The numbers don’t lie. Biden kept his promise to improve Obamacare.

Promise: “Not only will I restore Obamacare; I will rely on it.”

In a speech on November 2, 2020, then-presidential nominee Joe Biden promised, “Not only will I restore Obamacare; I will rely on it.”

It’s been two years since then, and how does he keep up with that promise?

KHN teamed up with our partners at PolitiFact to track 100 key pledges, including this one, made by Biden during the 2020 presidential campaign. The pledges cover issues related to improving the economy, responding to calls for racial justice and combating climate change. In terms of healthcare, they range from controlling COVID-19 and improving veterans’ health care to codifying Rowe vs. Wade. KHN recently tested the administration’s promises to lower the cost of prescription drugs and reduce the country’s maternal mortality rate.

Eight days after his tenure, Biden signed an executive order to strengthen Medicaid and the Affordable Care Act, or Obamacare. A couple of months later, he signed his first major piece of legislation, the American Rescue Plan, which included provisions expanding subsidy eligibility and increasing tax credits available to help low- and middle-income Americans purchase ACA insurance.

The law also offered financial incentives to encourage 12 states that refused to expand Medicaid eligibility to do so.

The consumer subsidies originally expired this year, but they were extended under the Inflation Reduction Act, which Biden signed into law on Aug. 16 after much debate and without a Republican vote. This measure also expanded eligibility for subsidies.

In October, the Biden administration addressed another issue at the ACA, the so-called familial disruption, which would prevent some people with workplace insurance from qualifying for subsidies.

Those points alone call for a “definite yes” to the question of whether Biden delivered on his campaign promise, said Sabrina Corlett, co-director of the Center for Health Insurance Reform at Georgetown University.

Joe Antos, a senior fellow at the American Enterprise Institute think-tank, offered a different view: Action taken on a mistake cannot count against Biden’s promise to “rebuild” the ACA. Antos said it wasn’t a glitch at all, but a deliberate element of the original ACA that was added to save the government money and help get it passed in Congress.

“Biden was vice president when the bill was signed and he allegedly supported it,” Antos said.

Corlett spoke about other changes in the Biden administration, including increased funding for consumer assistance programs that help people sign up for ACA coverage and made it easier to process some of the paperwork needed to sign up.

The White House released a formal review of other actions taken as a result of the order, including extending the annual open enrollment period to attract more policyholders and allowing low-income Americans to enroll at any time.

Last year, the ACA plan was chosen by a record 14.5 million Americans. This year’s enrollment period ended on January 15 in most states, and according to preliminary data, enrollment in 2023 will continue on an upward trend.

The increase in coverage is partly due to expanded subsidies that reduced premiums to $10 or less per month for some low-income consumers and eliminated the cut-off threshold, allowing some higher-income families to qualify for at least some of the subsidy. Corlett said.

Antos agreed that the administration has made changes that are “clearly based on Obamacare and spending expansion and likely to reach more people.”

What happened to financial incentives to force states to expand their Medicaid programs to include more low-income adults, especially those in or below the poverty line who don’t have children? These incentives still exist, but so far no state has done so.

South Dakota expanded after the bailout was passed, but that was because voters approved the vote, not financial incentives.

“It was part of Biden’s goal to close the coverage gap,” said Joan Alker, executive director of the Georgetown Center for Children and Families. “We still have 11 states resisting Medicaid expansion and that leaves a big gaping hole in coverage in those states. But it’s not because of a lack of effort on the part of the Biden administration.”

As enrollment has increased, subsidies have become more affordable, more people are helping consumers enroll, and there is more incentive to expand Medicaid, we see this as a promise kept.

Our sources:

Telephone interview with Sabrina Corlett, Co-Director, Center for Health Insurance Reform, Georgetown University, December 20, 2022.

Telephone interview with Joseph Antos, Senior Fellow, American Enterprise Institute, January 5, 2023.

Telephone interview with Joan Alker, Executive Director of the Georgetown University Center for Children and Families, January 10, 2023.

Archive Today, Transcript of Joe Biden’s Pittsburgh Campaign Speech, November 2, 2022

KHN, “The Inflation Reduction Act Makes Important Cost-Saving Changes for Many Patients—Maybe You,” August 12, 2022.

White House, Executive Order Further Expanding Americans’ Access to Affordable, Quality Health Insurance, April 5, 2022

KFF, “Market Registration 2014-2022”, accessed 5 January 2023.

KFF, “Five Things to Know About Extending Supplemental Affordable Care Act Subsidies in the Inflation Reduction Act”, August 11, 2022.

KFF, “Navigating to Fix Family Disruptions: Barriers for Consumers with Employer-Sponsored Coverage,” November 21, 2022.

NPR, “Buying ACA Health Insurance? Here’s what’s new this year, October 31, 2022

KHN (Kaiser Health News) is a national news service that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a charitable, non-profit organization providing health information to the nation.

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