Fact checking Vance’s health policy claims

The first and only debate between the vice presidential nominees, Sen. J.D. Vance and Minnesota Gov. Tim Walz, threw the 2010 health care law back into the spotlight.

Vance, R-Ohio, who was elected to the Senate in 2022, tried to distance his running mate, former President Donald Trump, from partisan efforts to repeal or weaken the law, also known as the Affordable Care Act.

His remarks, however, ignore the fact that 2017 was dominated by Republican efforts to overhaul former President Barack Obama’s signature health care law — an effort led by Trump himself.

CQ Roll Call fact-checked three of Vance’s boldest claims on the 2010 law.

Claim: Executive action on ACA and dividing risk pools

On the debate stage, Vance told Americans that Trump implemented regulations to allow states to experiment with how they cover risk pools, allowing them to divide plans between the sick and the healthy. This never happened under the Trump administration.

“And we talked about, you know, the reinsurance regulations is what I was talking about. Look, Donald Trump has said that if we allow states to experiment a little bit on how to cover both the chronically ill, but the non chronically ill. It’s not just a plan. He actually implemented some of these regulations when he was president of the United States. And I think you can make a really good argument that it saved Obamacare, which was doing disastrously until Donald Trump came along.”

Fact check: Vance was likely referring to Section 1332 state innovation waivers that were approved by the Trump administration.

These waivers allow states to alter certain marketplace requirements and tailor their insurance marketplaces to meet the needs of their populations, as long as the state continues to provide coverage that is at least as comprehensive and affordable as the baseline federal plans.

But Trump did not invent these waivers — they were created under the Obama administration as part of the 2010 health care law.

The Trump administration approved Section 1332 waivers in 13 states and partially approved a Minnesota waiver. Many of those waivers created reinsurance programs.

None involved split risk pools that would separate the healthy and the chronically ill.

Claim: Trump saved, strengthened the ACA

Vance later said Trump helped increase enrollment on the health insurance exchanges and prevented them from collapsing.

“He saved the very program from a Democratic administration that was collapsing and would have collapsed absent his leadership,” Vance said. “He did his job, which is to govern in a bipartisan way and get results.”

He later added, “A lot of what happened and the reason that Obamacare was crushing under its own weight is that a lot of young and healthy people were leaving the exchanges. Donald Trump actually helped address that problem.”

Fact check: During his time in the Oval Office, Trump repeatedly tried to repeal the health care law, and even backed litigation to nullify it, Texas v. Azar.

At one point, he even advocated repealing the law and replacing it at a later date.

Trump also supported a 2017 bill from congressional Republicans that would have overturned much of the health care law, allow insurers to charge higher premiums, and separate out the sick and healthy into different risk pools.

The Congressional Budget Office estimated that the bill would have increased the number of uninsured individuals by 23 million in 2026 relative to the existing health care law.

Under the Biden-Harris administration, enrollment in the health exchanges increased from roughly 11.4 million in 2020 to 21.4 million, according to KFF. Much of this growth was caused by the increased availability of health insurance subsidies.

Congress last renewed the expanded subsidies as part of President Joe Biden’s 2022 reconciliation package (PL 117-169), and they expire at the end of 2025. If the expanded tax credits end in 2025, as many as 3 million Americans could become uninsured, and 20 million Americans could see premium increases, according to congressional Democrats.

Claim: Price transparency

Vance claimed that Trump introduced prince transparency rules that have effectively lowered costs for consumers.

“He introduced pricing transparency. Think about health care. You go into a hospital, you try to buy something, and nobody knows what it actually costs. That price transparency will actually give American consumers a little bit more choice and will also drive down costs.”

Fact check: The Trump administration did implement price transparency rules for hospitals and health plans to provide more clarity about negotiated prices.

But there is not clear evidence to suggest it affected prices.

In 2019, Trump issued an executive order directing the Department of Health and Human Services to implement rules that would require insurers and hospitals to provide more information about the cost of services to patients. The rules use legal authority established under the 2010 health care law.

HHS, in turn, finalized hospital price transparency rule-making in 2019, and in 2020 finalized a rule requiring insurers to publish pricing information on their negotiated rates.

But since their implementation, experts have repeatedly pointed out to limited compliance and inconsistent data, limiting their ability to measure if they’ve had an impact on consumer prices.

These concerns persist three years after its implementation.

A Government Accountability Office report published Oct. 2 suggests that the Centers for Medicare and Medicaid Services needs more complete and accurate hospital pricing information to help increase competition and eventually lower prices.