“I heard one officer say about us ‘they smell like sh–,’” one detained person recounted in a federal court filing. “And another officer responded, ‘They are sh–.’”

Attorneys for immigrant children collected these stories, and more, from youth and families detained in what they called “prison-like” settings across the U.S. from March through June, even as the Trump administration has requested a federal district court judge terminate existing protections that mandate basic rights and services — including safe and sanitary conditions — for children held by the government.

The administration argues that the protections mandated under what is known as the Flores Settlement Agreement encourage immigration and interfere with its ability to establish immigration policy. U.S. District Court Judge Dolly Gee, who is in California, is expected to issue a ruling on the request after an Aug. 8 hearing.

With the agreement in place, children are being held in “unsafe and unsanitary” U.S. Customs and Border Protection facilities such as tents, airports, and offices for up to several weeks despite the agency’s written policy saying people generally should not be held in its custody longer than , according to the from immigrants’ attorneys. In the U.S. Department of Justice’s May request to terminate the Flores consent decree, the attorneys demanded more monitoring for children in immigration detention.

“The biggest fear is that without Flores, we will lose a crucial line of transparency and accountability,” said , executive director of the California-based Center for Human Rights and Constitutional Law. “Then you have a perfect storm for the abuse of individuals, the violation of their rights, and the kind of treatment that this country doesn’t stand for.”

The has set minimum standards and oversight for detained immigrant children since 1997, when it brought an end to a decade-long lawsuit filed on behalf of unaccompanied immigrant minors who had been subjected to poor treatment in unsafe and unsanitary conditions without access to medical care. It is named for Jenny Lisette Flores, a 15-year-old from El Salvador who was taken into U.S. custody in the mid-1980s, subjected to strip searches, and housed alongside unrelated men.

The agreement established national standards for the protection of immigrant children detained by federal authorities, with requirements for safe and sanitary detention facilities, access to clean water, appropriate food, clothing, bedding, recreational and educational opportunities, sanitation, plus appropriate medical and mental health care. Children in immigrant detention range from infants to teens.

In 2015, Gee ruled that the agreement includes children accompanied by adults.

The Justice Department and the Department of Homeland Security, which includes both the Customs and Border Protection agency and Immigration and Customs Enforcement, declined to respond on the record to questions about the administration’s intent to end the Flores agreement or about the conditions in which kids are detained. In a , government attorneys argued, among other points, that the agreement improperly directs immigration decisions to the courts, not the White House. U.S. Attorney General Pam Bondi also that the Flores agreement has “incentivized illegal immigration,” and that Congress and federal agencies have resolved the problems Flores was designed to fix.

ICE detention facilities have the “highest standards,” Abigail Jackson, a White House spokesperson, said in an email to ºÚÁϳԹÏÍø News. “They are safe, clean, and hold illegal aliens who are awaiting final removal proceedings.”

Immigration lawyers and researchers have on the idea that the Flores agreement encourages migration, arguing that the conditions in people’s homelands are driving them to move.

Trump is not the first president to seek to modify, or end, the agreement.

In 2016, President Barack Obama’s administration unsuccessfully sought to exempt accompanied minors from the Flores agreement, arguing that an influx of immigrants from Central America had overwhelmed the system.

In 2019, following a , the first Trump administration announced it would replace Flores with new regulations to expand family detention and eliminate detention time limits. The courts rejected that plan, too.

In 2024, President Joe Biden’s administration successfully requested to remove the Department of Health and Human Services from the agreement after the Office of Refugee Resettlement incorporated some Flores standards into agency regulations.

Allegations of unsafe conditions under the agreement also predate this latest immigration crackdown under Trump. One court filing from 2019 said that attorneys visiting two Texas detention centers found at least 250 infants, children, and teens, some of whom had been held at the facility for nearly a month. “Children were filthy and wearing clothes covered in bodily fluids, including urine,” the filing said.

Seven children are while in federal custody from 2018 to 2019, according to media reports.

And in 2023, 8-year-old Anadith Danay Reyes Alvarez became while in Customs and Border Protection custody in Texas for nine days. Her parents had turned over medical records detailing the girl’s medical history, including diagnoses of sickle cell disease and congenital heart disease, upon their detention. Yet her mother’s repeated pleas for emergency medical care were ignored.

Her family filed a in May.

Advocates attributed the deaths partly to prolonged detention in increasingly crowded facilities and delayed medical care. Officials have said they and in the wake of the deaths.

But with the Trump administration’s unprecedented push to detain and deport migrants — including families — the threat to the health of children caught up in those sweeps is alarming child advocates.

“Very rarely do you have spikes in populations of detained folk that you don’t see a drastic decrease in the quality of their medical care,” said Daniel Hatoum, a senior supervising attorney at the , one of the groups that filed the wrongful death claim for Anadith’s family.

Recent reports from court-appointed monitors cite continued ; temperature extremes; recreational opportunities; and clothing; and an inability to dim lights to sleep.

Terminating the Flores agreement would remove all outside oversight of immigration detention facilities by court-ordered monitors and attorneys. The public would have to depend on the government for transparency about the conditions in which children are held.

“Our system requires that there be some oversight for government, not just the Department of Homeland Security, but in general,” Hatoum said. “We know that. So, I do not believe that DHS could police itself.”

In the months after Trump took office and the Elon Musk-led Department of Government Efficiency began cuts, DHS’ Office for Civil Rights and Civil Liberties, the Office of the Citizenship and Immigration Services Ombudsman, and the Office of the Immigration Detention Ombudsman, which were intended to add a layer of oversight. After a lawsuit, the Trump administration , but it is unclear how those offices have been affected by shifts in policy and cuts in staffing.

Leecia Welch, an attorney with the legal advocacy group , said the Flores agreement itself, or efforts to hold the government responsible for abiding by its requirements, are not rooted in partisan politics. She said she raised concerns about conditions during Biden’s administration, too.

“These are not political issues for me,” Welch said. “How does our country want to treat children? That’s it. It’s very simple. I’m not going to take it easy on any administration where children are being harmed in their care.”

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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 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 as Americans have increasingly used it to gain health coverage. 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 involved cutting the program, including reducing by millions of dollars funding and and backing the many failed efforts in Congress and the courts to overturn the law. In June 2020, for example, to overturn the law in a case brought by more than a dozen GOP states. The high court eventually .

“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, , a health information nonprofit that includes ºÚÁϳԹÏÍø 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 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 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, by more than 2 million people during Trump’s presidency, and the by 2.3 million, including 726,000 children, from 2016 to 2019, according to the . That includes nearly three years of Trump’s presidency.

We rate Vance’s statement False.

SOURCES:

“Meet the Press” , Sept. 15, 2024.

Brookings Institution, “” Oct. 9, 2020.

Vox, “,” Aug. 31, 2017.

Center on Budget and Policy Priorities, “,” Sept. 13, 2018.

The New York Times, ‘,” June 26, 2020.

Constitutional Accountability Center, , accessed Sept. 16, 2024.

Harvard T.H. Chan School of Public Health, “,” Nov. 3, 2020.

Center on Budget and Policy Priorities, “” Sept. 15, 2020.

U.S. Census Bureau, , revised Aug. 22, 2024.

KFF, , accessed Sept. 16, 2024.

Brookings Institution, “” May 20, 2021.

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

The New York Times, “,” 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, “,” Aug. 15, 2017.

USA Today, “,” Oct. 12, 2017.

New York magazine, “,” Sept. 17, 2024.

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The room looked much the same as it did on March 23, 2010, when I had rushed over to the White House to witness President Barack Obama signing his historic health bill into law. I knew from that moment — standing under a portrait of President Teddy Roosevelt, who was the a need for national health insurance — that my life as a health journalist would never be the same.

Yet, when Biden scheduled an event to commemorate the 13th anniversary of the health law, I was unsure of the need to keep commemorating its birthday.

After all, on the 13th anniversary of President Lyndon Johnson signing Medicare and Medicaid into law — July 30, 1978 — the Democratic president in the White House did not hold an event to commemorate the date when tens of millions of older Americans and lower-income people gained coverage. Then-President Jimmy Carter at Camp David.

But with the ACA in 2010, after a century of debate, the U.S. health system was getting hit with a thunderbolt that would enable millions of people to gain medical coverage. The law made many changes affecting hospitals, doctors, insurers, drugmakers, and employers in an effort to live up to its lofty name by lowering costs.

Those sweeping provisions, the years spent implementing them, and efforts by Republicans and the courts to repeal or change the law have kept the Affordable Care Act in the news for even longer than I had anticipated. After 13 years, the job is still not done. North Carolina on Thursday became the 40th state to expand Medicaid under the ACA.

Biden used the health law anniversary to tout the law’s influence. He reminded his audience that Republicans still want to strip many of its benefits. He also stressed that the country has unfinished business to lower drug costs for many and expand health coverage to people who still don’t have it. Indeed, more than 2 million people are without coverage in the 10 states — highly populous Florida and Texas among them — that have yet to expand Medicaid.

Many former Obama staffers who helped get the law passed were there — including some who work in the Biden White House. (Obama was not there.) So, too, were several Democratic lawmakers who helped pass the law, including former House speaker Nancy Pelosi and former California congressman and now Health and Human Services Secretary Xavier Becerra.

“Look, 13 years ago today, we gathered in this room as President Obama signed into law the Affordable Health Care Act,” Biden began with his remarks. “Hard to believe 13 days ag- — 13 years ago. It seems like 13 days ago.”

“And I remember the three words I used at the time,” he said as many in the audience recalled the swear word he was caught whispering to Obama via a live microphone. “I thought it was. I thought it was a big deal. And I stand by the fact it was a big deal.”

Biden said that the health law has been called by many names, but that the most appropriate is Obamacare.

The law has become ingrained into the fabric of the country, Biden said. Over 40 million Americans are covered by Medicaid or online insurance marketplace plans, the highest on record, the Biden administration said Thursday. That’s a from 2021.

But a 13th anniversary celebration? Jessica Altman, who helped implement Obamacare in the Obama administration and is now CEO of Covered California, one of the Obamacare exchanges, said it was important to take time to remind people what the American health system used to look like as well as the many challenges remaining to improve it. (Altman is the daughter of KFF’s president and CEO. KHN is an editorially independent program of KFF.)

“We still have places to go, and we still have work to do and the people in that room are excited to keep doing it,” Altman said.

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Today, with , I hope we’ve learned the huge cost of allowing our public health structure to wither as we single-mindedly pursued the decades-long war on terror. Slowly, with no one much paying attention, here’s how it happened.

After the horror of 9/11 and the anthrax powder attacks that followed, the United States rapidly created a massive infrastructure to ferret out and combat terrorism, focusing mostly on threats from international actors. Within weeks, Congress passed the Patriot Act. It created the Department of Homeland Security and the , which alone has an annual budget of nearly $8 billion for, among other things, intensive screening at airports.

Even relatively remote counties were supplied with military-like equipment. As a reporter covering the 2004 election, I remember being shocked to see Humvees and soldiers in body armor at county fairs in the Midwest, though they seemed an unlikely terrorist target. In the years that followed, terrorists carrying explosives in and on flights resulted in more screening and attention.

Sadly, a good part of that focus and investment came at the expense of public health. “There’s only so much money, and so if you buy more of one thing, you have to buy less of another,” former FDA Commissioner Dr. Tom Frieden in explaining one reason the federal government had an enormous stockpile of anthrax vaccine, but not enough ventilators when covid-19 hit.

As our defenses against international and bioterrorism hardened, our defenses against infectious diseases shrank.

Though many public health experts fretted about possible pandemics, it was hard to capture lawmakers’ attention. After all, by the late 1990s, there were drugs to combat HIV/AIDS. Flu? There were vaccines. Infectious diseases? Perceived as conquered.

That’s partly why two large sources of money established after 9/11 — the Public Health Emergency Preparedness program and the Hospital Preparedness Program — were gradually chipped away.

Federal funds for state, local and tribal public health preparedness declined from , according to a report by the Trust for America’s Health, a nonpartisan research group. When the 2008 recession throttled government budgets, money was diverted again from public health programs to support other services.

The Affordable Care Act established the Prevention and Public Health Fund, with promised investment reaching about $2 billion annually by 2015. But by the Obama administration and Congress to pay for other priorities.

By the time a deadly virus arrived on our shores last year, nearly two-thirds of Americans were living in counties that spend more than twice as much on policing as they spend on nonhospital health care, which includes public health, by KHN and The Associated Press.

Since 2010, spending on local health departments has dropped by 18% and at least 38,000 state and local public health jobs have disappeared since the 2008 recession. When covid hit, about 75% of counties had no epidemiologist on staff to track disease.

Countries like South Korea and Taiwan orchestrated a rapid, aggressive public health response as soon as the pandemic began. Testing, contact tracing and quarantines helped control spread and death — as did good national systems for . In South Korea, a nation of 51 million, about 1,600 people have died. In Taiwan, population 26 million, the cumulative death toll is 10. Ten.

Contact tracing and quarantining takes people — lots of them. Tracking local spread takes epidemiologists and software. Many health departments in the U.S. had been limping by for years, with a skeleton staff, relying on fax machines. And remember, those local departments often also inspect restaurants, test water and give childhood vaccines.

Yes, President Donald Trump made the U.S. response far worse with lies and denial and sidelining the government’s top medical experts. But the lack of adequate public health agencies and sufficient personnel in most of the country made targeted and rapid response most likely impossible.

The Centers for Disease Control and Prevention, the national public health agency, has been regarded as a bastion of international scientific expertise, but that into good on-the-ground public health work. (Polio was eliminated by a vaccination campaign largely .)

The human costs exacted by the pandemic are incalculable. And it will take years to tally the full financial costs of job losses, business closures, the more than $5 trillion approved in federal aid to contain the catastrophe, money that might have been spent on longer-term investments on education and the environment.

The tragedy is that a good part of this pain could have been avoided had there been a robust and functioning public health infrastructure in early 2020. That investment would have been a bargain, compared with what has been spent in the past year alone — not to mention the financial burden well into the future.

Some experts have estimated that the nation has a . That’s about the number of people , now the third-largest Cabinet-level agency. But the deficits go well beyond staffing numbers.

The CDC and local public health departments need to be equipped with the same level of sophisticated tools provided to, say, airport screeners. Even though the federal government spent $36 billion to digitize medical records, we still don’t have a uniform national digital database that can track who is getting the vaccine.

Through Operation Warp Speed and private purchases, the U.S. helped make possible amazing new vaccines, paving a path out of the pandemic. By last December the government had , and the several hundred million more doses, hoping to vaccinate most Americans by summer.

That’s a great accomplishment. But would we be so desperate if some of that money had been spent over the past decades on public health? The pandemic is a reminder that the terrorism of nature can’t be ignored, and our public health system needs to be rebuilt and expanded.

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In a Facebook post, Oct. 20, 2020

A viral post claims that former President Barack Obama’s health insurance law penalized a family a large amount of money for not buying health insurance and that President Donald Trump was responsible for stopping the practice.

The post features writing on the back of a car windshield that says, “Because our family couldn’t afford health insurance, Obama/Biden penalized us about $10,000, then took that $10,000 and used it to pay for others’ free Obamacare. Trump ended that theft.”

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about .) We found a similar post on Instagram.

The post appears to refer to the penalty, a tax under the Affordable Care Act placed on those who chose not to get health insurance. At the end of 2017, Republican-backed tax legislation, also supported by Trump, zeroed out the fine. Beginning in 2019, people could no longer be penalized for not having health insurance. Thus, the mandate hasn’t been in effect for about two years.

But $10,000 — the hefty amount this family was supposedly penalized for not having health insurance — raised questions for us. And was that money really used to pay for other people’s health insurance? We decided to look into it.

The History of the Individual Mandate

The ACA was implemented in 2010 during the Obama administration. The aim of the health care law — often referred to as Obamacare — was to ensure everyone had health insurance.

To that end, the law used what health policy experts call a approach. For low-income and middle-income individuals who had difficulty affording health insurance, the government would provide tax subsidies to reduce the cost of insurance — that was the carrot. And to make sure everyone enrolled in a health insurance plan, those who didn’t sign up were fined, under what was known as the individual mandate provision. That was the stick.

The individual mandate, which didn’t kick in until 2014, was unpopular with the American public, according to polling at the time. A showed that 55% of Americans supported the idea of eliminating the requirement that everyone must have health insurance or pay a fine. (KHN is an editorially independent program of KFF.)

Although one of was to repeal and replace the ACA, efforts to do so failed in 2017 when the Republican-held Senate failed to get the votes it needed.

Instead, in their , Republicans set the penalty for the individual mandate to $0. Starting in 2019, Americans no longer had to pay a fine for not having health insurance. Trump signed the 2017 tax bill into law. So, it is true that Trump and congressional Republicans were responsible for neutralizing the penalty.

However, experts pointed out that the individual mandate is still in place, it’s just that the penalty is set to $0. In fact, the end of the penalty is behind the justification for a attempting to overturn the ACA, brought by Republican attorneys general and supported by the Trump administration. The plaintiffs argue that the health care law is no longer constitutional because the penalty no longer for the federal government. The Supreme Court will hear oral arguments on the case Nov. 10.

The Math

The viral social media posts claim that the family “couldn’t afford health insurance” and was penalized $10,000.

Health policy experts told us that while the social media post doesn’t give all the specifics needed to know if this was absolutely true, it seems unlikely a penalty would be this high.

One issue is the post doesn’t specify whether the $10,000 penalty was incurred in one year or over multiple years. It also doesn’t say how many individuals were part of the family.

Assuming the $10,000 penalty was incurred in one year, multiple experts told us that the family would have had an annual income above $400,000 and at least one person would have had to be uninsured for the entire year. That math is based on the penalty structure , the last year the mandate was enforced.

In 2018, the penalty was calculated one of two ways. The fine was the greater of the two results:

• $695 for an adult and $347.50 for a child, up to a max of $2,085 per family annually, or
• 2.5% of family income above a certain tax filing threshold ( the tax filing threshold was $10,650 for a single individual or $21,300 for joint filers in 2018).

The first way to calculate the penalty obviously doesn’t apply since the max was $2,085 per year. So, the second would be the only way to get a $10,000-a-year penalty. To arrive at such a number, you would have to take 2.5% of the family’s income. In this case, 2.5% of a $400,000 income gets you close to $10,000.

And experts said it is highly unlikely that a family with a $400,000 income would have had difficulty affording health insurance.

“So I would highly doubt the veracity of what is written on that car windshield,”, a senior fellow in health reform and private insurance at KFF wrote in an email. “People with that much income almost always have job-based health benefits and, if not, generally are inclined to insure themselves very well in order to protect assets — otherwise, if hospitalized and uninsured, they could owe many multiples of the penalty amount in medical bills.”

, a health policy professor at the University of North Carolina-Chapel Hill, also pointed out that a $10,000 penalty would have been rare.

“Very few American families would have paid anything close to that amount in penalty for not having insurance — the average penalty per person in 2017 was around $700,” Oberlander wrote in an email. “Moreover, only a small percentage of Americans ever paid the penalty for not having health insurance — in 2017, 4.6 million persons,” or about 1% of the population. (In 2017, 325 million people lived in the U.S., according to the .)

It’s also unclear whether it would have just been cheaper for the family to pay for health insurance rather than incur a $10,000 penalty, said , a health policy scholar at the Brookings Institution.

“It depends on the ages of the members of the family, where they live, what year (or years) we are talking about, and the family’s income,” Fiedler wrote in an email. “There are conceivable scenarios where the family could have found a bronze plan for $10k or less. But there are also plenty of plausible scenarios where they could not have. Without knowing more about the family’s circumstances, it’s just hard to say with any confidence.”

Where Did the Penalty Money Go?

Experts also told us that the post’s assertion that the penalties paid for not having health insurance were directly applied to fund other people’s health insurance was off the mark.

The individual mandate penalties were assessed during each annual tax filing, and then payments were made the year after there was a lapse in insurance coverage.

Those penalties were collected just like any other tax payment.

“As a strict accounting, keep in mind, everything gets dumped into the Treasury regardless of the source, and then it is appropriated out of the Treasury by Congress,” said , a senior research fellow in health care policy at the Heritage Foundation. “It’s not like money goes into one account and then another.”

So, while it’s certainly possible that the penalty money could have been used to help pay for some of the ACA subsidies for other people, the money also could have gone to any other number of things the government pays for, like the military, disaster relief or education.

“You don’t know exactly where your taxes or penalties go,” said , an assistant professor in economics at Emory University. “Maybe a small share went to Obamacare, but that’s a stretch. You can’t track where every dollar you spent on your taxes is going.”

It’s also misleading to say that other individuals received “free Obamacare” from the penalty payment. The experts said that while Medicaid expansion, which was a part of the ACA, does provide health care coverage for low-income people who are eligible, those who bought insurance on the marketplace would still likely have paid for some part of their coverage after subsidies were applied.

Our Ruling

A viral social media post claims that a family was penalized $10,000 for not being able to afford health insurance. It also claimed the penalty money was taken to pay for others’ “free ObamaCare” and Trump stopped that practice.

It is true that Trump and Congress did zero out the individual mandate requirement, so people could no longer be penalized for not having health insurance. But after that, skepticism abounds.

For instance, it’s very unlikely that a family would face a $10,000 penalty in one year. Moreover, if such a family did face this penalty for not having health insurance, they would likely be in a high-income bracket for which health insurance tends to come from an employer or be affordable. And the charge that the penalty was used to provide “free coverage” for others doesn’t fit with federal accounting processes.

Experts said, though, that the lack of specifics about this family’s situation makes it difficult to be completely definitive.

We rate this claim Mostly False.

SOURCES

Census Bureau,  accessed Oct. 27, 2020

The Commonwealth Fund, July 11, 2018

Email interview with , the Paul O’Neill Alcoa chair in policy analysis at Rand Corp., Oct. 23, 2020

Email interview with , professor of health policy and management at the University of North Carolina-Chapel Hill, Oct. 25, 2020

Email interview with , senior fellow in health reform and private insurance at KFF, Oct. 26-27, 2020

Email interview with , fellow with the USC Brookings-Schaeffer Initiative for Health Policy at the Brookings Institution, Oct. 26, 2020

of opinion, accessed Oct. 27, 2020

, accessed Oct. 27, 2020

IRS.gov, accessed Oct. 27, 2020

KFF, Sept. 1, 2020

KFF, Nov. 17, 2017

KFF, Nov. 15, 2017

LeadStories.com, Oct. 22, 2020

Phone interview with , Preston A. Wells Jr. senior research fellow at the Heritage Foundation, Oct. 23, 2020

Phone interview with , assistant professor in economics at Emory University, Oct. 23, 2020

PolitiFact, , July 15, 2020

Rand Corp., published in 2015

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Still, there was a virtual National Anthem and everyday people offering their thoughts on the upcoming election and the state of the nation. A young woman whose father, a Donald Trump voter, died of COVID-19, was among them. A list of marquee speakers including Sen. Bernie Sanders and former first lady Michelle Obama spoke directly into the camera.

Our partners at noted that “nothing jumped out as Pants on Fire false” during the course of the evening. Some claims, they went on to say, were interestingly accurate. Others could have used more context.

We focus here on two points related to the Trump administration’s pandemic preparedness.

“Vice President Biden and President Obama assembled a pandemic playbook to make sure that America was prepared and protected. The Trump administration disbanded the pandemic response team that was given to them.” — Eva Longoria Bastón

Longoria is largely correct on both points.

After the 2014 Ebola crisis, the Obama administration created a titled “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents.”

The National Security Council developed the guidebook in 2016 with the goal of assisting leaders “in coordinating a complex U.S. Government response to a high-consequence emerging disease threat anywhere in the world.” It outlined questions to ask, who should be asked to get the answers and what key decisions should be made.

 reported on the document in March, but White House press secretary Kayleigh McEnany dismissed the playbook’s usefulness when asked about it 

As for the pandemic response team, the Trump White House reorganized the team that oversaw global health security issues under former national security adviser John Bolton. Tom Bossert, a homeland security adviser who recommended strong defenses against disease and biological warfare, was by Bolton in April 2018, The Washington Post reported. In May 2018, the top White House official in charge of the U.S. response to pandemics, Rear Adm. Timothy Ziemer,Ìý and was not replaced.

Neither White House official nor their teams, which were responsible for coordinating the U.S. response to pandemic outbreaks across agencies, were replaced before the coronavirus arrived.

In November 2019, a bipartisan group of lawmakers and experts brought together by the Center for Strategic and International Studies to focus on U.S. global health security  that health security leadership on the NSC be restored.

— Jon Greenberg, PolitiFact

“And our current federal government is dysfunctional and incompetent. It couldn’t fight off the virus. In fact, it didn’t even see it coming. The European virus infected the Northeast while the White House was still fixated on China.” — New York Gov. Andrew Cuomo

There is evidence that suggests Cuomo is right. The disease most likely arrived in Europe from China, but it was travel from Europe to the United States that brought the disease to New York.

Researchers from the Icahn School of Medicine at Mount Sinai traced the strains of the COVID-19 virus — which was circulating in late January and was responsible for the New York City COVID-19 outbreak — back to Europe.

°Õ³ó±ðÌý, published in July, examined the genomic sequences of the COVID-19 virus based on samples taken from confirmed COVID cases in the Mount Sinai Health System. The cases were traced through March and represented a large number of New York City neighborhoods. Only one strain was closely related to COVID-19 strains circulating in Asia.

“These results show that SARS-CoV-2 came to the New York City area predominantly via Europe through untracked transmissions,” said Dr. Viviana Simon, professor of microbiology and infectious diseases at Mount Sinai’s Icahn School of Medicine, in a .

Cuomo’s charge that the Trump administration was fixated only on the spread from China has some merit as well. Beginning in mid-January, the travelers arriving from Wuhan, China, where the COVID-19 outbreak started. Then on Jan. 31, President non-U.S. citizens from traveling from China into the United States. But U.S. citizens could still travel back from China, as long as they observed a 14-day quarantine upon arrival. No such travel limits were put in place for Europe until .

— Victoria Knight, Kaiser Health News

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When Fox News host Chris Wallace noted that Trump has yet to put forward a replacement plan, Trump told him to stay tuned.

“We’re signing a health care plan within two weeks, a full and complete health care plan that the Supreme Court decision on DACA gave me the right to do,” on “Fox News Sunday.”

“The Supreme Court gave the president of the United States powers that nobody thought the president had.”

Trump said he would “do things on immigration, on health care, on other things that we’ve never done before.”

We wanted to know if the Supreme Court really did that. So we ran the president’s words by a number of people who study constitutional and administrative law. We heard several reasons why the Supreme Court might not have said what Trump thinks it said.

The Likely Source

We asked the White House press office for the basis of Trump’s assertion and never heard back. Several law professors pointed to a  by University of California-Berkeley law professor John Yoo, best known as authoring a that led to waterboarding enemy combatants during the George W. Bush administration.

In the article, Yoo argues that when the Supreme Court ruled against the administration’s rollback of Deferred Action for Childhood Arrivals, or DACA, the court made it more difficult for new presidents to unwind the policies of their predecessors.

How might this give Trump new power?

In theory, Trump could enact a policy, even one judged illegal by the courts, and the person who follows him into office would need to jump through a number of hoops to undo it.

Yoo wasn’t sure if Trump could use the argument to make sweeping changes in health care, saying it “depends on what the administration policy actually says.”

But as Yoo sees it, should Trump establish a new program, the ruling “requires his successor to follow a burdensome process, which could take a year or more, to repeal it.”

Many legal experts disagree with Yoo’s interpretation. Before we go there, we need to recap the court’s DACA decision.

Court Sends DHS Back to the Drawing Table

President Barack Obama created DACA on the grounds that every administration has to . Obama argued that it was more important to deport violent criminals, drug dealers and thieves than people who had come into the country illegally when they were little. So long as they had committed no serious offenses and met other criteria, they could apply to avoid deportation.

Under Trump, the Department of Homeland Security moved to end DACA. Supporters of the program sued, saying that under the Administrative Procedure Act, that action was arbitrary. In , a 5-4 majority on the Supreme Court agreed.

The ruling describes how Homeland Security Secretary Kirstjen Nielsen got in a procedural bind when she inherited the decision of her predecessor (Acting Secretary Elaine Duke) to end the program. She erred, Chief Justice John Roberts wrote, because instead of making the case for ending DACA as her own decision, she came up with new reasons to justify the earlier move.

“Because Nielsen chose not to take new action, she was limited to elaborating on the agency’s original reasons,” Roberts wrote. “But her reasoning bears little relationship to that of her predecessor and consists primarily of impermissible ‘post hoc rationalization.'”

The court didn’t say Homeland Security couldn’t change the policy. It said the Administrative Procedure Act requires an agency to consider the key options it faces and explain why it chose the one it picked. With DACA, it said the change needed to show a fuller vetting of its choices.

No New Power Created

So while Trump technically lost that case, he is using the ruling (and Yoo’s theory) to voice confidence that he can do things no one thought possible.

Legal scholars give several reasons that might be off the mark. Broadly, they say the court’s ruling changed nothing.

“It’s a straightforward application of long-standing administrative law doctrine that dates back at least to President Ronald Reagan,” said Cary Coglianese, director of the Penn Program on Regulation and a professor of law at the University of Pennsylvania. “Agencies have to explain why they are doing something. They have to look at the plausible alternatives and give a reason for the one they selected.”

Justice Brett Kavanaugh also did not see a new take on an old law. In his , he called the ruling on the Administrative Procedure Act “narrow.”

In a similar vein, the court left intact the specific power behind DACA of selective enforcement of the law.

“That’s an ordinary part of executive branch practice, and nothing in the Supreme Court’s DACA decision should be read to authorize anything beyond that simple practice,” said Yale University law professor Cristina Rodríguez.

The path to undoing this sort of executive action may not be as long as Yoo described. The court spelled out how Nielsen could have ended DACA without much delay, said Eric Freedman, professor of constitutional law at Hofstra University Law School.

“If she had considered other possible solutions, what she did would have been fine,” Freedman said. “She would have complied with the Administrative Procedure Act and no one would have enjoined her.”

There is also something unusual about DACA itself that makes it less of a model for other steps Trump might take.

The program was in place for quite a while before Trump tried to end it. As a result, about 700,000 people ultimately counted on it. The court said that reliance on the program should have factored into the decision to end it.

A new policy from Trump wouldn’t have time to accumulate that critical mass.

“Anything Trump does now will be enjoined tomorrow,” said Josh Blackman at the South Texas College of Law. “So there will be no reliance, and the next administration could do what it wanted.”

Blackman said the court’s ruling did create some murkiness around challenging the legality of an unwanted policy. But he said an agency could justify a change strictly for reasons of policy, not law.

Lastly, the DACA decision was about a policy not to enforce the law in certain circumstances. Robert Chesney at the University of Texas Law School said that focus also limits the scope of the ruling.

“If Trump wants to create new rules, the example does not fit in the first place,” Chesney said.

A “full and complete health care plan” and major immigration changes would likely require new government actions. Without new laws from Congress, that would be out of reach.

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Among the ads is a 15-second spot, titled that alleges Trump is trying to cut Medicare during the global health emergency.

“Our lives are on pause. We’re worried about our health. So why is Trump still trying to cut our Medicare? $451 billion in cuts in the middle of a deadly pandemic. Trump is putting us at risk,” the commercial’s narrator says.

The PAC, which was formed in 2011 to support President Barack Obama’s reelection campaign, has been tapped by Joe Biden, the presumptive Democratic presidential nominee, as his among Democratic super PACS for big-donor giving.

This ad caught our attention for two reasons. First, the term “Medicare cuts” has long been volleyed between both Republicans and Democrats in Congress and the White House — and often has proven to be a powerful political tool.

Second, the connection between “cuts” to Medicare and the coronavirus pandemic was a new concept we wanted to explore.

We reached out to Priorities USA Action to ask for the basis of these statements.

Josh Schwerin, a PAC spokesperson, sent us links to news articles and confirmed that the “$451 billion in cuts” referred to Trump’s 2021 proposed budget for Medicare.

Asked to pinpoint where the $451 billion came from, Schwerin pointed us to a February that said the president’s budget plan would “whack away at federal spending on health care over the next 10 years … including $451 billion less spent on Medicare.” He also sent us links to a February and February from Rep. Jahana Hayes (D-Conn.) — both of which also cited that figure.

Cuts Or A Reduction In Spending? An Argument That’s Been Around

In fall 2010, a few months after the Affordable Care Act was enacted, Republicans aired attacking Democrats for “cutting” or “gutting” Medicare. The reason was the law included a $500 billion reduction in projected spending for Medicare over 10 years, which would be used to help fund the ACA.

The the reductions in spending would come from lowering payments to Medicare Advantage plans and providers and would not affect the level of care that Medicare beneficiaries received. They also said it would help make the Medicare system more financially stable.

Now, almost 10 years later, to criticize the White House’s long-term plan for Medicare spending.

“‘Cuts’ is a term that has been thrown around for many years,” said Tricia Neuman, executive director of the Program on Medicare Policy at the Kaiser Family Foundation. “This is a semantic issue that often gets politicized, often in an election year.” (Kaiser Health News is an editorially independent program of the foundation.)

Neuman explained that what is being considered here is a reduction in the projected increase in spending over a certain period. This reduction is based on estimates of how much the government is projected to spend on programs — factoring in proposed policy changes — for the following 10 years, taking into account current levels of spending, assumptions about economic growth and trends in the use of Medicare coverage, said Neuman.

Trump’s 2021 budget blueprint for Medicare estimated that spending would increase each of the 10 years. But the estimate also suggested that the administration’s proposed policy changes would reduce the spending increase compared with estimates of what would be spent if the changes were not implemented.

“Let’s say Medicare spends $100 in 2020 and is projected to spend $200 in 2021,” Neuman said. “If the budget said we’re going to reduce the growth in spending by $25, that’s a reduction in an increase. But other people might call that a cut.”

The Number Itself And What It Means

We reached out to the Department of Health and Human Services, which oversees Medicare, for its take on that $451 billion figure but have not heard back.

Marc Goldwein, senior policy director for the nonpartisan Committee for a Responsible Federal Budget, said the actual figure could be anywhere from $400 billion to $600 billion, depending on how calculations are done. His analysis relied on the executive branch’s Office of Management and Budget calculations and landed on a figure close to . Other variables, such as “likely savings from drug price reform” — yet to be enacted — move it closer to $600 billion.

The left-leaning Center on Budget and Policy Priorities came up with a similar estimate: . The Congressional Budget Office’s estimate, not including savings generated from proposed drug pricing reforms, was closer to $400 billion.

In all cases, though, the reductions in Medicare spending would be achieved through proposals such as lowering payments to providers and paying the same amount for the same health service offered in different settings.

Goldwein said these proposals for Medicare reform are largely bipartisan and “either mimic or build upon” those advanced during the Obama era. He also said that, in his organization’s view, the “cuts” are savings to the Medicare program and beneficiaries, who would see lower premiums and out-of-pocket medical costs.

The policy experts said it’s likely the reductions in spending wouldn’t directly affect the care that Medicare beneficiaries receive. But provider groups have complained that lower reimbursements might drive some doctors to leave Medicare. Hospitals have argued against the proposal for equalizing payments for similar services because they say their overhead expenses are higher than those of a doctor’s office or off-site clinic and their higher rates help finance other necessary services.

Timing Matters

The Priorities USA Action ad also alleges that Trump is trying to cut Medicare “in the middle of a deadly pandemic.” But the timeline of events doesn’t support this statement.

The White House released the 2021 budget proposal on Feb. 10 — well before the COVID-19 outbreak had become a part of our national consciousness.

The first domestic case of COVID-19 was by the Centers for Disease Control and Prevention on Jan. 21. The World Health Organization the outbreak of the novel coronavirus a “public health emergency of international concern” on Jan. 30.

On Feb. 10, the day the budget was released, the CDC put out a stating there were 13 cases of the disease in the U.S. CNN also published an article that day stating the of COVID-19 cases and deaths had occurred in China. Authorities didn’t announce the from COVID-19 until Feb. 29. The WHO a pandemic on March 11.

“These budget proposals were probably developed well before the pandemic hit the U.S. and hit it hard,” said Neuman. However, she added, “the administration hasn’t disavowed these proposals, but they also haven’t pushed them forward.”

Joseph Antos, a scholar in health care and retirement policy at the right-leaning American Enterprise Institute, said it was a “ridiculous statement to connect cutting Medicare spending to the COVID crisis.”

“The implication of the video that this is going on actively while we’re in the middle of this crisis, that’s dead wrong,” said Antos.

Our Ruling

The Priorities ad said Trump is trying to make $451 billion in Medicare cuts “in the middle of a deadly pandemic.”

This is an exaggerated attack, even before the pandemic is layered on top of it. The dollar figure itself is “in the ballpark” of what the policy proposals would generate in spending reductions, giving this ad a sliver of truth. However, in the Trump budget, the amount is spread over 10 years — important context that was omitted.

What’s in Trump’s budget proposal is not a direct cut to Medicare. Instead, Priorities uses the age-old political tactic — employed on both sides of the aisle — of holding up a reduction in projected spending growth as a “cut.”

Moreover, the ad leaves the impression that Trump is trying to whack Medicare for seniors at a time when panic is particularly high because of the coronavirus. But that connection to the pandemic is also misleading. The presidential budget was released weeks before most of the nation began to comprehend the threat of COVID-19.

The claim contains an element of truth but ignores critical facts and context that would give a different impression. We rate it Mostly False.

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“They claim pandemics only happen once every 100 years, but what if that is no longer true? We want to be ready, early, for the next one. Because clearly, the Obama administration did not leave any kind of game plan for something like this,” said McConnell.

This claim caught our attention because its definitive nature was directly at odds with the position of some former Obama administration officials, who immediately disputed it and started circulating on social media the link to such a plan.

We reached out to McConnell’s press team to ask for the basis of his statement. McConnell spokesperson David Popp said in an emailed response that “this is a unique crisis and we are all adapting to the public health and economic challenges.” In terms of the pandemic’s economic impact, he said there was “definitely no playbook there” and instead credited McConnell with his work on the Act, a coronavirus relief bill passed by Congress.

The Pandemic Playbook

Soon after McConnell made his playbook comment, Ronald Klain, the White House Ebola response coordinator from October 2014 to February 2015, out a link to a titled “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents.”

The document, originally unearthed in March by , is a 69-page National Security Council guidebook developed in 2016 with the goal of assisting leaders “in coordinating a complex U.S. Government response to a high-consequence emerging disease threat anywhere in the world.” It outlined questions to ask, who should be asked to get the answers and what key decisions should be made.

Nicole Lurie, another Obama administration official, confirmed to us the existence of the NSC pandemic playbook and also said similar documents were created for the Department of Health and Human Services and the Centers for Disease Control and Prevention.

“To say there was no playbook was ridiculous,” said Lurie, who served as the assistant secretary for preparedness and response at HHS during both terms of the Obama administration.

The playbook lists types of infectious disease threats that could emerge. “Novel coronaviruses” were among pathogens flagged as having potential to cause heightened concern.

Lurie said there were tabletop exercises, which included planning for a pandemic-like situation, during the the Obama and Trump administrations. (The Trump administration also conducted an exercise — known as “” — in 2019.)

Other Obama-era officials offered similar stories in interviews this week with CNN:

“They were extensively briefed, to the extent that they paid attention to these things during the transition,” said , who directed USAID’s Office of U.S. Foreign Disaster Assistance.

“We absolutely did leave a plan. It was called a playbook,” said , former homeland security adviser to President Obama. The goal, she said, was to share the lessons learned during the Ebola and Zika outbreaks.

Meanwhile, Peter Loge, who served as a senior adviser within Obama’s Food and Drug Administration, told KHN he remembered a very clear message from the HHS secretary regarding the presidential transition.

“Our job was to set up the Trump political staff for success, and we took that mandate very seriously,” said Loge. He and his colleagues wrote memos to inform the Trump staff about priority issues. “But nobody called me and asked what I was doing in my job,” said Loge.

However, the Trump administration has maintained that the coronavirus sneaked up on the U.S., and Trump himself has even said it was a “very unforeseen thing.”

But, in a with reporters on the White House lawn, press secretary Kayleigh McEnany acknowledged the existence of the Obama pandemic playbook, even holding it up to show the press. She also dismissed its usefulness.

“The Obama-Biden plan that has been referenced was insufficient. It wasn’t going to work. What our administration did under the leadership of President Trump was do an entire 2018 pandemic preparedness report,” said McEnany. Trump, who was standing nearby, agreed.

Our Ruling

Senate Majority Leader Mitch McConnell said the Obama administration did not leave behind a “game plan” for a pandemic.

That’s wrong.

Multiple Obama-era officials have said they left a 2016 “pandemic playbook” that detailed exact steps to take in the event of an infectious disease outbreak. The White House press secretary even held up the actual document on the White House lawn.

There has been discussion in recent days as to whether the Obama plan was dated because it dealt with lessons learned from earlier outbreaks that may not apply to the current pandemic. Still, McConnell’s statement focused only on whether any such “game plan” existed, and ample evidence suggests it did.

We rate it Pants on Fire.

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