Vance Misleads: Trump Tried to Kill Affordable Care Act, Not Strengthen It

Sen. J.D. Vance, R-Ohio, told viewers of NBC’s “Meet the Press” on Sept. 15 that former President Donald Trump crafted the Affordable Care Act, even though he could have chosen to do the opposite.

“Donald Trump had two choices,” said Vance, his running mate. “He could have destroyed the program, or he could have expanded it and improved it so that Americans didn’t lose too much health care. He chose to rely on a plan, even if it came from his Democratic predecessor.”

The remarks follow the former president’s comments during his debate with Vice President Kamala Harris on September 10 in Philadelphia. Trump said of the Affordable Care Act: “I saved it.”

The Affordable Care Act, also known as Obamacare, has become increasingly popular as Americans increasingly use it to get health coverage. More than 20 million people are enrolled this year in plans sold on the marketplaces created by the law. That makes the law a political hot button for Republicans, who have largely abandoned attempts to repeal it over the past decade.

Both Vance and Trump’s statements are false. We reached out to Vance’s campaign, who provided no additional information. But here’s a look at the Affordable Care Act-related policies Trump has pursued as president.

So what did Trump do with the ACA?

Most of the Trump administration’s actions related to the Affordable Care Act have been to cut the program, including cutting millions of dollars in funding for marketing and enrollment assistance and supporting numerous unsuccessful attempts by Congress and the courts to overturn the law. In June 2020, for example, the administration asked the Supreme Court to strike down the law in a case brought by more than a dozen Republican states. The Supreme Court ultimately rejected the request.

“The fact that the ACA survived the Trump administration is a testament to the strength of the underlying statutory framework and the public’s support for it,” said Sabrina Corlette, co-director of the Center on Health Insurance Reform at Georgetown University.

The provisions of the Most Affordable Care Act went into effect in 2014, under the administration of President Barack Obama.

Average premium costs, already rising when Trump took office, jumped for some plans in 2018 before beginning a modest decline for the rest of his term, according to statistics from KFF, a nonprofit health information organization that includes KFF Health News.

Some of the increases are tied to a 2017 decision by the Trump administration to stop making payments to insurers intended to lower deductibles and copayments for low- and middle-income people. However, by law, insurers must still offer these plans.

Two months earlier, the Congressional Budget Office warned that stopping payments could cause some insurers to leave the ACA market — and that premiums would increase by 20% in the first year.

Most states, however, have let insurers make up for lost payments by raising monthly premiums. That move has had the unintended effect of increasing federal subsidies for people who buy affordable health insurance plans, because those subsidies are tied to the cost of premiums.

“By accident, it gave people cheaper access to better coverage in exchange plans,” said Joe Antos, a senior fellow emeritus at the American Enterprise Institute.

Some Republicans say Trump deserves credit for the improvement.

But Larry Levitt, KFF’s executive vice president for health policy, said that was not the Trump administration’s intention.

“The only time Trump improved the ACA, it was an unintended consequence of an attempt to weaken it,” he said.

At the same time, the Trump administration has expanded access to some types of lower-cost health coverage that don’t comply with the Affordable Care Act rules, including short-term plans that typically have more restrictions on care and can leave consumers with surprise medical bills. Democrats call these plans “junk insurance.”

Brian Blase, president of the Paragon Health Institute, a conservative health research group, said that broader access to cheaper, less comprehensive plans helped more people get coverage. Critics of the plans say that if they had lured too many healthy people with ACA-compliant insurance, the increases could have skyrocketed for the people who stayed.

Trump also supported congressional efforts to repeal and replace laws, all of which failed — including on the memorable night when Sen. John McCain, R-Arizona, helped derail those efforts by voting against them. The Trump administration never released its own replacement plan, despite the former president’s repeated promises that it would.

During the debate with Harris, Trump said he had “ideas for a plan” to replace Obamacare and that “you’ll be hearing about it in the not too distant future.”

On “Meet the Press,” host Kristen Welker asked Vance when Trump’s plan would be ready. He didn’t answer directly, but said it would involve “deregulating the insurance market.”

Democrats and political critics say it’s code for insurers to do business as they did before the ACA, when sick people could be denied coverage or charged exorbitant premiums based on pre-existing conditions.

Our decision

Vance’s claim that Trump, as president, took steps to strengthen the Affordable Care Act and protect health coverage for 20 million Americans is simply not supported by the facts.

The Trump administration’s policies, for example, have not supported the law, but have often undermined efforts to raise awareness of enrollment or have been advanced to sabotage the insurance market. In addition, Trump has openly supported congressional efforts to repeal the law and legal challenges to it.

According to the U.S. Census Bureau, the number of Affordable Care Act enrollees declined by more than 2 million people during Trump’s presidency, and the number of uninsured Americans increased by 2.3 million, including 726,000 children, between 2016 and 2019. That includes all three years of Trump’s presidency.

We consider Vance’s statement to be false.