Trump makes dubious claims about 'far cheaper' plan to replace 'Obamacare': AP fact check

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WASHINGTON — U.S. President Donald Trump isn't providing all the facts when he promises that people with preexisting medical problems will always be covered by health insurance if "Obamacare" is ruled unconstitutional.

Eager to get conservative Judge Amy Coney Barrett quickly confirmed to the Supreme Court, which is hearing his challenge to the Affordable Care Act, Trump asserts that "far cheaper" and "much better" plans will replace the Obama-era law. He also points to a new executive order offering protections. But his claims are illusory.

Various GOP bills, in fact, have been seen over the years as providing less than what "Obamacare" already provided, and it's unlikely an executive order will have much effect.

In a momentous past week, Trump painted a fantastical portrait of a coronavirus that affects "virtually nobody" among the young as he faced a grim U.S. milestone of 200,000 deaths and he asserted a constitutional basis that doesn't exist for rushing a replacement for the late Justice Ruth Bader Ginsburg.

Meanwhile, with the first presidential debate on Tuesday, Democratic presidential rival Joe Biden botched details about the pivotal Supreme Court vacancy and exaggerated his early statements on COVID-19.

A look at recent rhetoric, also covering voting fraud and racial progress:

HEALTH CARE

TRUMP: "Obamacare will be replaced with a MUCH better, and FAR cheaper, alternative if it is terminated in the Supreme Court. Would be a big WIN for the USA!" -- tweet Sunday.

THE FACTS: The bargain health insurance plans Trump often talks about are cheaper because they skimp on benefits such as maternity or prescription drug coverage and do not guarantee coverage of preexisting conditions. He and Republicans haven't provided details on any newer alternative plans.

The short-term plans that Trump often touts provide up to 12 months of coverage and can be renewed for up to 36 months.

Premiums for the plans can be one-third the cost of comprehensive insurance coverage. The health plan offerings are intended for people who want an individual health insurance policy but make too much money to qualify for subsides under the Affordable Care Act.

The administration expanded the short-term plans, which lack key protections of the Obama health law such as coverage for preexisting conditions, after failing to repeal the law in Congress. Trump is now trying to dismantle "Obamacare" by asking the Supreme Court to overturn it as unconstitutional.

The high court will hear arguments in the case on Nov. 10. The Republican-controlled Senate may confirm Barrett before the Nov. 3 election. Barrett, a conservative, has been critical of Justice John Roberts' opinion in 2012 upholding "Obamacare" while Ginsburg was one of the five votes in the decision.

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TRUMP, on Republicans: "Democrats like to constantly talk about it, and yet preexisting conditions are much safer with us than they are with them." -- remarks Thursday in North Carolina.

THE FACTS: That's highly questionable.

Republicans were unable to muscle their replacement for the Obama-era law through Congress when they controlled the House and Senate in 2017 during Trump's first year. Various GOP bills would have offered a degree of protection for people with preexisting conditions, but the proposed safeguards were seen as less than what the law already provided. The general approach in the Republican legislation would have required people to maintain continuous coverage to avoid being turned down because of a preexisting condition.

Trump has frequently claimed he will always protect preexisting conditions despite evidence to the contrary and has even asserted falsely that he was the one who "saved" such protections.

One of Trump's alternatives to Obama's law -- short-term health insurance, already in place -- doesn't have to cover preexisting conditions. Another alternative: association health plans, which are oriented to small businesses and sole proprietors and do cover preexisting conditions. Neither of the two alternatives appears to have made much difference in the market.

Democratic attacks on Republican efforts to repeal the health law and weaken preexisting condition protections proved successful in the 2018 midterms, when Democrats won back control of the House.

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TRUMP: "The historic action I'm taking today includes the first-ever executive order to affirm it is the official policy of the United States government to protect patients with preexisting conditions. So we're making that official." -- North Carolina remarks.

THE FACTS: It's already been the official federal policy to protect people with preexisting medical conditions because "Obamacare" already does that, and it's the law of the land. If he persuades the Supreme Court to overturn the Affordable Care Act as unconstitutional, it's unclear what degree of actual protection the executive order would offer in place of the law.

President Barack Obama's health law states that "a group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage."

Other sections of the law act to bar insurers from charging more to people because of past medical problems and from cancelling coverage, except in cases of fraud. In the past, there were horror stories of insurers cancelling coverage because a patient had a recurrence of cancer.

It's dubious that any president could enact such protections through an executive order, or Obama would never have needed to go to Congress to get his health law passed. Likewise, President Bill Clinton could have simply used a presidential decree to enact his health plan, or major parts of it, after it failed to get through Congress.

"I can't imagine what authority the president could invoke to require insurers to cover preexisting conditions if the Supreme Court does throw the ACA out," said Larry Levitt, executive vice-president for health policy at the nonpartisan Kaiser Family Foundation.

Levitt said to make coverage of preexisting conditions a reality, insurers would need to be barred as they are under Obamacare from placing limits on lifetime and annual benefit payments, and allow for uniform premiums for the sick and healthy. Also, subsidies have to be offered to encourage healthy people to enrol in plans so premiums are kept down.

VOTING FRAUD

TRUMP: "We need nine justices. You need that. With the unsolicited millions of ballots that they're sending, it's a scam; it's a hoax. Everybody knows that. And the Democrats know it better than anybody else. ... So doing it before the election would be a very good thing because you're going to probably see it." -- remarks Tuesday to reporters.

THE FACTS: There's nothing fraudulent about mail-in ballots, and Trump's repeated false assertions certainly don't provide a valid justification to speed up a judicial nomination.

There are no such things as "unsolicited" ballots. Five states routinely send ballots to all registered voters so they can choose to vote through the mail or in person. Four other states and the District of Columbia will be adopting that system in November, as will almost every county in Montana. Election officials note that, by registering to vote, people are effectively requesting a ballot, so it makes no sense to call the materials sent to them "unsolicited."

More broadly speaking, voter fraud has proved exceedingly rare. The Brennan Center for Justice in 2017 ranked the risk of ballot fraud at 0.00004% to 0.0009%, based on studies of past elections.

In the five states that regularly send ballots to all voters who have registered, there have been no major cases of fraud or difficulty counting the votes.

Of the four states adopting the system of universal mail balloting this year, only Nevada is a battleground, worth six electoral votes and likely to be pivotal only in a national presidential deadlock.

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TRUMP, referring to ballots being automatically mailed out to registered voters: "Eighty million ballots ... We are going to be counting ballots for the next two years." -- Pennsylvania rally on Saturday.

THE FACTS: False.

There aren't 80 million ballots being mailed out automatically in the 10 states doing it this year -- it's half that amount at roughly 44 million, according to Michael McDonald, a University of Florida professor and expert in election statistics. Voters in other states who specifically request mail ballots will also receive them, but Trump has repeatedly said he considered those ballots quite fine and "OK."

It's true that many states are expecting a surge in mail-in voting because of the coronavirus pandemic, which may lead to longer times in vote counting. But there is no evidence to indicate that massive fraud from "unsolicited" balloting is afoot. And even if the election is messy and contested in court, the country will have a president in January -- and not be in limbo for months or years as Trump and his GOP allies assert -- because the Constitution and federal law ensure it.

200,000 DEATHS

TRUMP, on the coronavirus: "We're rounding the turn." -- interview aired Sunday on Fox News Channel.

TRUMP: "We're rounding the corner -- with or without a vaccine." -- interview on "Fox & Friends" on Sept. 21.

TRUMP, asked if the virus will "go away" if there isn't a vaccine immediately available: "Sure, with time it goes away. And you'll develop -- you'll develop herd-like, a herd mentality. It's going to be -- it's going to be herd-developed, and that's going to happen." -- ABC News town hall on Sept. 15.

THE FACTS: Trump appeared to promote a "herd immunity" approach to the virus if a vaccine isn't immediately available that would require millions more people to get infected and significantly higher deaths.

Public health officials say that to reach herd immunity, which is when the virus can no longer spread easily, at least 70% of the population, or 200 million people, would need to develop antibodies. The U.S. currently has 7 million COVID-19 cases.

"Developing herd immunity doesn't just take time, it works by infecting over a hundred million and killing hundreds of thousands," University of Michigan professor Justin Wolfers tweeted. "He's describing a massacre."

Fauci last month called a herd immunity approach "totally unacceptable" because "a lot of people are going to die."

He also disagrees the virus is "rounding the corner," saying Americans should not "underestimate" the pandemic and they will "need to hunker down and get through this fall and winter because it's not going to be easy." Fauci and other health experts such as Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, have warned of a potentially bad fall because of dual threats of the coronavirus and the flu season.

Dr. Scott Gottlieb, a former head of the Food and Drug Administration under Trump, on Sunday also pointed to potential warning signs. "As reported Covid cases continue to rise around the U.S., the number of Covid hospitalizations - which is an important, objective measure of total disease burden - have stopped their decline, and may be starting to increase again," he tweeted.

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TRUMP, speaking hours before the U.S. hit a milestone of 200,000 virus deaths: "It affects elderly people, elderly people with heart problems, and other problems. If they have other problems, that's what it really affects. ... In some states thousands of people -- nobody young -- below the age of 18, like nobody -- they have a strong immune system -- who knows? ... It affects virtually nobody." -- rally in Ohio on Sept. 21.

THE FACTS: No, it's affected quite a few.

In all, the U.S. death toll from the coronavirus topped 200,000 Tuesday, by far the highest in the world, hitting the once-unimaginable threshold six weeks before an election that is certain to be a referendum on his handling of the crisis. The number of dead is equivalent to a 9-11 attack every day for 67 days. It is roughly equal to the population of Salt Lake City or Huntsville, Alabama.

Kids certainly aren't immune and Trump ignores racial disparities among those who get infected. He is also brazenly contradicting what he privately told journalist Bob Woodward.

"Now it's turning out it's not just old people, Bob," he told Woodward in March. "It's plenty of young people."

Although it's true that children are less likely than adults to develop COVID-19, the CDC has nevertheless counted more than 419,000 infections in Americans younger than 18, or about 8.5% of all cases. Racial disparities in the U.S. outbreak also extend to children, with Hispanic and Black children with COVID-19 more likely to be hospitalized than white kids.

"It isn't just the elderly," Dr. Anthony Fauci, the government's top infectious diseases expert, told CNN on Tuesday. He noted that a person of any age with underlying health conditions is at significantly higher risk of serious effects if they get COVID-19.

The total number of kids who have been infected but not confirmed is almost certainly far higher than the CDC figures, experts say, because those with mild or no symptoms are less likely to get tested. Kids also can spread disease without showing symptoms themselves.

The CDC in May also warned doctors to be on the lookout for a rare but life-threatening inflammatory reaction in some children who've had the coronavirus. The condition had been reported in more than 100 children in New York, and in some kids in several other states and in Europe, with some deaths.

GINSBURG

TRUMP, on Ginsburg's request that her replacement be chosen by the next president: "I don't know that she said that, or if that was written out by Adam Schiff, and Schumer and Pelosi. That came out of the wind. It sounds so beautiful, but that sounds like a Schumer deal, or maybe Pelosi or Shifty Schiff." -- interview with "Fox & Friends" on Sept. 21.

THE FACTS: He's making a baseless assertion that congressional Democrats invented Ginsburg's request, which Trump is ignoring by announcing on Saturday his choice of Barrett to replace Ginsburg.

In the days before her death on Sept. 18, Ginsburg told her granddaughter Clara Spera that "my most fervent wish is that I will not be replaced until a new president is installed," according to NPR's Nina Totenberg, a longtime veteran Supreme Court reporter.

Totenberg, who is close to the Ginsburg family, reaffirmed her reporting this week. She told MSNBC on Sept. 21 that others in the room at the time also heard Ginsburg make the statement, including her doctor. "I checked because I'm a reporter," Totenberg said.

There is certainly no evidence that House Speaker Nancy Pelosi, Rep. Adam Schiff or Senate Minority Leader Chuck Schumer manufactured Ginsburg's request, as Trump asserts. "Mr. President, this is low. Even for you," Schiff tweeted in response.

COURT NOMINATION

TRUMP, on why he's moving forward with a nomination so close to the Nov. 3 election: "I have a constitutional obligation to put in nine judges -- justices." -- remarks Tuesday to reporters.

THE FACTS: To be clear, there is no constitutional requirement to have nine justices on the Supreme Court.

The Constitution, in fact, specifies no size for the Supreme Court, and Congress has the power to change its size.

Over its history, the high court has varied in size from five to 10 justices, depending on the number of judicial circuits in the U.S., according to Russell Wheeler, a visiting fellow at the Brookings Institution and former deputy director of the Federal Judicial Center. He explained that a major duty of the justices until the late 19th century was to try cases in the old circuit courts. Congress decided on nine circuits in the late 1860s.

President Franklin D. Roosevelt pushed to expand the high court in the 1930s in a bid to gain broader judicial support for his New Deal policies, but that effort failed.

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BIDEN, arguing that a Supreme Court nomination should be decided by the next president so voters can "have their voice heard in who serves on the court": "There's no court session between now and the end of this election." -- remarks Sept. 20 in Philadelphia.

THE FACTS: He's wrong on the scheduling. A new Supreme Court session begins Oct. 5, nearly one month before the election on Nov. 3. The justices are set to hear oral arguments in several cases during that time.

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BIDEN: "We can't keep rewriting history, scrambling norms, ignoring our cherished system of checks and balances. That includes this whole business of releasing a list of potential nominees that I would put forward. They're now saying, after Ruth Bader Ginsburg passed away, they said, `Biden should release his list.' It's no wonder the Trump campaign asked that I release the list only after she passed away." -- remarks Sept. 20 in Philadelphia.

THE FACTS: It's not true that the Trump campaign waited until Ginsburg's death last week to call for Biden's list of potential Supreme Court nominees. Trump was calling for it last month.

On Sept. 9, Trump released a list of 20 additional people he would consider nominating to the high court if there were vacancies. He released a similar list in 2016.

In a press release that same day, Trump's 2020 campaign manager, Bill Stepien, said "Voters deserve transparency and a clear view of what direction candidates for president would take our federal courts. We now forcefully demand that Joe Biden do the same."

Trump called for a list from Biden even earlier, during the Republican National Convention on Aug. 24.

"Remember this, I'm saying that -- I'm demanding actually, a list. Let Biden put up a list of the judges he's going to appoint," Trump said.

Biden has pledged to appoint the first Black woman to the Supreme Court but hasn't offered additional details.

RACIAL PROGRESS

TRUMP CAMPAIGN: "Black Americans don't have to imagine what the economy would be like under Joe Biden because they've already lived through it. He oversaw the slowest recovery since the Great Depression, with stagnant wage growth and anemic job creation." -- statement Wednesday from Katrina Pierson, the campaign's senior adviser.

THE FACTS: That's not fully accurate. The economy was healthy when Trump arrived at the White House.

Even if the recovery from the 2008 financial crisis was agonizingly slow, Trump took office with unemployment at a low 4.7%, steady job growth and a falling federal budget deficit. The longest expansion in U.S. history began in the middle of 2009 and continued until the start of the year, spanning both the Obama and Trump presidencies.

The U.S. economy did benefit from Trump's 2017 tax cuts with a jump in growth in 2018, but the budget deficit began to climb as a result of the tax breaks that favoured companies and the wealthy in hopes of permanently expanding the economy. Annual growth during Obama's second term averaged about 2.3%. Trump notched a slightly better 2.5% during his first three years, but the country swung into recession this year because of the coronavirus and will probably leave Trump with an inferior track record to his predecessor over four years.

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TRUMP CAMPAIGN: "President Trump, on the other hand, has a real record of accomplishments for the Black community, including achieving record-low unemployment prior to the global pandemic. ...President Trump is a far better choice for Black Americans and it isn't even a close call." -- Pierson's statement.

THE FACTS: The campaign is skirting key facts.

Republicans can talk successfully about the decline in unemployment rates for Black and Hispanic workers. But that's just one gauge -- and plenty of troubles and inequalities abound for minorities. Minority groups still lagged behind white people with regard to incomes, wealth and home ownership before the pandemic. And when the coronavirus struck, it became clear that the economy did not work well for everybody as the job losses and infections disproportionately hit minorities.

Black unemployment now stands at 13%. Hispanic unemployment is 10.5%. The white unemployment rate is 7.3%. For every dollar of total wealth held by white households, Blacks have just 5 cents, according to the Federal Reserve. It's 4 cents for Hispanics.

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BIDEN, criticizing Trump for posing for pictures while holding a Bible in front of a church near the White House after protesters in a park were forcibly removed: The protesters were removed so Trump could "walk across to a Protestant church and hold a Bible upside down -- I don't know if he ever opened it -- upside down, and then go back to a bunker in the White House." -- CNN town hall on Sept. 17.

THE FACTS: To be clear, Trump was not holding a Bible upside down.

His administration did fire off chemical irritants and smoke bombs in June to clear demonstrators who had gathered in Lafayette Park to speak out against the killing of George Floyd, a Black man who died after a Minneapolis police officer pressed his knee onto his neck. Trump then walked across the park to hold up a Bible at St. John's Church for the cameras. Associated Press photos and other videos show the Bible was right side up. St. John's is an Episcopal church.

Trump also took shelter in a White House bunker in the days before his visit to St. John's, not after, as Biden asserts.

Associated Press writers Mark Sherman, Jessica Gresko, Jill Colvin, Kevin Freking and Darlene Superville in Washington, Nicholas Riccardi in Denver, Bill Barrow in Atlanta and Carla K. Johnson in Seattle contributed to this report