Vice President Kamala Harris at the ABC News presidential debate, Sept. 10

Since Vice President Kamala Harris entered the presidential race, she and former President Donald Trump have sparred over their approaches to lowering prescription drug costs. Harris has described this as an important campaign promise that Trump made but didn’t deliver on.

“Donald Trump said he was going to allow Medicare to negotiate drug prices,” Harris said during the ABC News debate on Sept. 10 in Philadelphia. “He never did. We did.”

She previously told CNN that Trump’s promise to pursue such negotiations “never happened” during his administration.

During the 2016 presidential campaign, Trump repeatedly promised, if elected, to take steps to allow the government to negotiate drug prices. He never enacted such a policy in office. The Trump administration pursued smaller, temporary programs aimed at lowering drug costs.

However, experts say the effect of Trump’s moves fell far short of the expected effect of the Medicare drug price negotiation program included in President Joe Biden’s Inflation Reduction Act and of what Trump promised.

Medicare Drug Price Negotiation Policy, Explained

The Inflation Reduction Act — a sweeping climate and health care law Biden signed in August 2022 — included a measure authorizing the Centers for Medicare & Medicaid Services to negotiate Medicare prescription drug prices directly with pharmaceutical companies.

“The idea behind drug price negotiation is that Medicare can use its buying power to get a better price than what is currently being negotiated for these drugs,” according to Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News.

Medicare covers more than 67 million Americans, giving it enormous potential influence over prices for U.S. drugs and medical services.

In August, CMS announced it had secured significant discounts on the list prices of 10 drugs because of its negotiations. Those discounts ranged from a 38% reduction for blood cancer medication Imbruvica on the low end to a 79% cut for diabetes drug Januvia on the high side. (List prices and the prices Medicare drug plans pay can differ.)

The new prices are expected to save Medicare $6 billion in the first year, with Medicare beneficiaries set to save an additional $1.5 billion in out-of-pocket costs, according to the White House.

Those new prices aren’t set to take effect until 2026 — though Biden and Harris have highlighted other aspects of the law that are bringing down drug costs sooner, such as a $35-a-month out-of-pocket price cap on insulin for Medicare enrollees and a $2,000 yearly out-of-pocket spending cap for Part D drugs effective in January. The Part D program covers most generic and brand-name outpatient prescription drugs.

CMS will start negotiating prices for the next group of drugs — 15 a year for the next two years — in early 2025, and those talks will continue annually at least through the end of the decade.

Trump’s Promises Versus His Actions

As a presidential candidate in 2016, Donald Trump pledged to pursue prescription drug price negotiation programs — and sometimes overstated such a policy’s power to cut prices.

During multiple campaign rallies and media interviews that year, Trump suggested allowing the government to negotiate drug prices directly with manufacturers would save $300 billion a year, a claim a fact-checker said was “absurd” then.

“The problem is, we don’t negotiate,” Trump said during an MSNBC town hall in Charleston, South Carolina, on Feb. 17, 2016. “We’re the largest drug buyer in the world. We don’t negotiate.” He went on to say: “If we negotiated the price of drugs, Joe, we’d save $300 billion a year.”

Similarly, at a Feb. 24, 2016, rally in Virginia Beach, Virginia, Trump reiterated his interest in making this change. “If you bid them out we’ll save $300 billion … and we don’t even do it. We’re going to do it.” The pharmaceutical industry would push back, he said, but he added: “Trust me I can do it.”

In office, however, Trump backed away from those promises, rejecting a bill spearheaded by then-House Speaker Nancy Pelosi (D-Calif.) to authorize such negotiations. The Democratic-led House ultimately passed that legislation, though the Republican-led Senate didn’t consider it.

“Pelosi and her Do Nothing Democrats drug pricing bill doesn’t do the trick,” Trump wrote on X, the social platform then known as Twitter.

Trump pursued smaller initiatives that sought to lower drug costs. One such program, the “most favored nation” model, tried to cap the cost of some Part B medications — those administered in a doctor’s office or hospital outpatient setting — at the lowest price paid in certain peer nations with a per capita GDP of at least 60% that of the United States.

“Medicare is the largest purchaser of drugs anywhere in the world by far,” Trump said in announcing the program. “We’re finally going to use that incredible power to achieve a fairer and lower price for everyone.”

The Trump campaign didn’t respond to an inquiry about prescription drug price negotiations or the most favored nation model.

The program would have started in January 2021 and lasted seven years. CMS officials estimated the government would save more than $85 billion on Part B spending. But some of those savings came from assumptions that Medicare beneficiaries would lose access to some Part B medications under the model, with some manufacturers unlikely to sell products at the lower, foreign prices.

Trump’s program never took effect. Amid lawsuits from several drug companies and industry groups, a federal judge stayed the plan in December 2020. The Biden administration scrapped it in 2022.

Even if the most favored nation model had been enacted, experts say it wouldn’t have come close to saving Americans or the government as much money as the IRA’s drug price negotiation provisions. A contemporaneous analysis of Trump’s proposal estimated that 7% of the 60 million Medicare beneficiaries in 2018 would have benefited.

More importantly, the most favored nation model did not authorize the government to negotiate prescription drug prices with manufacturers — the policy Trump promised to implement.

What Comes Next?

A recent KFF poll shows 85% of Americans, including more than three-quarters of Republicans, favor allowing Medicare to negotiate prices with drug companies.

And lowering drug costs continues to be a key issue for both campaigns, with Trump and Harris sparring over everything from the price of insulin to the impact of the Inflation Reduction Act on Medicare spending.

“I’ll lower the cost of insulin and prescription drugs for everyone with your support, not only our seniors,” Harris told supporters at an Aug. 16 campaign event in Raleigh, North Carolina, promising to extend the IRA’s price caps.

A Trump campaign spokesperson, meanwhile, previously told KFF Health News that the former president “will do everything possible to lower drug costs for Americans when he’s back in the White House, just like he accomplished in his first term.” She provided no specifics.

Trump, however, has also repeatedly promised to repeal parts of the Inflation Reduction Act — though he has never specifically mentioned the drug price negotiation provision — and to rescind unspent money. Congressional Republicans have spoken publicly about their intentions to roll back the drug price negotiation provision.

Even without legislative changes, the next president will have the opportunity to steer Medicare’s prescription drug price negotiation process.

“An administration that wants to be more lenient on drug companies might be more lax in the negotiations process,” said Tricia Neuman, a senior vice president at KFF and the executive director of its Program on Medicare Policy. “Or the administration could perhaps be tougher than the Biden administration.”

Our Ruling

As a presidential candidate in 2016, Donald Trump promised to let the government negotiate prescription drug prices directly with pharmaceutical companies. As president, however, he instead tried to tie some U.S. drug prices to their costs in other countries. Drugmakers and industry groups sued, challenging the move, and courts blocked it.

Harris, therefore, is correct that Trump never was able to open Medicare up to drug negotiations despite his sweeping campaign promises.

We rate Harris’ claim True.

Our Sources:

ABC News, “READ: Harris-Trump Presidential Debate Transcript,” Sept. 10, 2024

Axios, “Hill GOP Sets Sights on Scrapping Drug Price Talks,” Sept. 17, 2024

Centers for Medicare & Medicaid Services, “Trump Administration Announces Prescription Drug Payment Model To Put American Patients First,” Nov. 18, 2020

CNN, “READ: Harris and Walz’s Exclusive Joint Interview With CNN,” Aug. 30, 2024

Congress.gov, “H.R.3 – Elijah E. Cummings Lower Drug Costs Now Act,” accessed Sept. 17, 2024

Factbase, “Donald Trump Attends an MSNBC Town Hall in Charleston, South Carolina,” Feb. 17, 2016

Factbase, “Donald Trump in Pawleys Island, SC,” Feb. 19, 2016

Federal Register, “42 CFR Part 513,” Nov. 27, 2020

KFF, “A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration,” Feb. 11, 2021

KFF, “KFF Health Tracking Poll September 2024: Support for Reducing Prescription Drug Prices Remains High, Even As Awareness of IRA Provisions Lags,” Sept. 13, 2024

KFF, “Most People Are Unlikely To See Drug Cost Savings From President Trump’s ‘Most Favored Nation’ Proposal,” Aug. 27, 2020

KFF Health News, “5 Things To Know About the New Drug Pricing Negotiations,” Aug. 30, 2023

KFF Health News, “Harris Did Not Vote To ‘Cut Medicare,’ Despite Trump’s Claim,” Aug. 20, 2024

KFF Health News, “Trump Is Wrong in Claiming Full Credit for Lowering Insulin Prices,” July 18, 2024

Phone interview with Tricia Neuman, a senior vice president at KFF and the executive director of its Program on Medicare Policy, Sept. 13, 2024

Reuters, “Federal Judge Blocks Trump Administration Drug Pricing Rule,” Dec. 23, 2020

The Washington Post, “Trump’s Truly Absurd Claim He Would Save $300 Billion a Year on Prescription Drugs,” Feb. 18, 2016

The White House, “Remarks by President Trump at Signing of Executive Orders on Lowering Drug Prices” July 24, 2020

The White House, “Remarks by Vice President Harris at a Campaign Event in Raleigh, NC,” Aug. 16, 2024

X, then known as Twitter, “@RealDonaldTrump,” Nov. 22, 2019

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Vance and Walz acknowledged occasional agreement on policy points and respectfully addressed each other throughout the debate. But they were more pointed in their attacks on their rival’s running mate for challenges facing the country, including immigration and inflation.

The moderators, “CBS Evening News” anchor Norah O’Donnell and “Face the Nation” host Margaret Brennan, had said they planned to encourage candidates to fact-check each other, but sometimes clarified statements from the candidates.

After Vance made assertions about Springfield, Ohio, being overrun by “illegal immigrants,” Brennan pointed out that a large number of Haitian immigrants in Springfield, Ohio, are in the country legally. Vance objected and, eventually, CBS exercised the debate ground rule that allowed the network to cut off the candidates’ microphones.

Most points were not fact-checked in real time by the moderators. Vance resurfaced a recent health care theme — that as president, Donald Trump sought to save the Affordable Care Act — and acknowledged that he would support a national abortion ban.

Walz described how health care looked before the ACA compared with today. Vance offered details about Trump’s health care “concepts of a plan” — a reference to comments Trump made during the presidential debate that drew jeers and criticism for the former president, who for years said he had a plan to replace the ACA that never surfaced. Vance pointed to regulatory changes advanced during the Trump administration, used weedy phrases like “reinsurance regulations,” and floated the idea of allowing states “to experiment a little bit on how to cover both the chronically ill but the non-chronically ill.”

Walz responded with a quick quip: “Here’s where being an old guy gives you some history. I was there at the creation of the ACA.” He said that before then insurers had more power to kick people off their plans. Then he detailed Trump’s efforts to undo the ACA as well as why the law’s preexisting condition protections were important.

“What Sen. Vance just explained might be worse than a concept, because what he explained is pre-Obamacare,” Walz said.

The candidates sparred on numerous topics. Our PolitiFact partners fact-checked the debate here and on their live blog.

The health-related excerpts follow.

The Affordable Care Act:

Vance: “Donald Trump could have destroyed the [Affordable Care Act]. Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care.”

False.

As president, Trump worked to undermine and repeal the Affordable Care Act. He cut millions of dollars in federal funding for ACA outreach and navigators who help people sign up for health coverage. He enabled the sale of short-term health plans that don’t comply with the ACA consumer protections and allowed them to be sold for longer durations, which siphoned people away from the health law’s marketplaces.

Trump’s administration also backed state Medicaid waivers that imposed first-ever work requirements, reducing enrollment. He also ended insurance company subsidies that helped offset costs for low-income enrollees. He backed an unsuccessful repeal of the landmark 2010 health law and he backed the demise of a penalty imposed for failing to purchase health insurance.

Affordable Care Act enrollment declined by more than 2 million people during Trump’s presidency, and the number of uninsured Americans rose by 2.3 million, including 726,000 children, from 2016 to 2019, the U.S. Census Bureau reported; that includes three years of Trump’s presidency.  The number of insured Americans rose again during the Biden administration.

Abortion and Reproductive Health:

Vance: “As I read the Minnesota law that [Walz] signed into law … it says that a doctor who presides over an abortion where the baby survives, the doctor is under no obligation to provide lifesaving care to a baby who survives a botched late-term abortion.”

False.

Experts said cases in which a baby is born following an attempted abortion are rare. Less than 1% of abortions nationwide occur in the third trimester. And infanticide, the crime of killing a child within a year of its birth, is illegal in every state.

In May 2023, Walz, as Minnesota governor, signed legislation updating a state law for “infants who are born alive.” It said babies are “fully recognized” as human people and therefore protected under state law. The change did not alter regulations that already required doctors to provide patients with appropriate care.

Previously, state law said, “All reasonable measures consistent with good medical practice, including the compilation of appropriate medical records, shall be taken by the responsible medical personnel to preserve the life and health of the born alive infant.” The law was updated to instead say medical personnel must “care for the infant who is born alive.”

When there are fetal anomalies that make it likely the fetus will die before or soon after birth, some parents decide to terminate the pregnancy by inducing childbirth so that they can hold their dying baby, Democratic Minnesota state Sen. Erin Maye Quade told PolitiFact in September.

This update to the law means infants who are “born alive” receive appropriate medical care dependent on the pregnancy’s circumstances, Maye Quade said.

Vance supported a national abortion ban before becoming Trump’s running mate.

CBS News moderator Margaret Brennan told Vance, “You have supported a federal ban on abortion after 15 weeks. In fact, you said if someone can’t support legislation like that, quote, ‘you are making the United States the most barbaric pro-abortion regime anywhere in the entire world.’ My question is, why have you changed your position?”

Vance said that he “never supported a national ban” and, instead, previously supported setting “some minimum national standard.”

But in a January 2022 podcast interview, Vance said, “I certainly would like abortion to be illegal nationally.” In November, he told reporters that “we can’t give in to the idea that the federal Congress has no role in this matter.”

Since joining the Trump ticket, Vance has aligned his abortion rhetoric to match Trump’s and has said that abortion legislation should be left up to the states.

— Samantha Putterman of PolitiFact, on the live blog

A woman’s 2022 death in Georgia following the state passing its six-week abortion ban was deemed “preventable.”

Walz talked about the death of 28-year-old Amber Thurman, a Georgia woman who died after her care was delayed because of the state’s six-week abortion law. A judge called the law unconstitutional this week.

A Sept. 16 ProPublica report found that Thurman had taken abortion pills and encountered a rare complication. She sought care at Piedmont Henry Hospital in Atlanta to clear excess fetal tissue from her uterus, called a dilation and curettage, or D&C. The procedure is commonly used in abortions, and any doctor who violated Georgia’s law could be prosecuted and face up to a decade in prison.

Doctors waited 20 hours to finally operate, when Thurman’s organs were already failing, ProPublica reported. A panel of health experts tasked with examining pregnancy-related deaths to improve maternal health deemed Thurman’s death “preventable,” according to the report, and said the hospital’s delay in performing the procedure had a “large” impact.

— Samantha Putterman of PolitiFact, on the live blog

What Project 2025 Says About Some Forms of Contraception, Fertility Treatments

Walz said that Project 2025 would “make it more difficult, if not impossible, to get contraception and limit access, if not eliminate access, to fertility treatments.”

Mostly False. The Project 2025 document doesn’t call for restricting standard contraceptive methods, such as birth control pills, but it defines emergency contraceptives as “abortifacients” and says they should be eliminated from the Affordable Care Act’s covered preventive services. Emergency contraception, such as Plan B and ella, are not considered abortifacients, according to medical experts.

PolitiFact did not find any mention of in vitro fertilization throughout the document, or specific recommendations to curtail the practice in the U.S., but it contains language that supports legal rights for fetuses and embryos. Experts say this language can threaten family planning methods, including IVF and some forms of contraception.

— Samantha Putterman of PolitiFact, on the live blog

Walz: “Their Project 2025 is gonna have a registry of pregnancies.”

False. 

Project 2025 recommends that states submit more detailed abortion reporting to the federal government. It calls for more information about how and when abortions took place, as well as other statistics for miscarriages and stillbirths.

The manual does not mention, nor call for, a new federal agency tasked with registering pregnant women.

Fentanyl and Opioids:

Vance: “Kamala Harris let in fentanyl into our communities at record levels.”

Mostly False.

Illicit fentanyl seizures have been rising for years and reached record highs under Biden’s administration. In fiscal year 2015, for example, U.S. Customs and Border Protection seized 70 pounds of fentanyl. As of August 2024, agents have seized more than 19,000 pounds of fentanyl in fiscal year 2024, which ended in September.

But these are fentanyl seizures — not the amount of the narcotic being “let” into the United States. 

Vance made this claim while criticizing Harris’ immigration policies. But fentanyl enters the U.S. through the southern border mainly at official ports of entry. It’s mostly smuggled in by U.S. citizens, according to the U.S. Sentencing Commission. Most illicit fentanyl in the U.S. comes from Mexico made with chemicals from Chinese labs.

Drug policy experts have said that the illicit fentanyl crisis began years before Biden’s administration and that Biden’s border policies are not to blame for overdose deaths. 

Experts have also said Congress plays a role in reducing illicit fentanyl. Congressional funding for more vehicle scanners would help law enforcement seize more of the fentanyl that comes into the U.S. Harris has called for increased enforcement against illicit fentanyl use.

Walz: “And the good news on this is, is the last 12 months saw the largest decrease in opioid deaths in our nation’s history.”

Mostly True.

Overdose deaths involving opioids decreased from an estimated 84,181 in 2022 to 81,083 in 2023, based on the most recent provisional data from the Centers for Disease Control and Prevention. This decrease, which took place in the second half of 2023, followed a 67% increase in opioid-related deaths between 2017 and 2023.

The U.S. had an estimated 107,543 drug overdose deaths in 2023 — a 3% decrease from the 111,029 deaths estimated in 2022. This is the first annual decrease in overall drug overdose deaths since 2018. Nevertheless, the opioid death toll remains much higher than just a few years ago, according to KFF. 

More Health-Related Comments:

Vance Said ‘Hospitals Are Overwhelmed.’ Local Officials Disagree.

We asked health officials ahead of the debate what they thought about Vance’s claims about Springfield’s emergency rooms being overwhelmed.

“This claim is not accurate,” said Chris Cook, health commissioner for Springfield’s Clark County.

Comparison data from the Centers for Medicare & Medicaid Services tracks how many patients are “left without being seen” as part of its effort to characterize whether ERs are able to handle their patient loads. High percentages usually signal that the facility doesn’t have the staff or resources to provide timely and effective emergency care.

Cook said that the full-service hospital, Mercy Health Springfield Regional Medical Center, reports its emergency department is at or better than industry standard when it comes to this metric.

In July 2024, 3% of Mercy Health’s patients were counted in the “left-without-being-seen” category — the same level as both the state and national average for high-volume hospitals. In July 2019, Mercy Health tallied 2% of patients who “left without being seen.” That year, the state and national averages were 1% and 2%, respectively.  Another CMS 2024 data point shows Mercy Health patients spent less time in the ER per visit on average — 152 minutes — compared with state and national figures: 183 minutes and 211 minutes, respectively. Even so, Springfield Regional Medical Center’s Jennifer Robinson noted that Mercy Health has seen high utilization of women’s health, emergency, and primary care services. 

— Stephanie Armour, Holly Hacker, and Stephanie Stapleton of KFF Health News, on the live blog

Minnesota’s Paid Leave Takes Effect in 2026

Walz signed paid family leave into law in 2023 and it will take effect in 2026.

The law will provide employees up to 12 weeks of paid medical leave and up to 12 weeks of paid family leave, which includes bonding with a child, caring for a family member, supporting survivors of domestic violence or sexual assault, and supporting active-duty deployments. A maximum 20 weeks are available in a benefit year if someone takes both medical and family leave.

Minnesota used a projected budget surplus to jump-start the program; funding will then shift to a payroll tax split between employers and workers. 

— Amy Sherman of PolitiFact, on the live blog

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A Facebook ad from the campaign of Sen. Jon Tester (D-Mont.), launched on Sept. 6, 2024

In a race that could decide control of the U.S. Senate, Sen. Jon Tester (D-Mont.) is attacking his challenger, Republican Tim Sheehy, for his stance on abortion. 

Montana’s Senate race is one of a half-dozen tight contests around the country in which Democrats are defending seats needed to keep their one-seat majority. If Republicans flip Tester’s seat, they could take over the chamber even if they fail to oust Democrats in any other key races.

In a series of Facebook ads launched in early September, Tester’s campaign said Sheehy supports banning abortion with no exceptions.

An ad launched on Sept. 6 said, “Tim Sheehy wants to take away the freedom to choose what happens with your own body, and give that power to politicians. Sheehy would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women. We can’t let Tim Sheehy take our freedom away.”

Sheehy’s Anti-Abortion Stance Allows for Rape, Health Exceptions

Sheehy’s website calls him “proudly pro-life,” and he’s campaigning against abortion. He opposes a measure on Montana’s November ballot that would amend the Montana Constitution to provide the right to “make and carry out decisions about one’s own pregnancy, including the right to abortion.”

In July, we rated False Sheehy’s statement that Tester and other Democrats have voted for “elective abortions up to and including the moment of birth. Healthy, 9-month-year-old baby killed at the moment of birth.”

But contrary to the new ad’s message, Sheehy has voiced support for exceptions.

In a Montana Public Radio interview in May, Sheehy was asked, “Yes or no, do you support a federal ban on abortion?” 

Sheehy said, “I am proudly pro-life and support commonsense protections for when a baby can feel pain, as well as exceptions for rape, incest, and the life of the mother, and I believe any further limits must be left to each state.”

And in a June debate with Tester, Sheehy said, “I’ll always protect the three rights for women: rape, incest, life of the mother.”

The issues section of Sheehy’s campaign website does not say that he has a no-exceptions stance, nor does it say he would “criminalize women” who have abortions.

In a statement, the Sheehy campaign told PolitiFact that the ad mischaracterizes Sheehy’s abortion position. Allowing no exceptions “has never been Tim’s position,” the campaign said.

Our Ruling

The Tester campaign’s ad says Sheehy “would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women.” 

Sheehy has said he supports abortion ban exceptions for rape or to save a pregnant woman’s life. We found no instances of him saying he would be OK with states criminalizing women who receive abortions in violation of state laws.

What gives the ad a kernel of truth is that Sheehy has voiced support for letting states decide abortion parameters within their borders. The Tester campaign argues that this means Sheehy would effectively enable legislators to pass abortion restrictions that don’t include exceptions or that criminalize women.

The Tester campaign’s argument relies on hypotheticals and ignores Sheehy’s stated support for exceptions, giving a misleading impression of Sheehy’s position.

We rate it Mostly False.

Our Sources

Jon Tester, Facebook ad, Sept. 6, 2024

Tim Sheehy, campaign issues page, accessed Sept. 12, 2024

KFF, “Policy Tracker: Exceptions to State Abortion Bans and Early Gestational Limits,” last updated July 29, 2024

Montana Public Radio, “Q&A: Tim Sheehy, Republican Candidate for U.S. Senate,” May 15, 2024 

Montana Senate debate (excerpt), June 9, 2024

Last Best Place PAC, “choice” web page, accessed Sept. 12, 2024

Montana Republican Party, 2024 platform, accessed Sept. 12. 2024

Daily Montanan, “Sheehy criticizes ballot measures, including initiative to protect abortion,” Aug. 22, 2024

Sabato’s Crystal Ball, “Where Abortion Rights Will (or Could) Be on the Ballot,” July 9, 2024

Heartland Signal, “Unearthed audio shows Tim Sheehy calling abortion ‘sinful,’ wanting it to ‘end tomorrow,’” Aug. 30, 2024

Montana Independent, “Jon Tester accuses Tim Sheehy of lying about abortion during first Senate campaign debate,” June 11, 2024

Statement to PolitiFact from the Sheehy campaign

Statement to PolitiFact from the Tester campaign

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Sen. JD Vance (R-Ohio) on “Meet the Press,” Sept. 15

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

“Donald Trump had two choices,” Vance, Trump’s running mate, said. “He could have destroyed the program, or he could actually build upon it and make it better so that Americans didn’t lose a lot of health care. He chose to build upon a plan, even though it came from his Democratic predecessor.”

The remarks follow statements the former president made during his Sept. 10 debate with Vice President Kamala Harris in Philadelphia. Trump said of the ACA, “I saved it.”

The Affordable Care Act, aka Obamacare, has grown more popular as Americans have increasingly used it to gain health coverage. More than 20 million people enrolled this year in plans sold through the marketplaces it created. That makes the law a tricky political issue for Republicans, who have largely retreated from their attempts over the past decade to repeal it.

Both Vance’s and Trump’s statements are false. We contacted Vance’s campaign; it provided no additional information. But here’s a review of policies related to Obamacare that Trump pursued as president.

So What Did Trump Do With the ACA?

Most of the Trump administration’s ACA-related actions involved cutting the program, including reducing by millions of dollars funding for marketing and enrollment assistance and backing the many failed efforts in Congress and the courts to overturn the law. In June 2020, for example, the administration asked the Supreme Court to overturn the law in a case brought by more than a dozen GOP states. The high court eventually rejected the case.

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

Most ACA provisions took effect in 2014, during Barack Obama’s presidential administration.

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 health information nonprofit that includes KFF Health News.

Some of those increases were tied to a 2017 Trump administration decision to stop making payments to insurers, which was intended to reduce deductibles and copayments for people with low to moderate incomes. By law, though, insurers still had to offer the plans.

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

Most states, however, let insurers make up for the lost payments by increasing monthly premiums. That had the unintended effect of boosting federal subsidies for people who buy Obamacare plans, because the subsidies are tied to the cost of premiums.

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

Some Republicans think Trump deserves credit for this inadvertent improvement.

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

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

Meanwhile, the Trump administration expanded access to some kinds of less expensive health coverage that aren’t compliant with ACA rules, including short-term plans that generally have more restrictions on care and can leave consumers with surprise medical bills. Democrats call the plans “junk insurance.”

Brian Blase, president of the Paragon Health Institute, a conservative health research group, said broader access to cheaper, less comprehensive plans helped more people get coverage. The plans’ critics say that if they had attracted too many healthy people from ACA-compliant insurance, increases could have spiked for people who remained.

Trump also supported congressional repeal-and-replace efforts, all of which failed — including on the memorable night when Sen. John McCain (R-Ariz.) helped kill the effort with a thumbs-down vote. The Trump administration never issued its own replacement plan, despite the former president’s many promises that he would.

Trump, during the debate with Harris, said that he has “concepts of 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.”

Critics say that’s code for letting insurers do business as they did pre-ACA, when sick people could be denied coverage or charged exorbitant premiums based on preexisting conditions.

Our Ruling

Vance’s assertion that Trump as president took steps to build upon the ACA and protect the health coverage of 20 million Americans is simply not supported by the record.

Trump administration policies, for example, didn’t buttress the ACA but often undermined enrollment outreach efforts or were advanced to sabotage the insurance marketplace. Also, Trump vocally supported congressional efforts to overturn the law and legal challenges to it.

By the numbers, Affordable Care Act enrollment declined by more than 2 million people during Trump’s presidency, and the number of uninsured Americans rose by 2.3 million, including 726,000 children, from 2016 to 2019, according to the U.S. Census Bureau. That includes nearly three years of Trump’s presidency.

We rate Vance’s statement False.

SOURCES:

“Meet the Press” interview with Sen. JD Vance, Sept. 15, 2024.

Brookings Institution, “Six Ways Trump Has Sabotaged the Affordable Care Act,” Oct. 9, 2020.

Vox, “Trump Is Slashing Obamacare’s Advertising Budget by 90%,” Aug. 31, 2017.

Center on Budget and Policy Priorities, “Trump Administration Has Cut Navigator Funding by Over 80 Percent Since 2016,” Sept. 13, 2018.

The New York Times, ‘Trump Administration Asks Supreme Court To Strike Down Affordable Care Act,” June 26, 2020.

Constitutional Accountability Center, Texas v. United States, accessed Sept. 16, 2024.

Harvard T.H. Chan School of Public Health, “Quantifying Health Coverage Losses Under Trump,” Nov. 3, 2020.

Center on Budget and Policy Priorities, “Uninsured Rate Rose Again In 2019, Further Eroding Earlier Progress,” Sept. 15, 2020.

U.S. Census Bureau, Health Insurance Historical Tables, revised Aug. 22, 2024.

KFF, Marketplace Average Benchmark Premiums, accessed Sept. 16, 2024.

Brookings Institution, “The Case for Replacing ‘Silver Loading,’” May 20, 2021.

KFF Health News, “Trump Administration Loosens Restrictions on Short-Term Health Plans,” Aug. 1, 2018.

The New York Times, “Biden Administration Finalizes Rule Curbing Use of Short-Term Health Plans,” March 28, 2024.

Telephone interview, Sabrina Corlette, co-director of the Center on Health Reforms at Georgetown University, Sept. 16, 2024.

Telephone interview, Joe Antos, senior fellow emeritus, American Enterprise Institute, Sept. 16, 2024.

Email correspondence, Brian Blase, president of the Paragon Health Institute, Sept. 16, 2024.

Email correspondence, Larry Levitt, KFF executive vice president for health policy, Sept. 18, 2024.

Congressional Budget Office, “The Effects of Terminating Payments for Cost-Sharing Reductions,” Aug. 15, 2017.

USA Today, “Trump To End Cost-Sharing Subsidies to Insurance Companies,” Oct. 12, 2017.

New York magazine, “Vance: Trump’s Health-Care Plan Is To Let Insurers Charge More for Preexisting Conditions,” Sept. 17, 2024.

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The debate was hosted by ABC with moderators David Muir and Linsey Davis, who occasionally fact-checked Trump. He complained on the Fox News show “Fox & Friends” on Wednesday morning that it was a “three-to-one” contest.

The two presidential candidates covered a wide range of issues — from job and inflation numbers to abortion and immigration — in exchanges marked by personal attacks. As our PolitiFact partners noted, Harris often directly addressed Trump while answering the moderators’ questions. Trump mostly stared straight ahead. In response to Trump’s claims about the Biden administration’s record on crime, Harris cited Trump’s criminal conviction in New York and other indictments.

The moderators questioned Trump about whether he would attempt to dismantle the Affordable Care Act, also known as Obamacare — the health insurance program he pledged and failed to repeal and replace during his previous administration.

He said, if president, he would “only change it if we come up with something that’s better and less expensive.” He went on to say, “There are concepts and options we have to do that, and you’ll be hearing about it in the not-too-distant future.”

Trump has promised an Obamacare replacement since he was on the campaign trail in 2015. He claimed during the debate that he “saved” the ACA by issuing regulations aimed at lowering insurance premiums.

Harris’ previous support for “Medicare for All,” a proposal to replace private health insurance with a government-run health system, drew questions from the moderators and attacks by Trump.

Abortion was a clear flash point. Harris called state restrictions on the procedure enacted since 2022 “Trump abortion bans” and said it was immoral to take away a woman’s ability to make decisions about her own body. She also pledged to sign any bill that would reinstate the protections outlined in Roe v. Wade, which the Supreme Court overturned in 2022.

Trump said that as president he would never face the question of signing a national abortion ban because the issue is now being settled in states. “I’m not signing a ban,” he said. “There’s no reason to sign a ban.”

Trump also resurfaced claims — repeatedly judged false by PolitiFact and other fact-checking organizations — that Democrats support abortions up to the moment of birth and the “execution” of babies after birth. ABC’s Davis flagged Trump’s statement, saying that willfully terminating a newborn’s life is illegal in every state. In addition, the majority of Democrats support abortion access up to fetal viability, when the fetus is able to survive outside the womb, typically around 24 weeks of pregnancy.

Harris brought up Project 2025, a policy blueprint created by the conservative Heritage Foundation from which Trump has sought to distance himself.

Moments after the debate ended, pop superstar Taylor Swift posted on Instagram that she would be voting for Harris “because she fights for the rights and causes I believe need a warrior to champion them.” Swift’s post featured a photo of her with her cat and was signed “Childless Cat Lady” — a reference to comments made by JD Vance, the Republican vice presidential candidate.

Our PolitiFact partners fact-checked the debate in real time on a live blog, with more coverage here, as Harris and Trump clashed on the economy, immigration, and abortion.

Excerpts detailing specific health-related claims follow.

Trump: “But the governor before, he said, ‘The baby will be born, and we will decide what to do with the baby.’”

False.

Trump initially referenced a West Virginia governor. He meant Virginia, and corrected himself later in the debate.

Former Virginia Gov. Ralph Northam, a Democrat and a physician, never said he would sanction the execution of newborns. What he did say during a 2019 radio interview is that in rare, late-pregnancy cases when fetuses are nonviable, doctors deliver the baby, keep it comfortable, resuscitate it if the family wishes, and then have a “discussion” with the mother.

The issue is that Northam declined to say what that discussion would entail. Trump puts words in the then-governor’s mouth, saying doctors would urge the mother to let them forcibly kill the newborn, which is a felony in Virginia (and all other states) punishable by a long prison sentence or death.

Trump: “Every legal scholar, every Democrat, every Republican, liberal, conservative, they all wanted [abortion] to be brought back to the states where the people could vote.”

False. 

The 1973 Roe v. Wade decision inspired legions of supporters and opponents. Before the U.S. Supreme Court overturned it in 2022, numerous legal scholars wrote briefs urging the court to uphold the ruling.

Some legal scholars who favor abortion rights have criticized the 1973 ruling’s legal underpinnings, saying that different constitutional arguments, based on equal protection, would have provided a stronger case. But legal experts, including some who held this view, said those scholars would not have advocated for overturning Roe on this basis.

Trump: On the Affordable Care Act, “I saved it.”

False. 

During 2016, Trump campaigned on repealing and replacing the Affordable Care Act. While president, he sought to repeal the measure — and failed.

But his administration pursued various policies that hindered its reach and effectiveness, including cutting millions of dollars in advertising and outreach funding. He cut subsidies to insurance companies that offered coverage on the exchanges. He also took regulatory steps to permit less expensive and less comprehensive health coverage — for example, short-term health plans that didn’t comply with the ACA.

During the Trump administration, ACA enrollment declined, and the number of uninsured Americans rose by 2.3 million from 2016 to 2019, including 726,000 children, according to the U.S. Census Bureau.

Trump: Harris “wants everybody to be on government insurance” for health care.

This is misleading.

Harris once co-sponsored a bill to expand Medicare to Americans of all ages, but she does not currently support this proposal.

In April 2019, Harris became one of 14 original co-sponsors of the Medicare for All Act of 2019 sponsored by Sen. Bernie Sanders (I-Vt.). The legislation would have established a national health insurance program administered by the federal Department of Health and Human Services.

The bill would have created an automatic, federally run health insurance program for all Americans, which would mirror the socialized medicine systems in such countries as the United Kingdom.

Harris backed the bill when she was preparing to run in the 2020 presidential primaries and many candidates believed that Democratic base voters wanted the most liberal positions possible.

However, Medicare for All failed to advance to a vote in the Senate. After her 2020 candidacy ended, Harris focused instead on bolstering the ACA as opposed to pushing for Medicare for All.

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— Former President Donald Trump, July 24, in a speech at a rally in Charlotte, North Carolina.

Attacking Vice President Kamala Harris on immigration, Republicans and allies of former Donald President Trump’s are saying the presumptive Democratic presidential candidate supported using taxpayer dollars to provide free health coverage to immigrants who are in the country without legal permission.

Senate and House candidates, an American political action committee supporting Trump, and the Republican National Committee have made similar assertions in recent days.

We contacted the Trump and Harris campaigns for comment about Trump’s statement, but neither responded.

The claims are misleading. It’s true that Harris supported allowing immigrants residing in the U.S. to obtain public health insurance regardless of legal status. During the first 2019 Democratic presidential primary debate in Miami, Kamala Harris raised her hand when a moderator asked candidates to raise their hands if their administration’s health plan would cover immigrants who are in the country illegally.

But that doesn’t mean Harris specifically said she supported taxpayer funding for the benefits or that the health coverage would be free.

PolitiFact has checked similar claims Republicans and Trump made in 2019 and found them Mostly False. The moderator didn’t ask Harris and the other candidates directly whether their plans would provide the coverage free of charge or with taxpayer money, so the claim is unsubstantiated.

Recently, Republicans have pointed to statements Harris made in 2019 while running for president to portray her as supporting giving public benefits to immigrants living in the country illegally. Specifically, CNN’s Jake Tapper asked Harris whether her “Medicare for All” plan would cover such immigrants.

The National Republican Senatorial Committee on July 23 posted on the social platform X a clip of the interview with the message: “FLASHBACK: Kamala Harris tells Jake Tapper she endorses universal healthcare and Medicare-for-all for illegal immigrants.”

But that clip doesn’t show her saying that. Instead, in response to a question about whether Medicare for All should apply to people in the country illegally, she said, “I am opposed to any policy that would deny in our country any human being from access to public safety, public education, or public health, period.” Tapper didn’t ask anything else about this.

Medicare for All is a system, promoted by some Democrats, in which all Americans would get their health insurance from a government program modeled after the one that currently covers people 65 and older and people with disabilities.

Under the Emergency Medical Treatment and Labor Act, which became law in 1986, all patients regardless of citizenship or immigration status are already entitled to treatment in hospital emergency rooms. 

Some anti-immigration groups say they still believe Harris supports taxpayer-paid health benefits for immigrants lacking legal residency.

“Instead of pushing back, she at the very least implicitly endorses Medicare for illegal aliens,” said Joey Chester, a spokesperson for Federation for American Immigration Reform, a group that seeks to reduce overall immigration. That she raised her hand during the 2019 debate means her position is to give taxpayer-funded health care benefits to people who are in the country illegally, he added.

Harris’ proposal would have provided comprehensive health insurance to all Americans. But it was not all free. She would have allowed Americans to immediately buy into the program while expanding it over 10 years. The plan she produced was similar to current Medicare, in which people can buy plans that the federal government or private insurers administer.

A 10-year phase-in would automatically enroll newborns and uninsured people. But her proposal didn’t break down how it would pay for coverage of recipients living in the U.S. without authorization.

Harris wrote in a 2019 article on Medium that “good options” to pay for Medicare for All plans include an income-based premium by employers, higher taxes on the wealthiest 1% of Americans, taxing Wall Street trades, and savings from accelerating health care-delivery system reforms and changes in the way providers are paid.

California, where Harris served as attorney general from 2011 to 2017, was the first state this year to expand Medicaid eligibility to all qualified immigrants regardless of legal status, phasing it in over several years. Medicaid is a federal-state health program that provides health coverage to low-income and disabled adults.

The California program for immigrants is funded almost entirely by state dollars, according to the Public Policy Institute of California, a nonprofit research institution. Federal law generally bans states from using federal money to pay for health coverage for immigrants living in the country without legal permission.

However, taxpayers can bear the brunt of uncompensated care, when people without insurance — including immigrants lacking legal residency — seek care at hospitals or from other providers. The costs are passed on to other consumers in the form of higher prices and are considered a drain on state and local government budgets.

“Government payments are the main source for helping to defray providers’ costs for care to the uninsured, and those government payments are ultimately funded by taxpayers,” said Laurel Lucia, health care program director at the University of California-Berkeley Center for Labor Research and Education Center, which provides research and policy information.

Immigrants who are in the country illegally also pay billions of dollars in taxes.

“If she does support subsidized coverage for noncitizens, I’d see that as a good thing, not a bad thing,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy. “Many recent immigrants are taking care of our children, our elderly, working in hospitality, food service, and food production. Isn’t it in our best interests for these folks to have access to good health care?”

Our Ruling

Republicans have sought to portray Harris as extreme on immigration and assert that she supports free, taxpayer-funded health benefits for immigrants who are in the country illegally.

Harris signaled in 2019 that her Medicare for All proposal would cover all immigrants regardless of status. She has also said that she would oppose any policy that would deny anyone in the country access to “public health.” However, health policy and immigration experts say there’s no evidence she would provide the coverage free, paid for by other taxpayers. Immigrants lacking legal residency also pay taxes.

Harris has not expressly said she supports free, taxpayer-supported health coverage for immigrants living in the U.S. illegally.

Trump’s statement contains an element of truth but ignores critical facts that would give a different impression. We rate this claim Mostly False.

Sources

YouTube, former President Donald Trump rally in Charlotte, North Carolina, July 24, 2024.

YouTube, Democratic presidential primary debate in Miami, June 27, 2019.

X, Republican National Committee post of Jake Tapper’s State of the Union interview with Kamala Harris, remarking on immigrant health care, July 23, 2024.

Email interview with Edwin Park, research professor at the McCourt School of Public Policy at Georgetown University, July 24 and July 25, 2024.

Email interview with Sabrina Corlette, research professor, founder, and co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy, July 25, 2024.

Email interview with Laurel Lucia, health care program director at the University of California-Berkeley Labor Center, July 24 and 25, 2024.

Email interview with Joey Chester, spokesperson, Federation for American Immigration Reform, July 25, 2024.

PolitiFact, “Fact-Checking Trump Ad on Democrats, Health Care for Immigrants Illegally in the Country,” Aug. 1, 2019.

PolitiFact, “Florida GOP Chair Twists’ Response by Democrats at Debate on Health Care for Undocumented Immigrants,” Nov. 8, 2019.

Medium, “Kamala Harris: My Plan for Medicare for All,” July 29, 2019.

American Immigration Council, “Adding Up the Billions in Tax Dollars Paid by Undocumented Immigrants,” April 4, 2016.

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Former President Donald Trump in a Truth Social post, June 8

Former President Donald Trump has repeatedly claimed that he — and not President Joe Biden — deserves credit for lowering older Americans’ prescription drug prices, specifically for insulin.

In a June 8 post on Truth Social, the former president’s social platform, Trump wrote: “Low INSULIN PRICING was gotten for millions of Americans by me, and the Trump Administration, not by Crooked Joe Biden. He had NOTHING to do with it.”

Trump again claimed sole credit for lowering insulin prices during the June 27 presidential debate in Atlanta. After Biden touted the $35 monthly out-of-pocket cap for Medicare patients mandated by the Inflation Reduction Act, Trump responded: “I’m the one that got the insulin down for the seniors. I took care of the seniors.”

It’s not just the former president making such claims. Fox News anchor John Roberts and former Arkansas Gov. Mike Huckabee, a Republican, both have said the Biden administration is wrong to take credit for lowering insulin costs.

Because drug prices and Medicare will likely be issues in the presidential campaign, we dug into the facts surrounding those claims.

The Trump Administration’s Program

Trump is correct that his administration enacted a program to lower insulin costs for some patients on Medicare.

In July 2020, Trump signed an executive order establishing the “Part D Senior Savings Model,” a temporary, voluntary program run by the Centers for Medicare & Medicaid Services that let some Medicare Part D prescription drug plans cap monthly out-of-pocket insulin copay costs at $35 or less. It covered at least one insulin product of each dosage and type.

The program began Jan. 1, 2021, and ran through Dec. 31, 2023. In 2022, the Trump-era program included a total of 2,159 Medicare drug plans, and CMS estimated that more than 800,000 Medicare beneficiaries who use insulin could have benefited from it that year.

The Department of Health and Human Services has estimated that more than 1.5 million Medicare beneficiaries paid more than $35 a month for insulin in 2020, before Trump’s program took effect. An analysis by the Rand Corp., a nonpartisan think tank, showed the program reduced participants’ out-of-pocket insulin costs by $198 to $441 per year on average, depending on their Medicare plan.

The Inflation Reduction Act Provisions

The Inflation Reduction Act, which Congress passed and Biden signed into law in August 2022, included an insulin provision that went further than Trump’s voluntary initiative.

The act did cap out-of-pocket costs of insulin for Medicare patients at $35 per month. But whereas the Trump program applied only to certain Medicare Part D plans, the act mandated that all Medicare drug programs cap out-of-pocket insulin costs — including those in what’s known as Medicare Part B, which pays for medical equipment such as insulin pumps. The act’s insulin provisions took effect Jan. 1, 2023, for Part D plans and July 1 of that year for Part B.

The act also mandated that the out-of-pocket price cap apply to all insulin products a given Medicare plan covers, not just a subset.

Taken together, those provisions mean a far greater number of Medicare beneficiaries stand to benefit from the act’s insulin provisions — including people receiving insulin via a pump, who were left out of the Trump-era program.

CMS estimates that more than 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. Although some of those people were likely already paying less than $35 per month for their medications, the Inflation Reduction Act benefited far more than the 800,000 patients affected by Trump’s program.

“It’s likely a larger population than under the Trump administration’s model,” said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News.

“The Trump administration did establish this voluntary model, and one perhaps could view that as some precedent for what we saw in the Inflation Reduction Act,” Cubanski added. “But I think it’s inaccurate to state that President Biden had nothing to do with enabling millions of Americans to benefit from lower insulin copayments.”

Preliminary research shows the Inflation Reduction Act’s insulin provisions had a greater average financial benefit than those in Trump’s program. Insulin-using older Americans were estimated to save an annual average of $501 per person, HHS figures show.

The Inflation Reduction Act has also had an impact beyond Medicare. After the law passed, some pharmaceutical companies — including Eli Lilly and Co., Novo Nordisk, Sanofi, and Civica Rx — self-imposed price caps for all insured insulin users, not just Medicare patients. During his 2023 State of the Union address, Biden proposed expanding this benefit to all insulin patients, and he’s made that point a staple of his campaign appearances.

“I’m determined to make that apply to every American, not just seniors, in the second term,” he said at a campaign event in May in Philadelphia.

The Stakes for the 2024 Election

Beyond insulin products, the Inflation Reduction Act caps total out-of-pocket prescription costs at $2,000 annually for people with Medicare drug plans starting in 2025, down from $3,300 this year for most Medicare beneficiaries.

But every congressional Republican opposed the Inflation Reduction Act, including its insulin savings provisions, in 2022, and the law is vulnerable to repeal should Trump take the White House. Trump has repeatedly criticized the law and called for overturning some of its provisions. He has not specified how he would address its health measures.

In an email exchange with KFF Health News, Trump campaign spokesperson Karoline Leavitt highlighted drug savings programs the former president instituted during his term in office, but repeatedly declined to extrapolate on, or defend, Trump’s claim that Biden deserves no credit for lowering insulin costs.

Asked whether Trump intended to maintain the Inflation Reduction Act’s insulin provisions should he win a second term in office, Leavitt wrote, “President Trump will do everything possible to lower drug costs for Americans when he’s back in the White House, just like he accomplished in his first term.”

Our Ruling

Trump can claim some credit for lowering insulin costs for seniors, as his administration advanced a voluntary program to do so.

But his claim that Biden had “NOTHING to do with it” is patently false. The Inflation Reduction Act, which Biden signed into law, imposed a mandatory Medicare insulin price cap that applied across the program, benefiting a significantly larger number of insulin users — including people not enrolled in Medicare. 

We rate Trump’s claim False.

Sources:

Civica Rx, “Civica to Manufacture and Distribute Affordable Insulin,” March 3, 2022

Centers for Medicare & Medicaid Services, “Part D Senior Savings Model,” accessed July 2, 2024

CMS, “President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors,” May 26, 2020

CNN, “READ: Biden-Trump Debate Transcript,” June 28, 2024

Eli Lilly and Co., “Lilly Cuts Insulin Prices by 70% and Caps Patient Insulin Out-of-Pocket Costs at $35 Per Month,” March 1, 2023

Email exchange with Karoline Leavitt, Donald J. Trump 2024 campaign national press secretary, July 1, 2024

Facebook.com, post by @MikeHuckabee, June 10, 2024

Federal Registrar, “Access to Affordable Life-Saving Medications,” July 24, 2020

Department on Health and Human Services, “Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics,” Jan. 24, 2023

KFF, “Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit,” April 20, 2023

Novo Nordisk, “Novo Nordisk To Lower U.S. Prices of Several Pre-Filled Insulin Pens and Vials up to 75% for People Living With Diabetes in January 2024,” March 14, 2023

Phone interview with Juliette Cubanski, deputy director of KFF’s Program on Medicare Policy, June 16, 2024

Rand Corp., “Evaluation of the Part D Senior Savings Model,” May 2023

Republican Study Committee, “Fiscal Sanity to Save America,” March 20, 2024

Sanofi, “Sanofi Capping Its Insulin to a $35 Out-of-Pocket Costs in the U.S.,” June 1, 2023

Stat, “Biden and Trump Are Fighting To Claim Credit for $35 Insulin. It Was Actually a Pharma Giant’s Idea,” June 13, 2024

The White House, “FACT SHEET: President Biden’s Cap on the Cost of Insulin Could Benefit Millions of Americans in All 50 States,” March 2, 2023

The White House, “Remarks by President Biden and Vice President Harris at a Campaign Event | Philadelphia, PA,” May 29, 2024

The White House, “Remarks of President Joe Biden — State of the Union Address as Prepared for Delivery,” Feb. 7, 2023

Truthsocial.com, post by @realDonaldTrump, June 8, 2024

X.com, post by @justinbaragona, June 3, 2024

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Sitting in the Fiserv Forum, the convention’s Milwaukee venue, Vance took questions from host Sean Hannity and addressed criticism about his previous comments on domestic violence, abortion, and his 2016 disapproval of Trump.

A couple of times, Vance accused the media of twisting controversial comments about violent marriages and abortion exemptions. We took a closer look at four of his claims.

Vance Mischaracterizes Biden’s Stance on Abortion

Vance addressed his own and Trump’s position on abortion. He described Trump’s position “to let voters in states” decide abortion laws as “reasonable,” contrasting it with Biden’s. 

“Donald Trump is running against a Joe Biden president who wants taxpayer-funded abortions up until the moment of birth,” Vance said.

This is False and misleads about how rarely abortions are performed late in pregnancy. 

The vast majority of abortions in the U.S. — about 91% — occur in the first trimester. About 1% take place after 21 weeks, and far fewer than 1% occur in the third trimester and typically involve emergencies such as fatal fetal anomalies or life-threatening medical emergencies affecting the pregnant woman.

Biden has said he supported Roe v. Wade, the landmark 1973 U.S. Supreme Court ruling that legalized abortion and was overturned in June 2022, and wants federally protected abortion access. 

Roe didn’t provide unrestricted access to abortion. It legalized abortion federally but also enabled the states to restrict or ban abortions once a fetus is viable, typically around 24 weeks into pregnancy. Exceptions to that time frame typically were allowed when the pregnant woman’s life or health was at risk.

The Democratic-led Women’s Health Protection Act of 2021, which failed to pass the Senate, would have effectively codified a right to abortion while allowing for post-viability restrictions similar to Roe‘s.

During the 2020 presidential campaign, Biden promised to repeal the Hyde Amendment, which says federal funds can’t be used to pay for abortions, except in cases of rape or incest or to save the woman’s life. However, the amendment has continued to be included in congressional spending bills. 

Vance’s Comments About Women in Violent Marriages

Hannity asked Vance to explain controversial 2021 comments about women staying in violent marriages. 

“Both me and my mom actually were victims of domestic violence,” Vance told Hannity. “So, to say ‘Vance has supported women staying in violent marriages,’ I think it’s shameful for them to take a guy with my history and my background and say that that’s what I believe. It’s not what I believe. It’s not what I said.” 

The comments in question came from a 2021 event Vance participated in at Pacifica Christian High School in California. In a conversation about his 2016 memoir “Hillbilly Elegy,” the event moderator asked Vance about his experience being raised by his grandparents, following his mother’s divorces and struggles with drug addiction. 

“What is causing one generation to give up on fatherhood when the other one was so doggedly determined to stick it out even in tough times?” the moderator asked. 

Vance talked about the economic effect of men losing manufacturing jobs then discussed his grandparents’ marriage. 

In his memoirs, Vance detailed his grandparents’ relationship and told a story about Vance’s grandmother pouring lighter fluid on his grandfather and striking a match after he came home drunk. She had previously threatened to kill her husband if he came home drunk again, according to a 2016 book review published by The Washington Post. 

Vance commended his grandparents for staying together, comparing it with younger generations. 

“This is one of the great tricks that I think the sexual revolution pulled on the American populace, which is the idea that, like, ‘Well, OK, these marriages were fundamentally, you know, they were maybe even violent, but certainly they were unhappy. And so getting rid of them and making it easier for people to shift spouses like they change their underwear, that’s going to make people happier in the long term.’ 

“And maybe it worked out for the moms and dads, though I’m skeptical. But it really didn’t work out for the kids of those marriages.”

In response to a 2022 Vice News story highlighting the comments, Jai Chabria, a strategist for Vance, said the media missed Vance’s point.

“This is a comment that he made where he’s talking about how it’s important that couples stay together for the kids, that we actually have good kids first,” he said. “All he is saying is that it is far too often the case where couples get divorced, they split up, and they don’t take the kids’ needs into consideration.”

Vance’s Comments About Rape, Abortion, and ‘Inconvenience’

Hannity asked Vance to discuss his position on abortion, allowing the senator to address his past comments that have been criticized. 

“Let me go back to the issue of abortion,” Hannity said. “And there was this article that said, ‘Oh, JD Vance said it’s inconvenient.'”

Vance told Hannity, “The Democrats have completely twisted my words. What I did say is that we sometimes in this society see babies as inconveniences, and I absolutely want us to change that.”

We looked into comments Vance made on abortion while he was running for Senate in 2022. His opponent claimed Vance had said that rape was inconvenient, but we found that’s not directly what Vance said. 

In a 2021 interview, Vance was asked whether laws should allow women to get abortions if they were victims of rape or incest. He said society should not view a pregnancy or birth resulting from rape or incest as “inconvenient.” 

“My view on this has been very clear, and I think the question betrays a certain presumption that is wrong,” Vance said in 2021. “It’s not whether a woman should be forced to bring a child to term, it’s whether a child should be allowed to live, even though the circumstances of that child’s birth are somehow inconvenient or a problem to the society. The question really, to me, is about the baby.”

Editor’s note: This is excerpted from PolitiFact’s full coverage. You can read the full story here.

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Tim Sheehy, Montana GOP candidate for U.S. Senate, said in a June 8 debate

Tim Sheehy, the Republican candidate seeking to unseat Democratic Sen. Jon Tester of Montana and give U.S. Senate control to the GOP, is campaigning on what he calls Tester’s and Democrats’ “extreme” position on abortion. 

In a televised debate June 8, Sheehy accused Tester and Democrats of voting for “elective abortions up to and including the moment of birth.” That statement prompted Tester to respond: “To say we’re killing babies at 40 weeks is total BS.”

Sheehy has made this accusation on his campaign website, which says, “Jon Tester supports elective abortion on demand up until the moment of birth. Think about that again: Jon Tester supports aborting a healthy, full-term baby the day before it’s due. That is the extreme position here.” Similar statements have been made in the campaign’s social media posts.

Painting the Democratic candidate with, in Sheehy’s words, an “extreme” position on abortion is a familiar conservative campaign strategy and campaign talking point this election cycle. But how does it hold up? 

Some Recent History

Asked for evidence to support Sheehy’s accusations, Sheehy’s campaign spokesperson, Katie Martin, said the Republican candidate was referring to Tester’s vote for the Women’s Health Protection Act, which failed to pass the Senate in 2022. She cited the bill’s provisions that said health providers and patients would have the right to perform and receive abortion services without certain limitations or requirements impeding access.

Anti-abortion advocates say the measure, which has been reintroduced in the current Congress, would create a loophole eliminating any limits to aborting a fetus later in pregnancy. And, rather than define when a fetus is viable during pregnancy, the bill would leave the question of viability to the health provider, who is financially motivated to perform abortions, according to Susan B. Anthony Pro-Life America, a nonprofit group supporting anti-abortion candidates, including Sheehy.

“It would impose no-limits abortion on demand in all 50 states at any point in pregnancy,” said Marjorie Dannenfelser, president of SBA Pro-Life America.

In 2022, the legislation failed two votes in the Senate before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision removed federal protections for abortion access and left the issue to the states to decide. Tester voted for the measure both times, but the bill failed to advance after votes of 46-48 and 49-51.

Alina Salganicoff, director of the Women’s Health Policy Program at KFF, said nothing in the Women’s Health Protection Act supports an abortion up to the moment of birth. Rather, the legislation would allow a health provider to perform abortions without obstacles such as waiting periods, tests deemed medically unnecessary, unnecessary in-person visits, or other restrictions imposed by states.

The bill would explicitly allow an abortion after a fetus is viable when, according to the legislation, “in the good-faith medical judgment of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient’s life or health.”

“This is not abortion on demand until the moment of birth,” Salganicoff said. “Even if politicians and anti-abortion activists make this claim, there are no clinicians that provide ‘abortions’ moments before birth.”

Besides the Women’s Health Protection Act, the Sheehy campaign cited Tester’s opposition to “born-alive” legislation meant to protect babies who survive botched abortions.

“At what week does he think it’s inappropriate for medical providers to perform an abortion?” Martin said of Tester. “That would clear up his stance on the issue. Based on his voting record, it suggests he does, in fact, support abortion on demand up until the moment of birth.”

In 2002, Congress passed a “born-alive” law that gave legal protections to infants who survive abortions. A stalled 2022 bill sought to expand that law to add criminal penalties to health professionals who do not take steps to preserve the life of any child born. Montana voters rejected a similar ballot question in 2022.

Tester was elected to the Senate four years after the first bill passed and a vote was not taken on the 2022 measure.

Looking at the Data

Instances of fetuses surviving abortions are rare. So are abortions performed later in pregnancy: Just 1% of all abortions in the U.S. happen at or after 21 weeks of gestation. (The percentage of abortions that occur when the fetus is presumed to be viable, 24 weeks or later, is presumably lower, but the Centers for Disease Control and Prevention does not break out abortion rates for that period.)

An analysis by SBA Pro-Life America’s research arm, the Charlotte Lozier Institute, concluded that 6% of abortions performed in 2020, or an estimated 55,800 abortions, happened at or after 15 weeks of pregnancy.

“Most late-term abortions are elective, performed on healthy women with healthy babies for the same reasons given for first-trimester abortions,” Dannenfelser said.

SBA Pro-Life cites abortions at 15 weeks and later because that is the stage of development at which a fetus can feel pain, according to the group. That is the same rationale behind Republican Sen. Lindsay Graham’s 15-week abortion ban legislation introduced in 2022.

But the American College of Obstetricians and Gynecologists says “the science conclusively establishes” that a fetus does not have the capacity to feel pain until 24 or 25 weeks.

“Every medical organization that has examined this issue and peer-reviewed studies on the matter have consistently reached the conclusion that abortion before this point does not result in the perception of pain in a fetus,” according to the OB-GYN medical group.

Katrina Kimport, a professor in the University of California-San Francisco’s Department of Obstetrics, Gynecology & Reproductive Sciences, said “born-alive” laws are trying to regulate something that doesn’t happen.

Kimport, whose research involved interviewing 30 people in 2018 who had abortions after 24 weeks of pregnancy, and 10 more from 2021 to 2022, also criticized Sheehy’s use of “elective abortion.” In her view, that terminology reflects a political colloquialism that’s come to mean an abortion that is optional. That’s different from the medical definition, she said, in which an elective procedure is one that may be necessary but is not an emergency and can be scheduled for a particular date, such as knee surgery.

Women have abortions later in pregnancy either because they find out new information or because of economic or political barriers, Kimport said.

“I have never spoken to somebody whose abortion decision was not informed by deep thought and consideration,” she said.

Trying to Change the Debate

Mary Ziegler is a University of California-Davis law professor who specializes in the law, history, and politics of reproduction, health care, and conservatism. She said Sheehy’s argument reprises a Republican talking point that abortion opponents have made for decades.

Similar arguments are being heard nationwide as 10 states consider ballot measures to constitutionally protect abortion this election cycle.

Republicans such as Sheehy are accusing Democrats of being extreme on abortion partly to steer the discussion away from their own uncertain position, Ziegler said. The anti-abortion bloc is a key part of the GOP base, but since the Dobbs ruling, voters in seven states, including Montana, have added or upheld abortion rights in elections.

“They can’t really disavow what pro-life groups want as extreme because many of their base voters would be horrified by that,” Ziegler said. “But they can’t embrace it because then many swing voters would be horrified by that.”

Kimport said Sheehy’s statement “reveals a blatant misunderstanding of pregnancy care.”

“What people don’t understand about third-trimester abortions is that there aren’t very many, but for the people who do need abortions later in pregnancy, the circumstances are often desperate and intense,” she said. “And these are the people who are being maligned in these political conversations.”

Our Ruling

Sheehy’s description of Tester’s “extreme” position that would allow abortion “up until the moment of birth” simply doesn’t hold up.

These statements are rooted in Tester’s support for the Women’s Health Protection Act. That bill, however, doesn’t open the door to abortion on demand later in pregnancy. Instead, it allows for the role of medical judgment. In addition, CDC data indicates that late-term pregnancies are rare. Also, the term “elective abortion” is a political rather than medical phrasing.

We rate this claim False.

sources:

NBC Montana, “WATCH: Incumbent U.S. Senator Tester debates challenger Tim Sheehy,” July 9, 2024

X social platform, post by @SheehyforMT, June 9, 2024

Tim Sheehy’s U.S. Senate campaign website, accessed June 9, 2024

Email interview with Katie Martin, Tim Sheehy’s spokesperson, June 11, 2024

Susan B. Anthony Pro-Life America, “SBA Pro-Life America’s Candidate Fund Endorses Tim Sheehy for U.S. Senate,” Jan. 30, 2024

Marjorie Dannenfelser, president of SBA Pro-Life America, in a statement, June 26, 2024

Email interview with Alina Salganicoff, KFF senior vice president and director of the nonprofit’s Women’s Health Policy Program, June 12, 2024

Phone interview with Katrina Kimport, University of California-San Francisco professor, June 12, 2024

Phone interview with Mary Ziegler, University of California-San Diego professor, June 12, 2024 

Email interview with Rachel Kingery, American College of Obstetricians and Gynecologists spokesperson, June 12, 2024

KFF, “Status of Abortion-Related State Constitutional Amendment Measures for the 2024 Election,” updated June 28, 2024

KFF, ”Abortions Later in Pregnancy in a Post-Dobbs Era,” Feb. 21, 2024

Julie Rovner, KFF Health News, “Abortion ‘Until the Day of Birth’ Is Almost Never a Thing,” Nov. 15, 2023

American College of Obstetricians and Gynecologists, “ACOG Guide to Language and Abortion,” accessed June 11, 2024

American College of Obstetricians and Gynecologists, “Facts Are Important: Understanding and Navigating Viability,” accessed June 11, 2024 

American College of Obstetricians and Gynecologists, “Facts Are Important: Gestational Development and Capacity for Pain,” accessed June 11, 2024

Charlotte Lozier Institute, Fact Sheet: “Abortions at 15 Weeks in the United States,” updated Jan. 12, 2023

PolitiFact, “Ron DeSantis’ False Claim That Some States Allow ‘Post-Birth Abortions. None Do,” July 21, 2023

Women’s Health Protection Act of 2021, accessed June 11, 2024

Women’s Health Protection Act of 2022, accessed June 11, 2024

Women’s Health Protection Act of 2023, accessed July 2, 2024

Born-Alive Infants Protection Act of 2002, accessed June 11, 2024 

Born-Alive Abortion Survivors Act of 2022, accessed June 11, 2024 

Montana Free Press, “How Montana’s LR-131 ‘Born Alive’ Referendum Failed,” Nov. 15, 2022 

Ballotpedia, “History of Abortion Ballot Measures,” accessed June 13, 2024

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

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President Joe Biden in a campaign advertisement, May 8

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.

our sources

ABC News/Ipsos Poll, “Six Months Out, a Tight Presidential Race With a Battle Between Issues & Attributes,” May 5, 2024

Avalere, “Repeal of ACA’s Pre-Existing Condition Protections Could Affect Health Security of Over 100 Million People,” Oct. 23, 2018

Biden-Harris 2024 campaign email, “NEW AD: Biden-Harris 2024 Launches ‘Terminate’ Slamming Trump for Attacks on Health Care,” May 8, 2024

Center for American Progress, “Number of Americans With Preexisting Conditions by District for the 116th Congress,” Oct. 2, 2019

Census Bureau, “Health Insurance Coverage in the United States: 2022,” September 2023

CNN, “Trump Administration Gives States New Power to Weaken Obamacare,” Oct. 22, 2018

Department of Health and Human Services, “Health Insurance Coverage for Americans with Pre-Existing Conditions: The Impact of the Affordable Care Act,” Jan. 5, 2017

Department of Health and Human Services, “The Health Insurance Portability and Accountability Act (HIPAA) of 1996 Helpful Tips,” accessed May 15, 2024

Email exchanges with Biden-Harris 2024 campaign official, May 13-15, 2024

Email exchange with Karoline Leavitt, Trump 2024 campaign national press secretary, May 13, 2024

KFF, “KFF Health Tracking Poll: The Public’s Views on the ACA,” May 15, 2024

KFF, “Recent Trends in Mental Health and Substance Use Concerns Among Adolescents,” Feb. 6, 2024

KFF Health News, “Drowning in a ‘High-Risk Insurance Pool’ — At $18,000 a Year,” Feb. 27, 2017

KFF Health News and PolitiFact, “Biden’s in the Ballpark on How Many People Have Preexisting Conditions,” Oct. 1, 2020

The New York Times, “Trump Leads in 5 Key States, as Young and Nonwhite Voters Express Discontent With Biden,” May 13, 2024

Phone interview and email exchanges with Theo Merkel, a senior fellow at the Manhattan Institute and the director of the Private Health Reform Initiative at the Paragon Health Institute, May 14-15, 2024

Phone interview with Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy, May 22, 2024

Phone interview with Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University, May 14, 2024

Truthsocial.com, post by @realDonaldTrump, Nov. 25, 2023

The Wall Street Journal, “Healthcare.gov to Shut Down During Parts of Enrollment Period for Maintenance,” Sept. 23, 2017

Work, Aging and Retirement, “Job Lock, Work, and Psychological Well-Being in the United States,” Feb. 19, 2016

YouTube.com/@CSPAN, “First 2020 Presidential Debate between Donald Trump and Joe Biden,” Sept. 29, 2020

YouTube.com/@JoeBiden, “Terminate” campaign advertisement, May 10, 2024

Phone interview with Joseph Antos, a senior fellow at the American Enterprise Institute, June 5, 2024

Health Affairs, What It Means To Cover Preexisting Conditions, Sept. 11, 2020

KFF, Pre-Existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA, Dec. 12, 2016

PolitiFact, “Does Trump Want To Repeal the ACA, as Biden Says? Tracking His Changing Stance Over the Years,” June 3, 2024

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

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