It鈥檚 a tried-and-true campaign strategy.
Candidates go on the attack, claiming their opponent will do harm to Medicare. After all, people are . These voters are also generally to protect the federal health insurance program for seniors.
It鈥檚 no surprise, then, that in an ad released this month, former Vice President Joe Biden鈥檚 campaign played the Medicare card.
鈥淒onald Trump is lying about Medicare and Social Security,鈥 an ominous, mature, male voice warns viewers in the . He goes on to say that 鈥淭rump鈥檚 pushing to slash Medicare benefits.鈥
Clearly, we鈥檝e heard this dire message before 鈥 from candidates of both parties through the years.
We issued a skeptical rating that Trump promised to gut Social Security and Medicare if re-elected, noting that his deferral of payroll taxes did not mention Medicare at all. But Trump has not mentioned cuts to Medicare benefits on the trail, and he鈥檚 to the program in the future. So what is Biden鈥檚 claim talking about?
As a rationale for the statement, a Biden campaign spokesperson pointed us to the Trump administration鈥檚 support of Republicans鈥 efforts in a court case, , which seeks to overturn the Affordable Care Act. But the ad does not include any reference or explanation of how the case would affect Medicare benefits.
The legal challenge, brought by a group of Republican attorneys general, is pegged to the 2017 tax bill, which zeroed out the tax that functioned as a penalty for not having health coverage 鈥 known as the individual mandate. Without this linchpin tax, the Republicans argue, the entire law should be struck down. They based that on the Supreme Court decision in 2012 that the law was constitutional because the penalty was a valid use of Congress鈥 ability to levy taxes.
In the current case, lower courts have found the law unconstitutional, and a group of Democratic attorneys general appealed to the Supreme Court.
Oral arguments are scheduled for Nov. 10. The Trump administration filed a in support of invalidating the entire law unconstitutional.
Though best known for its vast expansion of health coverage through marketplace plans and Medicaid, the ACA also included a range of consumer protections 鈥 such as the ban on discrimination against people with preexisting conditions 鈥 and an estimated 165 Medicare-related provisions.
The Biden spokesperson pointed to one, which ended Medicare鈥檚 so-called doughnut hole.
We asked experts for their take. Immediately, we found differences in opinion.
That鈥檚 a 鈥減erfectly fair claim,鈥 said Nicholas Bagley, a professor at the University of Michigan Law School. Closing the doughnut hole matters to many people, he said.
Case Western Reserve University law professor Jonathan Adler took a different view. The argument that Medicare would be affected 鈥渋s a very aggressive reading of the filing in this case,鈥 he said, referring to the Trump administration鈥檚 brief in support of nullifying the ACA.
The next step seemed to be getting a better grasp of what鈥檚 at stake.
A Quick Review of the Doughnut Hole, Other Medicare Provisions
The refers to the prescription drug coverage that begins after a beneficiary spends a set amount 鈥 usually a few thousand dollars. Before the ACA, beneficiaries who reached that threshold were responsible for 100% of their medication costs until they spent enough for catastrophic coverage to kick in, which could be more than $1,000 in additional spending. Even with this coverage, beneficiaries were responsible for 5% of their drug expenditures. (If beneficiaries were responsible for 100% of costs today, people with high drug costs would obviously pay a lot more without the ACA provision.)
The ACA would have gradually ended that coverage gap. But, in 2018, Congress adopted changes to expedite the process. As of 2019, the doughnut hole was . Adler pointed to that congressional intervention as a step that could keep the doughnut hole closed if the ACA were overturned. Based on this legislative history, the argument could be made that closing the coverage gap was something Congress had an interest in apart from the ACA. Since the doughnut hole is officially closed, some analysts said this provision may not be vulnerable to the upcoming Supreme Court decision on the ACA.
鈥淵ou can make a lot of claims,鈥 said Gail Wilensky, a former head of the Centers for Medicare & Medicaid Services. 鈥淭hat one is really a stretch.鈥
Other ACA provisions tied to Medicare benefits seem more at risk, such as the one that mandated annual wellness visits and certain preventive services, such as mammograms, bone mass measurement for those with osteoporosis, and depression and diabetes screening, with no patient cost sharing.
鈥淚t鈥檚 not clear that the administration actively supports any change to the Medicare benefits with the case before SCOTUS,鈥 said Tricia Neuman, KFF senior vice president and executive director of the KFF’s program on Medicare policy. 鈥淏ut if they didn鈥檛 explicitly seek to wall off certain provisions, it is at least conceivable 鈥 though maybe not likely 鈥 that Medicare benefits in the ACA could be collateral damage.鈥 (KHN is an editorially independent program of KFF.)
According to an filed by the AARP, the Center for Medicare Advocacy and Justice in Aging in 2016, an estimated 40.1 million Medicare beneficiaries received at least one preventive service and 10.3 million had an annual wellness visit with no copay or deductible.
Other experts pointed to a troubling implication for Medicare: the nullification of the ACA provisions related to costs and slowing the growth of the program鈥檚 spending. Those efforts had been credited with extending the solvency of the Health Insurance Trust Fund and slowing the growth in Medicare premiums.
It 鈥渨ould impair the financial fitness鈥 of the trust fund, said Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities.
Trump 鈥渕ay not say it is his intent to slash Medicare benefits,鈥 agreed David Lipschutz, associate director of the Center for Medicare Advocacy, but overturning the ACA entirely would 鈥渃ause chaos writ large.鈥 And, because of the program鈥檚 size, that chaos 鈥渨ould upend the financial markets and the entire health care system,鈥 according to the brief filed by Medicare advocates.
What Comes Next Is Complicated
Enter the concept of severability. Many court watchers are quick to say the high court鈥檚 decision could go beyond upholding the entire law or declaring it unconstitutional. Instead, the justices could separate or sever parts of it not directly related to the zeroed-out tax penalty, the so-called individual mandate.
Of course, the Trump administration argued in its brief that the interwoven nature of the ACA鈥檚 provisions demanded that the entire law be invalidated.
鈥淚f you just go on that basis, they are not arguing for severability,鈥 said Van de Water.
But others point out another layer that warrants consideration.
鈥淓veryone who comments on this focuses on the administration鈥檚 argument for inseverability,鈥 Adler said. But he said it was more complicated than that.
The Trump administration鈥檚 position is 鈥渟imultaneously that the entire ACA should be invalidated鈥 and also that relief should be provided only where injury to the plaintiffs is shown. (The administration defines the plaintiffs as the two individuals who signed on to the original challenge.)
Another view is that this point in the administration鈥檚 argument is not clear-cut, mostly because it gives no hint as to which programs or provisions would fit into the category of harming the plaintiffs.
Ultimately, the fate of the sweeping health law is in the hands of the Supreme Court.
鈥淟egal analysts didn鈥檛 anticipate the case getting as far as it has,鈥 said Lipschutz.
But 鈥渢he White House threw its weight behind the lawsuit,鈥 said Bagley, at the University of Michigan. 鈥淪o, they own the consequences. Especially in the context of this presidential campaign.鈥
Our Ruling
An attack ad by the Biden campaign states that Trump is 鈥減ushing to slash Medicare benefits鈥 and ties this charge to the administration鈥檚 position on the pending legal challenge to the ACA.
The Biden campaign pointed to an ACA provision that sought to close the Medicare doughnut hole to support this claim. It may not be the best example, though, because some experts suggest it may not be as vulnerable as other parts of the law.
Experts outlined a range of other Medicare provisions that either provided new benefits or shored up the program鈥檚 financial fitness. If the whole law were to be nullified, as the administration has advocated, these changes could also be erased 鈥 a step that would affect benefits and potentially cause premiums to rise.
Overall, the Biden ad seems plausible, even though the link between Trump鈥檚 position on the legal challenge and its impact on Medicare benefits is less straightforward than in similar claims we have checked regarding preexisting conditions.
We rate the claim Half True.
