As soon as President Obama's new recommendations for gun violence prevention became public, right-wing media immediately claimed the president was issuing an executive action requiring doctors to ask patients about their guns. This is false. The president's released proposals only clarify that nothing in the Affordable Care Act changes longstanding law: doctors are still free (but not required) to discuss with their patients any health hazards, including a lack of gun safety at home or elsewhere.
Among the White House proposals for gun violence reduction, the president announced that the administration will "[c]larify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes." Nowhere in his proposal did he instead require doctors to ask about guns. The Drudge Report, however, immediately splashed across its website this graphic:
Rush Limbaugh picked up on this flatly inaccurate claim that the president required doctors to ask their patients about "gun ownership." Rather than explain the president's executive action only indicated future orders, regulations, or guidance will clarify that no law - including the ACA - prohibits them from discussing gun safety with their patients, Limbaugh reported it as a new directive that "deputizes gun-snitch doctors":
RUSH: So now doctors are being ordered, instructed to talk to patients and get information from them about gun ownership, where they are in their house, who has access to them, where the ammunition is kept. Doctors are now, quote, unquote, "permitted," unquote, to do this. It makes 'em deputies, agents of the state.
RUSH: They're trying to bring a screeching halt to the effort to stop the instances of doctor-patient relationship where the doctor gains the information and passes it on. That's why the reference to Obamacare. If you go back and read Obamacare, despite what the president said in his little release today Obamacare does limit the government when it comes to gun in terms of doctors and what they can collect. They're now trying to reverse that. That's what this is about today. They're trying to stop any effort that would change what's already in place, which is doctors reporting on citizens via patient conferences.
RUSH: Yep, and people are getting upset with it. They never have liked it. This section in Obamacare, it's too much legalese to read to you. But the summary of it is it does in fact limit what data the authorities can collect from patients, what information the doctors can collect from patients and report to the authorities. That section in Obamacare was put in by the NRA. It was a sop given to the NRA. What the regime is doing today is, A, saying, "No, it's not really there; Obamacare does not prevent this," when it does, and, "It doesn't matter anyway because we're now gonna require it even more than we already have."
Limbaugh concedes that the executive action doesn't literally say that doctors are required to ask about gun safety, but rather, in his interpretation, "the executive action today is almost essentially requiring it." The president's proposal was likely a direct response to these types of wildly erroneous interpretations of the health care reform law and executive orders that were already floating around the right-wing blogosphere, before Limbaugh added his analysis. For example, on January 9, a Breitbart.com writer claimed the ACA says "the government cannot use doctors to collect 'any information relating to the lawful ownership or possession of a firearm or ammunition.'" But the relevant provisions within the health care reform law are explicitly limitations on what the secretary of Health and Human Services can do, not "the government" at large, and nowhere is there a prohibition on doctors inquiring about gun safety. In fact, such a prohibition has been held to be an unconstitutional violation of a doctor's First Amendment rights. As explained by the White House proposal released today:
Some have incorrectly claimed that language in the Affordable Care Act prohibits doctors from asking their patients about guns and gun safety. Medical groups also continue to fight against state laws attempting to ban doctors from asking these questions. The Administration will issue guidance clarifying that the Affordable Care Act does not prohibit or otherwise regulate communication between doctors and patients, including about firearms.
The administration is basing their interpretation on the text and intent of the law itself. The amendment may indeed have been a last-minute lobbying success for the NRA, but right-wing media inflate its reach in addition to their false claims about what the president actually did today. As reported by NBCNews.com, "[t]here are some who believe the health-care law outlaws doctors from asking patients about guns in their homes. But that's not true." From Kaiser Health News:
Did you know the Affordable Care Act stands up for gun rights? The "Protection of Second Amendment Gun Rights" section says the health law's wellness programs can't require participants to give information about guns in the house. It also keeps the Department of Health and Human Services from collecting data on gun use and stops insurance companies from denying coverage or raising premiums on members because of gun use.
The massacre in Newtown, Conn., renews the controversy about whether gun violence is a public health issue. Should health authorities view guns in the same category as pneumonia and car crashes? The debate has been going on for years, with epidemiologists arguing firearms can kill just as many as a bad flu season and gun-rights advocates viewing any attention from public health officials as a step toward gun confiscation -- the beginning of the end of the Second Amendment.
The ACA language, which does not prohibit doctors from inquiring about guns in the household, was included at the request of Nevada Democrat Sen. Harry Reid, the Senate majority leader and a gun rights supporter. Reid's office did not respond to a request for comment.
The language was inserted after the act cleared the Senate Finance Committee and before it was voted on by the full Senate.
The National Rifle Association did not respond to a request for comment.
Serial health care misinformer Betsy McCaughey appeared on Fox News to continue pushing debunked falsehoods about the health care reform bill, including claims that the government will dictate care and that employees will be forced into a "one-size-fits-all" health care plan.
Appearing on the January 14 edition of Fox & Friends to promote her upcoming book, Beating Obamacare -- which she said is "a no-spin, easy-to-understand guide" to the law -- McCaughey claimed that employees who gain coverage under the Affordable Care Act would be given a "government-mandated one-size-fits-all plan." McCaughey further claimed health care exchanges will "only sell the government mandated plan" like "a dealership that sells four-door sedans." McCaughey also repeated the falsehood that the ACA "puts the federal government in charge of your health care for the first time."
But despite co-host Gretchen Carlson's promotion of McCaughey's claims, all of them have been thoroughly debunked. The health care bill doesn't create "one-size-fits-all" health care plans but does require plans to provide a minimum level of coverage. There is nothing in the law which prohibits insurers from offering additional benefits above the basic requirements.
In addition, McCaughey's suggestion that the exchanges would only offer one plan is absurd. The entire purpose of the exchanges is to provide a market where consumers are offered a choice of affordable plans. In fact, the ability of exchanges to provide competition is one reason they were endorsed by the American Medical Association:
Fox News misrepresented how Darden Restaurants and Denny's are responding to the Affordable Care Act in order to suggest that the Affordable Care Act is harming workers and driving up prices.
An owner of a number of Wendy's restaurants in Omaha, Nebraska announced that the franchise would cut employees' hours to avoid providing health care for many of its workers. Fox Business host Stuart Varney dishonestly argued that the decision by this one Wendy's franchise owner was part of larger trend, citing moves by Darden Restaurants and Denny's to bolster his claim.
But Varney's reference to Darden Restaurants and Denny's is wrong. Darden, the owner of the Olive Garden, announced in October that the company would scale back employee hours to avoid having to provide health insurance. Darden subsequently backed off and confirmed it would not move full-time employees to part-time status.
In the case of Denny's, John Metz, the owner of dozens of Denny's restaurants, announced a plan to institute a five percent surcharge to all his customers' checks but later did not go through with his plan. After Metz announced his plan, Denny's chief executive John Miller contacted him to express that the surcharge was "inconsistent with our values." Miller told the Huffington Post in an email that he was disappointed "that [Metz's] comments have been interpreted as the company's position." Miller added:
"Unfortunately, the comments of this franchisee, who represents less than 1 percent of our system and who owns restaurants in other concepts, has been portrayed as reflective of the entire Denny's brand," Miller said. "I am confident his perspective is not shared by the company or hundreds of franchisees/small business owners who make up the majority of the Denny's community. Specifically, his comments suggesting that guests might reduce the customary tip provided to their server as an offset to his proposed surcharge are inconsistent with our values and approach to business throughout our brand."
Metz did not go through with the 5 percent surcharge.
These fast food restaurants have rescinded their plans to cut hours or increase prices, in part as a result of strong negative public reaction. In addition, a study conducted by the Urban Institute found that the health care law would have a "negligible impact" on most business' costs and could save money for small businesses employing 100 or fewer workers.
Fox News host Neil Cavuto and Fox guest Stephen Moore agreed that President Obama is wrong to suggest that federal spending growth is driven by health care costs, when in fact Obama is right. Health care spending is the only category of federal spending projected to grow substantially over the next two decades, and government health insurance is actually more efficient than private sector insurance. And the president's Patient Protection and Affordable Care Act contains provisions that aims to contain and reduce national health care costs.
From the December 20 edition of Fox News' Your World with Neil Cavuto:
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From the December 20 edition of Fox News' Fox & Friends:
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Fox News relied on dubious arguments from a conservative group with a history of ethical problems to cast doubt on how the Obama administration is implementing government regulations related to the health care reform law.
In a segment titled "Regulation Nation," anchor Jenna Lee claimed that the health care law's new regulations are on the "fast track" because the public hasn't been afforded enough time to offer input on them before their passage. Correspondent Shannon Bream added that this was in contrast to a 1993 executive order from former President Clinton, which required a minimum of 60 days for comment.
Bream based her reporting on the work of right-wing group Americans for Limited Government, which has a history of ethical problems that include fraud and financial disclosure issues. The group has also been accused of engaging in character attacks.
In fact, the Obama administration has complied with regulatory rules. Moreover, despite Bream's assertion that comment periods should last at least 60 days, there is no required minimum period.
Federal Register guidelines state that "in general, agencies will specify a comment period ranging from 30 to 60 days," but they may also use shorter periods "when that can be justified." Clinton's 1993 executive order recommended that a comment period last at least 60 days "in most cases."
An executive order President Obama signed in January 2011 improving regulation and regulatory review reaffirmed Clinton's order, reading:
To the extent feasible and permitted by law, each agency shall afford the public a meaningful opportunity to comment through the Internet on any proposed regulation, with a comment period that should generally be at least 60 days.
Bream ended the segment by claiming that "there have been nearly 6,000 federal regulations proposed just in the last 90 days."
According to the government's regulation website, regulations.gov, there have been 5,803 new postings in the last 90 days. However, more than 4,000 of those are "notices," which include updates to previous regulations, scheduled hearings, grant applications, and meeting announcements. Less than 1,500 are listed as new regulations and rules.
Fox previously used the term "Regulation Nation" to launch a weeklong attack on federal regulations just as the Republican Party announced its push for repealing regulations. Fox also has a history of attacking health care reform.
A Wall Street Journal op-ed by former Reagan and Bush administration lawyers David Rivkin Jr. and Lee Casey launches another in a series of legally suspect attacks on the constitutionality of the Affordable Care Act. But this new challenge to the constitutionality of the individual mandate, based on the Constitution's "Uniformity Clause," is so fanciful that even other conservative media question its validity.
Conceding that their argument has been "rarely considered," Rivkin and Casey nonetheless claim that because Roberts upheld the individual mandate under Congress' power to tax, it is now subject to the "Uniformity Clause," which requires the tax to "be uniform throughout the United States":
[B]y transforming the mandate into a tax to avoid one set of constitutional problems (Congress having exceeded its constitutionally enumerated powers), the court has created another problem. If the mandate is an indirect tax, as the Supreme Court held, then the Constitution's "Uniformity Clause" (Article I, Section 8, Clause 1) requires the tax to "be uniform throughout the United States."
[Al]though the court has upheld as "uniform" taxes that affect states differently in practice, precedent makes clear that a permissible tax must "operate with the same force and effect in every place where the subject of it is found," as held in the Head Money Cases (1884). The ObamaCare tax arguably does not meet this standard.
ObamaCare provides that low-income taxpayers, who are nevertheless above the federal poverty line, can discharge their mandate-tax obligation by enrolling in the new, expanded Medicaid program, which serves as the functional equivalent of a tax credit. But that program will not now exist in every state because, as a matter of federal law, states can opt out. The actual tax burden will not be geographically uniform as the court's precedents require.
But Rivkin and Casey neglect to mention that their argument has in fact been considered and rejected more than once since 1884. The Congressional Research Service concluded the argument presented "no constitutional issue" because the individual mandate would "satisfy the requirement of uniformity...on its face," pursuant to the more recent case of United States v. Ptasynski. That 1983 Supreme Court decision held that "it was settled fairly early that the [Uniformity] Clause does not require Congress to devise a tax that falls equally or proportionately on each State." Quoting from yet another Supreme Court opinion, Ptasynski further observed that "[t]he uniformity provision does not deny Congress the power to take into account differences that exist between different parts of the country, and to fashion legislation to resolve geographically isolated problems." As such:
Where Congress defines the subject of a tax in nongeographic terms, the Uniformity Clause is satisfied. See Knowlton v. Moore, 178 U.S. at 178 U. S. 106. We cannot say that, when Congress uses geographic terms to identify the same subject, the classification is invalidated. The Uniformity Clause gives Congress wide latitude in deciding what to tax and does not prohibit it from considering geographically isolated problems.
The National Review Online's Matthew Franck also found Rivkin and Casey's arguments unconvincing, noting that they did not consider (or quote) the rest of the 1884 Supreme Court case they cited:
But it's not at all clear that the choice of a state to opt out of a program that would make the alternative to paying the tax cheaper, or relieve affected persons of the taxpaying obligation altogether, renders the federal tax geographically non-uniform for constitutional purposes. All persons similarly situated-unable or unwilling to purchase health insurance, while obligated either to do so or to pay a tax-will be subject to the tax. The reasons for their being subject to the tax may be partly in the power of the state governments where they live-and the authority of states to make a choice that costs them something may itself be authorized by federal law-but that does not necessarily mean that the federal government has used its taxing power in a non-uniform manner. In the Head Money ruling itself, the Court held that the tax in question (if it really was a tax, and not an exercise of the commerce power-oh, how the world turns), a 50-cent charge on foreign passengers entering the country at American seaports, was not invalid by virtue of its not applying to foreigners entering the country over land by rail. "[T]he law applies to all ports alike," the Court observed, and added: "Perfect uniformity and perfect equality of taxation, in all the aspects in which the human mind can view it, is a baseless dream, as this court has said more than once."
Despite the apparent holes in Rivkin and Casey's arguments, supporters of the Affordable Care Act should not ignore them. Rivkin has a notable track record in moving off-the-wall legal arguments into the political mainstream, as he was among the first to suggest - similarly without any support in existing law -- that the individual mandate might be unconstitutional under the Commerce Clause.
Fox News is promoting another legal challenge to the Affordable Care Act that originated in a right-wing think-tank and was hyped by conservative blogs. The State of Oklahoma filed a lawsuit based on a problematic theory that alleges tax credits within federally-run health insurance marketplaces called "exchanges" are unauthorized, which was developed by Michael Cannon, Director of Health Policy Studies at the Cato Institute, and National Review Online contributing editor and Case Western Reserve University School of Law professor Jonathan H. Adler. But Fox News has not only failed to report the extensive debunking of this tax credit theory, it has also mischaracterized this challenge to tax credits offered in exchanges as a "serious" constitutional one, although the new constitutional arguments are even more far-fetched than the original statutory claims.
Major newspapers in Pennsylvania, Oklahoma, and Nevada have urged their governors to reject expansion of Medicaid -- the shared state-federal program that provides health care coverage to low income Americans -- under the Affordable Care Act, citing high costs that they claim would add to the states' financial burdens. In fact, a new report by the Kaiser Family Foundation finds that the Medicaid expansion would substantially reduce the number of uninsured at little cost to their state budgets.
As governors continue to decide whether to implement key aspects of the Affordable Care Act, the editorial boards of the Pittsburgh Tribune-Review and the Las Vegas Review-Journal urged the rejection of Medicaid expansion, while the editorial board of The Oklahoman applauded the recent decision by Republican Gov. Mary Fallin to reject the funding.
From the Pittsburgh Tribune-Review:
As stipulated under the Patient Protection and Affordable Care Act, Medicaid eligibility will expand to an additional 800,000 Pennsylvanians -- in effect, placing a quarter of the state's residents on government insurance, according to the Commonwealth Foundation. Never mind that Medicaid currently consumes 30 percent of the state's operating budget.
Once fully realized, ObamaCare will have all the appeal of a perpetual flu.
From the Las Vegas-Review Journal:
The accompanying Medicaid expansion, meanwhile, would throw millions of additional Americans into a system that's already bankrupting state governments and increasing costs in the private market. Geoffrey Lawrence of the Nevada Policy Research Institute, noting last week that Gov. Sandoval is pondering whether to expand Medicaid eligibility in Nevada, said any Medicaid expansion would mean reduced access to care for those currently enrolled.
President Obama won re-election this month, but the states hold the future of ObamaCare in their hands. Knowing the harm the law would do to our citizens, the economy, and the quality of American health care, Gov. Sandoval should join with many of his colleagues and decline to become the enabler of a vastly expensive, European-style medical rationing system that poll after poll has shown most Americans do not want.
From The Oklahoman:
Oklahoma has joined a growing list of states that won't expand Medicaid or implement state-run health exchanges, two key components of Obamacare. Predictably, the political left argues Republicans are being obstructionist. But why would state Republicans rush to implement a bad law to benefit a president who's made clear he would never do the same if the tables were turned?
As of June 2011, Medicaid programs in all 50 states and the District of Columbia provided health care coverage to 52.6 million people. However, as the economy has improved, the rate of growth of enrollment in the program has slowed down. With the passage of the Affordable Care Act, the federal government wants to expand the program in an effort to decrease the number of uninsured by providing coverage to those with an income below 133 percent of the federal poverty level. Previously, qualification for the program varied depending on factors such as age or employment status. Despite the claims from these editorial boards, the Affordable Care Act's Medicaid expansion provision will in fact achieve its goal, at only a slightly higher cost than what those states currently pay for Medicaid.
A recent study published by the Kaiser Family Foundation found that if all states expanded Medicaid it could lead to health care coverage for an additional 21.3 million people nationally with a total cost of around $1 trillion. Yet, the combined costs to states would only be approximately $76 billion as the federal government will cover the other $952 billion.
Specifically, Pennsylvania, Nevada, and Oklahoma would see significant increases in the number of people insured for only small changes to their current spending.
In Pennsylvania, if all states expanded Medicaid, the state would see a 52 percent reduction in uninsured citizens, while spending 1.4 percent more on Medicaid than current expenditures when accounting for the savings in uncompensated care. While Pennsylvania's expansion costs are higher than some other states, healthcare professionals note that this is because Pennsylvania currently has one of the more draconian Medicaid systems in the country. From WHYY in Pennsylvania:
New Jersey is on the opposite end of the spectrum, with projected costs of $1.2 billion with an expansion. And Pennsylvania? Almost $2 billion over 10 years, even after accounting for savings.
"Pennsylvania has not expanded to adults whereas other states have," said Ann Bacharach with the Pennsylvania Health Law Project.
"If you're a single, childless adult, there is not much that the state can offer in terms of coverage," Bacharach said.
So the new enrollees covered by an expansion would add costs, but the federal contribution would not provide the same savings in Pennsylvania as it will in Delaware.
Meanwhile, Nevada would see a 44.8 percent reduction in uninsured citizens for only 2.6 percent more in Medicaid spending if all states expanded Medicaid coverage. As Media Matters has previously noted, the Review-Journal's editorial board has attacked the Medicaid provision of the Affordable Care Act while neglecting to note any of the benefits expanding Medicaid would have on their state.
Lastly, Oklahoma would see a 54.4 percent reduction in uninsured for only 1.9 percent more in Medicaid spending if all states expanded Medicaid coverage. From Tulsa World:
[David Blatt, director of the Oklahoma Policy Institute] said the governor's calculations also leave out savings to the state in areas such as health, mental health and corrections that are currently outside the Medicaid system but could be included with expansion. Savings to those agencies has been estimated at more than $49.4 million a year.
Also missing from the calculation would be tax revenue increases the state would see as a result of the Affordable Care Act, he said.
For example, the state has a small tax on insurance premiums. If thousands of Oklahomans begin purchasing insurance through a federal health insurance exchange, that tax revenue goes up, he said.
If every state adopted the Medicaid expansion provision they would receive $9 in federal money for every $1 they spend to expand the program. As John Holahan, head of the Urban Institute's Health Policy Research Center and the study's author, said, "It's hard to conclude anything other than this is pretty attractive and should be pretty hard for states to walk away from." Unfortunately, the editorial boards of the Tribune-Review, Review-Journal, and The Oklahoman failed to provide that perspective and explain the overall benefit of Medicaid expansion to their readers.
Fox hosted serial health care misinformer Betsy McCaughey to push false and misleading claims about health care reform, following announcements from some Republican governors that they have decided not to create state-run health insurance exchanges.
Rush Limbaugh and Fox News hosts are embracing Mitt Romney's claim that President Obama won reelection because he provided "gifts" to various groups of voters in the form of government policies and programs. These claims are the latest installment in Limbaugh and Fox News' multi-year narrative that roughly half of Americans are "takers" that mooch off of America's wealthy through government programs.
Fox News used Mitt Romney's claim that President Obama won the election by giving "gifts" to certain voters to press its argument that Americans who benefit from government programs mooch off wealthy people.
On November 14, Romney told donors to his campaign that the Obama campaign "focused on giving targeted groups a big gift." The Los Angeles Times reported that Romney said "The Obama campaign was following the old playbook of giving a lot of stuff to groups that they hoped they could get to vote for them and be motivated to go out to the polls, specifically the African American community, the Hispanic community and young people." Romney listed the Affordable Care Act and Obama's immigration policies as examples of these gifts.
On November 15, Fox & Friends embraced these comments. Fox Business host Stuart Varney claimed that in Europe "politicians have bought votes by handing out goodies to the population" for generations and that has led to unrest over austerity programs. He continued, "Now look over here. What position are we in in America right here? I say we're just getting started. We're throwing the handouts out left, right, and center." Fox & Friends co-host Brian Kilmeade interrupted, saying: "Mitt Romney mentioned that yesterday. He said he couldn't win because all these other people were giving things away." Varney agreed, saying that American politicians are "buying votes with taxpayer money, handouts all over the place."
Varney then criticized the president for wanting to "tax the rich" to reduce the deficit, saying: "The president thinks that if you tax the top 2 percent some more, you will pay for all the goodies, all the handouts that we've got going."
In the past, Fox has repeatedly pushed similar arguments, trying to pit people who receive government benefits -- labeled as "takers" by Fox -- against the "makers," Fox's term for the wealthy. Fox continued to press this theme during the 2012 presidential campaign. For instance, after video surfaced of Romney claiming that 47 percent of Americans believe they are victims, are dependent on government, and thus wouldn't vote for him, Fox cheered on Romney's comments.
Fox personalities and other right-wing commentators have also pushed the same theme following Obama's reelection. Fox host Bill O'Reilly said that voters feel economic anxiety and just "want stuff," while Fox host Eric Bolling said Obama is a "maker versus taker guy." Fox contributor Monica Crowley said that the election showed that "more people now are dependent on government than not." Rush Limbaugh compared the president to Santa Claus, saying that "small things beat big things" in the election and "people are not going to vote against Santa Claus."
From the November 13 edition of Premiere Radio Networks' The Rush Limbaugh Show:
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Fox News ignored important facts about the Affordable Care Act to falsely claim that House Republicans could simply defund the law, however economist have found that defunding the healthcare law withholds funds that actually lower the deficit in the long term.
On the November 8 edition of Fox News' Hannity, host Sean Hannity asked Republican strategist Noelle Nikpour whether House Republicans "could fight to defund Obamacare" instead of conceding that "Obamacare is the law of the land." Nikpour responded, "Yeah, they can."