on surprise medical billing, which is a concern that has drawn bipartisan interest, President Donald Trump waded into another high-profile health issue: making sure insurance protects people who have preexisting health conditions.
鈥淲e will always protect patients with preexisting conditions, very importantly,鈥 Trump said on May 9.
It鈥檚 natural Trump would want to make this claim.
from the suggests that such protections, which prohibit individual insurance plans from charging people more based on their medical history, are a top priority for Americans and among the most popular provisions of the Affordable Care Act. (KHN is an editorially independent program of the foundation.)
With that context, we decided to put a microscope to the president鈥檚 claim.
We asked White House staff to point us to the policies or proposals on which Trump鈥檚 statement was based. They declined to provide specifics but reiterated the president鈥檚 assertion.
Texas V. Azar, And A Health Policy Vacuum
Interviews with four separate experts, though, suggested that the administration鈥檚 stance on a pending lawsuit that seeks to overturn the Affordable Care Act runs counter to Trump鈥檚 claim.
The case, known as Texas v. Azar, comes from a group of Republican attorneys general who argue that the entire health law should be struck because the 2017 tax bill gutted Obamacare鈥檚 requirement to have insurance, often called the individual mandate. In December, a Texas judge agreed.
The case is now before the 5th Circuit Court of Appeals. And, most relevant here, the 鈥 that is, the Trump administration鈥檚 legal arm 鈥 has refused to defend the ACA in these proceedings.
It鈥檚 highly unusual for an administration to decline to defend a federal law in court.
鈥淭his is a case when the department can make strong arguments in defense of the statute. Refusing to defend in those circumstances is almost unprecedented,鈥 said Nicholas Bagley, a law professor at the University of Michigan.
Initially, the Trump administration鈥檚 position on the lawsuit focused on the individual mandate, arguing that without it the ACA鈥檚 preexisting condition protections should be struck down, too. In filing a brief to the appellate court, though, the DOJ joined the plaintiffs to argue the law should be scrapped entirely. This outcome would also eliminate the law鈥檚 protections for people with preexisting health conditions.
In that context, 鈥渢here is real cause for skepticism鈥 about Trump鈥檚 assertion, said Wendy Netter Epstein, a law professor at DePaul University.
The most generous assessment came from Jonathan Adler, a health law expert at Case Western Reserve University. Adler has supported previous Obamacare challenges, that this one is legally unsound.
He agreed that the White House鈥檚 actual actions are 鈥渁t odds with the president鈥檚 promise.鈥
But, Adler said, the structure of Trump鈥檚 claim 鈥 promising what his administration 鈥渨ill鈥 do, rather than commenting on what it has done 鈥 leaves open the possibility of taking other steps to keep preexisting condition protections in place.
That鈥檚 true, other experts acknowledged. So far, the White House has postponed a legislative push until after the 2020 election 鈥 leaving a if the courts do wipe out the health law.
And, the GOP bills the White House has supported to date 鈥 including the so-called legislation first proposed in 2017, which the administration again 鈥 would fall short, multiple experts said.
Unlike the ACA, Graham-Cassidy allows states to redefine which core benefits 鈥 a list that includes protections for people with health problems 鈥 insurance plans must cover, which would make those specific protections optional. (For more on Graham-Cassidy, here鈥檚 from last fall.)
Plus, experts said, even if the White House had a plan, the odds of it gaining passage are slim with a divided Congress.
That makes safeguarding the ACA in court 鈥渢he only show in town鈥 if the administration is serious about protecting consumers who have preexisting conditions, Bagley said.
There鈥檚 one loophole that conservatives 鈥 the White House included 鈥 might lean on, suggested Sabrina Corlette, a professor at Georgetown University鈥檚 Health Policy Institute. It relies on what people mean when they talk about 鈥減rotections.鈥
Some experts also point out that the administration has issued regulations that run contrary to Trump鈥檚 claim. In particular, it recently issued a loosening restrictions on the length of so-called short-term health plans, which supporters said would bring a more affordable option to the individual insurance market. But these plans, which, because of the rule change, can last a year instead of three months, are considered bare-bones and are not required to provide preexisting condition protections.
Our Ruling
Trump said his administration will 鈥渁lways protect patients with preexisting conditions.鈥
But the White House鈥檚 policy trajectory does exactly the opposite. The DOJ鈥檚 stance, which reflects a policy in place at the same moment the president made this claim, would eliminate the only law guaranteeing that people with preexisting conditions both receive health coverage and do not have to pay more for it.
And on the regulatory front, the administration has advanced a health insurance option that is not required to include these protections.
Furthermore, the administration has not put forth any plan that might keep those guarantees in place. Every replacement health bill it has endorsed has offered protections less generous than those offered by the ACA. And it has taken further steps that could make it harder for people with preexisting conditions to get affordable coverage.
This statement is not accurate and makes a claim in direct opposition to what鈥檚 actually happening. We rate it False.
