During the final presidential debate, President Donald Trump claimed that 180 million people would lose their private health insurance to socialized medicine if the Democratic presidential nominee, former Vice President Joe Biden, is elected president.
鈥淭hey have 180 million people, families under what he wants to do, which will basically be socialized medicine 鈥 you won鈥檛 even have a choice 鈥 they want to terminate 180 million plans,鈥 .
throughout the week, and we thought the linkage of Biden鈥檚 proposed health care plan with socialism was something we needed to check out. Especially since Biden opposed “Medicare for All,” the proposal by Sen. Bernie Sanders (I-Vt.) that would have created a single-payer health system run completely by the federal government, and has long been attacked by Republicans as 鈥渟ocialist.鈥
The Trump campaign did not respond to our request asking where the evidence for this claim came from. Experts called it a distortion of Biden鈥檚 plan.
Where the Number Comes From
Experts agreed the number of people who have private health insurance either through an employer-sponsored plan or purchased on the Affordable Care Act鈥檚 health insurance marketplace is around 180 million people.
麻豆女优, a nonpartisan health policy organization, that about 157 million Americans had health insurance through their employer, while almost 20 million had insurance they purchased for themselves. Together, that adds up to about 177 million with private health insurance. (KHN is an editorially independent program of 麻豆女优.)
What Does Biden Support?
Biden supports expanding the ACA through several measures, including a public option. Under his plan, this public option would be a health insurance plan run by the federal government that would be offered alongside other private health insurance plans on the insurance marketplace.
鈥淭he marketplace is made up of multiple insurers in areas,鈥 said , a health policy fellow at the Urban Institute. 鈥淪ometimes there are five or more [plans]; sometimes there is only one. Biden is talking about adding a public option in the marketplace. You could pick between these private insurers or you could pick the public option.鈥
Getting rid of the so-called employer firewall is also part of Biden鈥檚 proposal.
This firewall was implemented during the rollout of the ACA. It was designed to maintain balance in the insurance risk pools by preventing too many healthy people who have work-based coverage from opting instead to move to a marketplace plan. And it all came down to who qualified for the subsidies that made these plans more affordable.
Currently, those who are offered a health insurance plan through their employer that meets certain minimum federal standards aren鈥檛 eligible to receive these subsidies, which come in the form of tax credits. But that leaves many low-income workers with health care plans that aren鈥檛 as affordable or comprehensive as marketplace plans.
Biden鈥檚 plan would eliminate that firewall, meaning anyone could choose to get health insurance either through their employer or through the marketplace. That鈥檚 where many Republicans argue that we could start to see leakage from private health insurance plans to the public option.
鈥淭he problem is healthy people leaving employer plans,鈥 said , a scholar in health care at the conservative-leaning American Enterprise Institute. That could mean the entire workplace plan鈥檚 premiums would go up. 鈥淵ou could easily imagine a plan where it spirals, the premiums go up, and then even more people start leaving the plans to go to the public option.鈥
Blumberg, though, said that because the marketplace would still include private health insurance plans alongside the public option, it doesn鈥檛 mean everyone who chooses to leave their employer plan would go straight to the public option.
She has done based on a plan similar to the one Biden is proposing. She estimates that only about 10% to 12% of Americans would choose to leave their employer-sponsored plans, which translates to about 15 million to 18 million Americans.
麻豆女优 also did an and found that 12.3 million people with employer coverage could save money by buying on the exchange under the Biden plan.
But 鈥渋t鈥檚 not clear all of those people would choose to leave their employer coverage, though, as there are other reasons besides costs that people might want to have job-based insurance,鈥 , vice president and director of the program on the ACA at 麻豆女优, wrote in an email.
Either way, none of the estimates are anywhere close to the 180 million that Trump claimed.
Is This Type of Public Option Socialism?
Overall, experts said no, what Biden supports isn鈥檛 socialized medicine.
鈥淪ocialized medicine means that the government runs hospitals and employs doctors, and that is not part of Biden鈥檚 plan,鈥 , executive vice president for health policy at 麻豆女优, wrote in an email. 鈥淯nder Biden鈥檚 plans, doctors and hospitals would remain in the private sector just like they are today.鈥
However, Antos said that, in his view, the definition of socialism can really vary when it comes to health care.
鈥淚 would argue in one sense, we would already have socialized medicine. We have massive federal subsidies for everybody, so in that sense, we鈥檙e already there,鈥 said Antos. 鈥淏ut, if socialized medicine means the government is going to dictate how doctors practice or how health care is delivered, we are obviously not in that situation. I don鈥檛 think the Biden plan would lead you that way.鈥
And in the end, Antos said, invoking socialism is a scare tactic that politicians have been using for years.
鈥淚t鈥檚 just a political slur,鈥 said Antos. 鈥淚t鈥檚 meant to inflame the emotions of those who will vote for Trump and meant to annoy the people who will vote for Biden.鈥
Our Ruling
Trump said 180 million people would lose their private health insurance plans to socialized medicine under Biden.
While about 180 million people do have private health insurance, there is no evidence that all of them would lose their private plans if Biden were elected president.
Biden supports implementing a public option on the health insurance marketplace. It would exist alongside private health insurance plans, and Americans would have the option to buy either the private plan or the public plan. While estimates show that a number of Americans would likely leave their employer-sponsored coverage for the public plan, they would be doing that by choice and the estimates are nowhere near Trump鈥檚 180 million figure.
Experts also agree that the public option is not socialized medicine, and it鈥檚 ridiculous to conflate Biden鈥檚 plan with Medicare for All.
We rate this claim Pants on Fire.
