Chelsea Clinton mischaracterizes Bernie Sanders' health care plan

Hitting the campaign trail on her mother’s behalf, Chelsea Clinton attacked Democratic presidential candidate Sen. Bernie Sanders’ universal health care plan.

"Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance," Clinton said in New Hampshire Jan. 12. "I don't want to empower Republican governors to take away Medicaid, to take away health insurance for low-income and middle-income working Americans. And I think very much that's what Sen. Sanders' plan would do."

The Sanders campaign and his supporters swiftly called Clinton’s statements inaccurate, so we decided to look into them ourselves — in particular, her claim that Sanders’ plan would "empower" governors "to take away health insurance for low-income and middle-income working Americans."

Given that Sanders’ proposed plan specifically calls health insurance an entitlement for all, we found that this is a mischaracterization at best.

Sanders hasn’t released a health care proposal as a presidential candidate, but his campaign has said a bill he introduced in the Senate in 2013 would serve as the model. Sanders has called the plan "Medicare for all," referring to the the health safety net that covers those over 65.

Clinton has a point that enacting the law would disrupt health insurance as we know it, said Gerald Friedman, an economics professor at the University of Massachusetts at Amherst who has analyzed similar proposals.

The bill, the American Health Security Act of 2013, specifically strips insurance benefits from the Affordable Care Act, the Children’s Health Insurance Program, Medicare and Medicaid. The bill also bans the sale of private health insurance that duplicates benefits provided by the government program.

And she is also right that states would be the primary administrators of the system. The bill calls it a "state-based American Health Security Program." However, the assertion that it would empower Republican governors to take away individual’s health insurance is misleading.

Sanders’ plan requires states to set up the specifics of their health care system, though they must meet federal standards for various administrative details. For example, states must identify a single agency to manage the program. If a state does not set up a system, or if they refuse to meet the federal standards, the federal government will step in and run that state’s program.

Clinton’s comments seem to be based on how many Republican governors have reacted to the Affordable Care Act, a.k.a. Obamacare, deciding not to accept an expansion of Medicaid, the government insurance program for low-income individuals.

The Sanders’ campaign said the provision that allows the federal government to step in and run state programs would prevent governors who oppose the law from refusing to provide health coverage for their residents or offering subpar programs.

The bill also states that every U.S. resident "is entitled to benefits for health care services" and would require auto-enrollment at birth or at the point when someone becomes a legal resident.

Former Secretary of State Hillary Clinton’s campaign told us that Chelsea Clinton’s point was that the law would get rid of all of the existing benefits — Obamacare, Medicaid, Medicare, CHIP, etc. — for everyone.

That may be true, but Sanders’ health care seeks to immediately replace all of these programs, as well as attempt to cover all those currently uninsured. That would be a federal-level change, rather than governors choosing to scrap those federal programs, and Sanders’ bill does make an effort to establish measures to circumvent the states that try to undermine the law.

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It sounds like Clinton is saying that millions would be left totally uninsured as a result of Sanders' plan giving more authority to governors, which isn't the case.

"Her claim is analogous to saying that Medicare dismantled private insurance for the elderly," said David Himmelstein, co-founder of Physicians for a National Health Program and an advocate for a national health insurance system. "It replaced defective private coverage with something better."

Hillary Clinton’s campaign also emphasized that at the very least, state governments could administer the program in such a way that they provide low-quality insurance compared to other states, such as by limiting reimbursement rates for providers. The campaign noted that Sanders' bill says the federal government must fund between 81 and 91 percent of each state’s program, so if a state doesn't cover the remaining costs, that could affect the services provided.

One final note: It’s not at all clear that Sanders’ plan would pay for itself or be practical to implement. (We explored those issues in a separate story.) And his plan would certainly get rid of many existing programs. But Chelsea Clinton attacked the plan for one area that seems pretty clear, and that’s its coverage provisions. The plan’s defining feature is that it offers health insurance coverage to every American.

Our ruling

Chelsea Clinton said Sanders’ health care plan would "empower" governors "to take away health insurance for low-income and middle-income working Americans."

Under Sanders’ plan, Americans would lose their current health insurance. However, his proposal would replace their health insurance and cover the currently uninsured. The program would auto-enroll every citizen and legal resident, all of whom would be entitled to benefits. While the plan would give governors authority to administer health insurance within their states, it includes provisions to allow federal authorities to take over if the governors refuse to implement it.

It’s impossible to predict with certainty how Sanders’ plan would play out in real life. But Clinton’s statement makes it sound like Sanders’ plan would leave many people uninsured, which is antithetical to the goal of Sanders’ proposal: universal health care.

We rate her claim Mostly False.