden in a head-to-head race in most swing states. And voters trust Trump to better handle issues such as inflation, crime and the economy by significant margins.

An ABC News/Ipsos poll of about 2,200 adults, released in early May, shows the only major policy issues on which Biden received higher marks than Trump were health care and abortion access. It’s no surprise, then, that the campaign is making those topics central to Biden’s pitch to voters.

As such, we dug into the facts surrounding Biden’s claim.

Preexisting Condition Calculations

The idea that 100 million Americans are living with one or more preexisting conditions is not new. It was the subject of a back-and-forth between then-candidate Biden and then-President Trump during their previous race, in 2020. After Biden cited that statistic in a presidential debate, Trump responded, “There aren’t a hundred million people with preexisting conditions.”

A KFF Health News/PolitiFact HealthCheck at the time rated Biden’s claim to be “mostly true,” finding a fairly large range of estimates — from 54 million to 135 million — of the number of Americans with preexisting conditions. Estimates on the lower end tend to consider “preexisting conditions” to be more severe chronic conditions such as cancer or cystic fibrosis. Estimates at the spectrum’s higher end include people with more common health problems such as asthma and obesity, and behavioral health disorders such as substance use disorder or depression.

Biden’s May ad focuses on how many people would be vulnerable if protections for people with preexisting conditions were lost. This is a matter of some debate. To understand it, we need to break down the protections put in place by the ACA, and those that exist separately.

Before and After

Before the ACA’s preexisting condition protections took effect in 2014, insurers in the individual market— people buying coverage for themselves or their families — could charge higher premiums to people with particular conditions, restrict coverage of specific procedures or medications, set annual and lifetime coverage limits on benefits, or deny people coverage.

“There were a number of practices used by insurance companies to essentially protect themselves from the costs associated with people who have preexisting conditions,” said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University and an expert on the health insurance marketplace.

Insurers providing coverage to large employers could impose long waiting periods before employees’ benefits kicked in. And though employer-sponsored plans couldn’t discriminate against individual employees based on their health conditions, small-group plans for businesses with fewer than 50 employees could raise costs across the board if large numbers of employees in a given company had such conditions. That could prompt some employers to stop offering coverage.

“The insurer would say, ‘Well, because you have three people with cancer, we are going to raise your premium dramatically,’ and therefore make it hard for the small employer to continue to offer coverage to its workers because the coverage is simply unaffordable,” recalled Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy who researches public health insurance markets.

As a result, many people with preexisting conditions experienced what some researchers dubbed “job lock.” People felt trapped in their jobs because they feared they wouldn’t be able to get health insurance anywhere else.

Some basic preexisting condition protections exist independent of the ACA. The 1996 Health Insurance Portability and Accountability Act, for example, restricted how insurers could limit coverage and mandated that employer-sponsored group plans can’t refuse to cover someone because of a health condition. Medicare and Medicaid similarly can’t deny coverage based on health background, though age and income-based eligibility requirements mean many Americans don’t qualify for that coverage.

Once the ACA’s preexisting condition protections kicked in, plans sold on the individual market had to provide a comprehensive package of benefits to all purchasers, no matter their health status.

Still, some conservatives say Biden’s claim overstates how many people are affected by Obamacare protections.

Even if you consider the broadest definition of the number of Americans living with such conditions, “there is zero way you could justify that 100 million people would lose coverage” without ACA protections, said Theo Merkel, who was a Trump administration health policy adviser and is now a senior research fellow with the Paragon Health Institute and a senior fellow at the Manhattan Institute for Policy Research, a conservative think tank.

Joseph Antos, a senior fellow at the American Enterprise Institute, a conservative think tank, called the ad’s preexisting conditions claim “the usual bluster.” To reach 100 million people affected, he said, “you have to assume that a large number of people would lose coverage.” And that’s unlikely to happen, he said.

That’s because most people — about 55% of Americans, according to the most recent government data— receive health insurance through their employers. As such, they’re protected by the Health Insurance Portability and Accountability Act rules, and their plans likely wouldn’t change, at least in the short term, if the ACA went away.

Antos said major insurance companies, which have operated under the ACA for more than a decade, would likely maintain the status quo even without such protections. “The negative publicity would be amazing,” he said.

People who lose their jobs, he said, would be vulnerable.

But Corlette argued that losing ACA protections could lead to Americans being priced out of their plans, as health insurers again begin medical underwriting in the individual market.

Park predicted that many businesses could also gradually find themselves priced out of their policies.

“For those firms with older, less healthy workers than other small employers, they would see their premiums rise,” he told KFF Health News.

Moreover, Park said, anytime people lost work or switched jobs, they’d risk losing their insurance, reverting to the old days of job lock.

“In any given year, the number [of people affected] will be much smaller than the 100 million, but all of those 100 million would be at risk of being discriminated against because of their preexisting condition,” Park said.

Our Ruling

We previously ruled Biden’s claim that 100 million Americans have preexisting conditions as in the ballpark, and nothing suggests that’s changed. Depending on the definition, the number could be smaller, but it also could be even greater and is likely to have increased since 2014.

Though Biden’s claim about the number of people who would be affected if those protections went away seems accurate, it is unclear how a return to the pre-ACA situation would manifest.

On the campaign trail this year, Trump has promised — as he did many times in the past — to replace the health law with something better. But he’s never produced a replacement plan. Biden’s claim shouldn’t be judged based on his lack of specificity.

We rate Biden’s claim Mostly True.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Trump, Biden tied in a dead heat heading into next week’s debate, poll shows

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A new poll shows the former and incumbent presidents tied in a dead heat with just over a week to go before their first head-to-head debate of the 2024 election cycle.

An NPR/PBS News/Marist National Poll released Tuesday shows both President Joe Biden and former President Donald Trump tied for support at 49%. Trump gains a slight 1% edge, pollsters say, when the survey is limited to those who indicate they will definitely vote this November.

“While Biden has improved his standing among independents, Trump has widened his advantage among white voters,” pollsters wrote.

Biden’s support among independents, once at 42% compared to Trump’s 54%, now stands at 50% against the 45th President’s 48%. Trump’s lead among white votes has jumped from six points to 12 and now stands at 55%, while Biden’s 58% support among non-white voters has jumped about as much, going from an 11% lead over Trump to 18%.

Trump’s recent criminal conviction on 34 felony counts of falsifying his business records in the lead up to the 2016 election is to blame for the widening gaps, according to Lee Miringoff, the director of the Marist College’s Institute for Public Opinion.

“Although the topline results remain largely the same, there are interesting developments under the hood. Since Trump’s guilty verdict in the New York hush money trial, some familiar electoral patterns have re-emerged. Biden’s standing has improved among independent and non-white voters, and Trump has secured greater support among white voters,” Miringoff said.

In a race that includes third-party candidates Robert Kennedy Jr., Jill Stein, Cornel West, and Chase Oliver, Trump again takes the lead by a single point, with Biden losing out the most to other options.

“Trump receives the support of 42% of registered voters nationally to 41% for Biden. Kennedy has 11% to 3% for West, 1% for Stein, and 1% for Oliver. Kennedy pulls similar proportions of support from Biden and Trump supporters. However, West, Stein, and Oliver pull a combined 7% from Biden. Among Trump supporters, only Oliver receives 1%,” pollsters wrote.

According to the poll, most surveyed voters prefer Trump when it comes to handling the economy and immigration, while a majority favor Biden on matters of abortion and “on who would better deal with preserving democracy.” Voters tend to think Biden cares more about the average person than does Trump, according to the poll, but are split on which of the two better represents the U.S. on the world stage.

The poll shows that inflation is the top issue for voters this year, with 30% saying the cost of living is their top concern as they consider a presidential candidate, while preserving democracy comes in second at 29% and immigration third at 18%.

Most voters, according to the poll, are dissatisfied with the pair of major party candidates offered — again — at the top of the ticket.

The first presidential debate will be hosted by CNN on June 27.

Key results from Georgia runoff, Virginia and Oklahoma primaries

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Daniela Altimari and Mary Ellen McIntire | CQ-Roll Call (TNS)

WASHINGTON — A veteran lawmaker who chairs the House Appropriations Committee and a former national security official who played a role in former President Donald Trump’s first impeachment both won primaries easily Tuesday as voters cast ballots in Oklahoma, Virginia and Georgia.

Here’s a rundown of key results:

Cole wins easily in Oklahoma

In Oklahoma’s 4th District, Republican Rep. Tom Cole, the powerful chairman of the House Appropriations Committee, easily defeated four fellow Republicans, including a political unknown who loaned his campaign more than $5 million.

Rep. Tom Cole (R-OK), leaves the House Republican Conference caucus meeting in the U.S. Capitol in Washington, D.C., on April 16, 2024. (Bill Clark/CQ Roll Call/Zuma Press/TNS)

Cole had 68% of the vote at 8:33 p.m., when The Associated Press called the race. Cole withstood a flood of negative ads funded by businessman Paul Bondar, who had about 21% of the vote and faced questions about his residency. He owns a home outside Dallas, holds a Texas driver’s license and voted in the Texas primary on March 5, according to a report on KFOR.

The race also drew the attention of outside groups backing Cole. Americans 4 Security PAC spent $3.1 million and Defending Main Street SuperPAC Inc. spent $346,000 against Bondar. On top of that, those two groups and five others, including the National Association of Realtors and the National Rifle Association, spent another $299,000 supporting Cole.

The race in the 4th District, which includes parts of Oklahoma City and much of south-central Oklahoma, is rated Solid Republican by Inside Elections with Nathan L. Gonzales. Trump, who endorsed Cole, won the district by more than 31 percentage points in 2020.

No call yet in Good battle with McGuire

Rep. Bob Good and state Sen. John McGuire were locked in a tight race Tuesday for the Republican nomination in Virginia’s 5th District that saw some of Good’s House GOP colleagues campaigning on both sides.

No call had been made in the race at 10 p.m., when less than 200 votes separated the two candidates and an estimated 88% of the vote had been counted, according to the AP.

McGuire announced his run not long after Good was one of eight Republicans who voted to oust California Rep. Kevin McCarthy from the speaker’s chair last year. Good’s endorsement of Florida Gov. Ron DeSantis in the presidential primaries was also a factor in Trump endorsing McGuire, even though Good backed Trump after DeSantis dropped out.

Good had support from his colleagues on the House Freedom Caucus, which he chairs, and several traveled to the district to campaign with him. But one Freedom Caucus member, Ohio Rep. Warren Davidson, bucked the group’s leader and endorsed McGuire.

Ex-Trump aide backed for open Georgia seat

Brian Jack, who served as White House political director under Trump and had his endorsement, secured the Republican nomination to an open seat in Georgia’s 3rd District.

Jack finished first in the five-candidate field in the May 21 primary but did not clear the 50% threshold to avoid a runoff with second-place finisher, state Sen. Mike Dugan.

On Tuesday, Jack had 66% of the vote at 7:50 p.m., when the AP called the race. The largely rural district in western Georgia is represented by Republican Drew Ferguson, who announced in December that he would not seek reelection.

Vindman, Anderson win in Virginia’s 7th

Eugene Vindman, a former National Security Council official whose twin brother testified during Trump’s first impeachment hearings, won the Democratic nomination in Virginia’s 7th District and will seek to succeed Rep. Abigail Spanberger, who is running for governor in 2025.

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Vindman had 51% of the vote in the seven-candidate field when the AP called the race at 8:06 p.m., just over an hour after polls closed. Former state Del. Elizabeth Guzman, was running second, followed by state Del. Briana Sewell and Prince William County Supervisor Andrea Bailey. The other candidates got less than 10% of the vote.

Vindman’s national profile brought a national focus to the race and helped him dominate fundraising by raising more than $5 million. Local Democrats, meanwhile, failed to coalesce around one candidate to make it a true two-person race.

The district is likely to be competitive in November, with a race rated Tilt Democratic by Inside Elections.

Vindman will face Republican Derrick Anderson, a retired Green Beret who was the preferred pick of national Republicans, including Speaker Mike Johnson.

Anderson had 46% in the six-candidate field when the AP called the race at 8:58 p.m. Cameron Hamilton, a retired Navy SEAL backed by some in the party’s more conservative wing, had 37%.

Smasal to take on Kiggans in Virginia’s 2nd

Missy Cotter Smasal won the Democratic primary to challenge GOP Rep. Jen Kiggans, a freshman who flipped a Virginia Beach-area seat two years ago.

Smasal was leading civil rights attorney Jeremiah Denton 68% to 32% when the AP called the race at 8:04 p.m. Smasal served in the Navy, as Kiggans did, and she currently is the executive director of a nonprofit focused on service women.

Kiggans has a strong fundraising advantage heading into the general election, though. She had $1.8 million on hand as of May 29, while Smasal had $368,000.

The race is rated Tilt Republican by Inside Elections.

Matchup set for Wexton’s seat in 10th

State Sen. Suhas Subramanyam and attorney Mike Clancy won their parties’ nominations in Virginia’s 10th District to succeed Democratic Rep. Jennifer Wexton , who is retiring because of health issues.

Subramanyam won a 12-way Democratic primary, besting state Del. Dan Helmer, who was the top fundraiser in the race. When the AP called the race at 9:15 p.m., Subramanyam had 30%, followed by Helmer’s 27%.

Clancy won a four-way Republican primary, and had 61% of the vote when the AP called the race at 7:41 p.m. Marine veteran Aliscia Andrews was running second with 23%.

The race is rated Likely Democratic by Inside Elections.

Cao to face Kaine for Senate in Virginia

Republican Hung Cao, a Navy veteran, will challenge Democratic Sen. Tim Kaine in November for a Virginia Senate seat.

Cao was leading the Republican primary with 68% of the vote in a five-candidate field that included Scott Parkinson, a Club for Growth vice president, when the AP called the race at 7:23 p.m.

Cao had Trump’s support and led the Republican field in fundraising, although he’ll begin the general election significantly trailing Kaine’s cash on hand. Kaine had $8.6 million on hand as of May 29, dwarfing Cao’s $203,000. Cao lost a House race to Rep. Jennifer Wexton in 2022.

The race is rated Solid Democratic by Inside Elections.

©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.

Tropical Storm Alberto forms in southwest Gulf, 1st named storm of the hurricane season

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By JAMIE STENGLE and MARIANA MARTÍNEZ BARBA (Associated Press)

MEXICO CITY (AP) — Tropical Storm Alberto formed on Wednesday in the southwestern Gulf of Mexico, the first named storm of what is forecast to be a busy hurricane season.

Alberto, which is bringing strong winds, heavy rainfall and some flooding along the coasts of Texas and Mexico, is expected to make landfall in northern Mexico on Thursday.

“The heavy rainfall and the water, as usual, is the biggest story in tropical storms,” said Michael Brennan, director of the National Oceanic and Atmospheric Administration’s National Hurricane Center.

Alberto was located 185 miles (about 300 kilometers) east of Tampico, Mexico and 295 miles (about 480 kilometers) south-southeast of Brownsville, Texas. It had top sustained winds of 40 mph (65 kph), according to the National Hurricane Center in Miami. A tropical storm is defined by sustained winds of between 39 and 73 mph (62 and 117 kph), and above that the system becomes a hurricane.

Brennan said that winds could get up to 45 mph (72 kph) to 50 mph (80 kph) before the storm makes landfall.

As much as 5 inches (13 centimeters) to 10 inches (25 centimeters) of rain was expected in some areas along the Texas coast, with even higher isolated totals possible, Brennan said. He said some higher locations in Mexico could see as much as 20 inches (50 centimeters) of rain, which could result in mudslides and flash flooding, especially in the states of Tamaulipas, Coahuila and Nuevo Leon.

At the Hotel Miramar Inn in Tampico, Mexico, near where Alberto was expected to come ashore, front desk attendant Diana Flores said the wind was gusty, but still not strong, and the rain hadn’t started yet. “There are people in the restaurant and on the beach,” Flores said early Wednesday.

Outer bands of rain lashed parts of Tamaulipas state in the northeast corner of Mexico overnight.

The storm was moving west at 9 mph (15 kph). Tropical storm warnings were in effect from the Texas coast at San Luis Pass southward to the mouth of the Rio Grande and from the northeastern coast of Mexico south of the mouth of the Rio Grande to Tecolutla.

“Rapid weakening is expected once the center moves inland, and Alberto is likely to dissipate over Mexico” on Thursday, the center said.

The U.S. National Weather Service said the main hazard for southern coastal Texas is flooding from excess rain. On Wednesday, the NWS said, there is “a high probability” of flash flooding in southern coastal Texas. Tornadoes or waterspouts are possible.

NOAA predicts the hurricane season that began June 1 and runs through Nov. 30 is likely to be well above average, with between 17 and 25 named storms. The forecast calls for as many as 13 hurricanes and four major hurricanes.

An average Atlantic hurricane season produces 14 named storms, seven of them hurricanes and three major hurricanes.

Brennan said that the first named system in the Atlantic on average comes on June 20, so Alberto is “about right on schedule.”

A no-name storm earlier in June dumped more than 20 inches (50 centimeters) of rain on parts of South Florida, stranding numerous motorists on flooded streets and pushing water into some homes in low-lying areas.

Brennan said there will be dangerous rip currents from the storm and drivers should watch out for road closures and turn around if they see water covering roadways.

“People underestimate the power of water and they sometimes don’t always take rainfall and the threats that come with it seriously, especially if you are driving in an area and you see water covering the road, you don’t want to drive into it,” Brennan said. “You don’t know how deep the water is. The road may be washed out. it doesn’t take but just a few inches of water that are moving to move your car.”

___ Stengle contributed to this report from Dallas.