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VERIFY: Breaking down Trump-Biden debate exchange over the Affordable Care Act

It's true that Donald Trump is seeking an end to the Affordable Care Act. How would that affect healthcare coverage?

One exchange that stood out in the first presidential debate between President Donald Trump and former Vice President Joe Biden was over healthcare.

During that exchange, Biden said Trump wanted to do away with the Affordable Care Act (ACA), also known as Obamacare, and remove coverage for pre-existing conditions. He said removing the law would cause 20 million people to lose their coverage and another 100 million-plus to lose coverage for pre-existing conditions.

The VERIFY team broke down each aspect of the claim step-by-step.


About six minutes into the debate's transcript, Biden said, "Now, what's at stake here is the president's made it clear, he wants to get rid of the Affordable Care Act. He's been running on that, he ran on that and he's been governing on that."

In a response Trump made at 15:59, he confirmed he wanted to get rid of it: "They said the problem is, no matter how well you run Obamacare, it's a disaster. It's too expensive. Premiums are too high, that it doesn't work. So we do want to get rid of it. Chris (Wallace), we want to get rid of that and give something that's cheaper and better."

And Trump's actions against the ACA include arguing that the law should be found unconstitutional by the Supreme Court. The U.S. Solicitor General sent a brief to the Supreme Court making that argument. The court is set to hear the case beginning November 10.

So that part's true.

Biden claimed during that same exchange that 20 million people would immediately lose their health insurance if the ACA is done away with and that coverage for 100 million people with pre-existing conditions will be taken away. Trump countered, "there aren't 100 million people with pre-existing conditions."

The first claim, regarding 20 million people losing their health insurance immediately, is consistent with data from non-government organizations. The Urban Institute said if the ACA were nulled or repealed, the number of uninsured people in the U.S. would increase by 19.9 million. The Kaiser Family Foundation has found that the number of uninsured people in the United States has dropped by nearly 20 million since the ACA's passage. There isn't any up-to-date government data on this, but the Kaiser Family Foundation is an often-cited source on American healthcare data.

Whether or not there are 100 million people with pre-existing conditions is unknown. The Center for Medicare and Medicaid Services (CMS) says that anywhere between 50 million and 129 million non-elderly Americans have some type of pre-existing health condition. It adds "as many as 82 million Americans with employer-based coverage have a pre-existing condition." 

So the exact number of people with pre-existing conditions is unknown, although 100 million is within the estimated range. The exact number who could lose affordable coverage for those conditions is also unknown, but the CMS lists a smaller number, 82 million, as particularly at risk of losing affordable coverage if the ACA is nulled.

Trump has often claimed that he will protect those with pre-existing conditions and signed an executive order last week that said his administration is committed to protecting those people's coverage. Still, no substantive laws have been passed to guarantee it. At the moment, if the ACA is nulled, so too will protections for people with pre-existing conditions.

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