Guide to right-wing media myths and facts about the Senate health care bill
Research ››› ››› DINA RADTKE & NICK FERNANDEZ
Right-wing media figures are trying to curry favor for the Better Care Reconciliation Act (BCRA) by attacking the Affordable Care Act (ACA), pushing lies about the BCRA, disparaging the nonpartisan Congressional Budget Office (CBO) or distorting its analysis of the legislation, and muddying the truth about the health care system in general. Here is a guide to the myths right-wing media are employing to sell the Senate Republican health care bill.
MYTH: The Affordable Care Act is failing
Fox News’ Jillian Mele: “More evidence” that “Obamacare is a prescription for failure” after the country’s “second largest health insurer just pulled out.” On the June 22 edition of Fox News’ Fox & Friends, anchor Jillian Mele asserted that health insurance company Anthem’s decision to not participate in state health insurance exchanges set up through the Affordable Care Act (ACA) is “more evidence” that “Obamacare is a prescription for failure.” From the June 22 edition of Fox News’ Fox & Friends:
JILLIAN MELE: And more evidence this morning Obamacare is a prescription for failure. The nation's second largest health insurer just pulled out. Anthem ended its agreement in Indiana and Wisconsin for next year because it just can't manage the cost of sick patients signing up for Obamacare. Instead, Anthem will offer an off-exchange medical plan in five counties across Indiana and one in Wisconsin. [Fox News, Fox & Friends, 6/22/17]
Wash. Times’ Stephen Dinan: “Obamacare as it exists right now can’t survive.” Washington Times staff writer Stephen Dinan called the ACA a “failed law,” claiming that “Obamacare as it exists right now can’t survive.” From the June 26 edition of Fox News’ Happening Now:
JON SCOTT (CO-HOST): Mitch McConnell right now has five senators, his Republican senators in opposition. He can only lose two of them and still get this thing passed. So does he get it passed?
STEPHEN DINAN: I would agree with [Senate Minority Leader] Chuck Schumer [(D-NY)]. I’d say it’s probably about a 50/50 proposition. There’s some theory that the Republicans would be very happy just to go ahead and have a vote and have it go down to defeat and then try and recenter this whole conversation. Look, Republicans have lost the messaging battle on this Obamacare repeal. They argue that this is a conversation, a choice between either disastrous Obamacare, basically a failed law, and their replacement. Democrats, though, have said, no, no, no. Obamacare can survive. The evidence suggests that Obamacare as it exists right now can’t survive. It’ll need a massive infusion of cash. Republicans haven’t done a very good job, though, of setting that conversation up for Americans. So most Americans think it’s a choice between Obamacare with its coverage and then the Republican plan with 23 million fewer people on coverage. And that’s probably not a very good comparison. [Fox News, Happening Now, 6/26/17]
Townhall: ACA “is failing” and in a “death spiral.” In an post headlined “Death Spiral Watch: As Democrats Attack, the System They Built Keeps Imploding,” Townhall political editor and Fox News contributor Guy Benson claimed that the ACA is “spiraling” and “failing -- and those failures are getting worse.” From the June 23 post:
As liberals flail away at the Senate's newly-released healthcare bill, and conservatives scramble to adjust serious design flaws, Americans must not lose sight of an inescapable and crucial fact: The current law, which was exclusively written and passed by Democrats, is failing -- and those failures are getting worse. Within the past 48 hours, two major insurance carriers announced plans to withdraw from Obamacare marketplaces in a slew of states. Despite hiking individual market federal exchange premiums by an average of 105 percent over the past four years, in a quixotic effort to compensate for Obamacare's systemic adverse selection flaw, carriers are still losing hundreds of millions of dollars per state, per year. For many, they can't sustain those financial blows any further, so they're pulling the ripcord. [Townhall, 6/23/17]
MSNBC’s Ali Velshi: Premiums under the ACA are “where [they’re] supposed to be.” MSNBC contributor Ali Velshi explained that the Congressional Budget Office (CBO) had predicted the currently observed rates in premiums when it scored the ACA in 2009. Velshi noted that in the first two years of the ACA, premiums “had been set too low,” so the change in premium levels is “actually where we were supposed to be.” From the October 25 edition of MSNBC Live with Craig Melvin:
CRAIG MELVIN (HOST): Plans set to rise by an average of 25 percent in the 39 states served by Healthcare.gov. MSNBC’s Ali Velshi is here to break down these numbers to help separate some fact from fiction, if you will. What can you tell us?
ALI VELSHI: Well, you're going to hear a lot of different, specific numbers, so I want to give you a narrative, a sort of a sense of what’s going on. In 2017, they are expecting that 13.8 million Americans in total will be enrolled in America. This is not the number of people insured, obviously, because many people are insured through their work. This is the number of people insured through Obamacare. It’s a little increase over 2016. The silver plan, which is the benchmark plan they use -- there’s gold, silver, platinum, bronze, and other plans -- is going to be up an average of 22 percent. With a number you used, 25 percent, that's across 39 states. This will be the whole average, about 22 percent. And that will bring the premiums up to about $3,552 a year.
MELVIN: That doesn't include subsidies, correct?
VELSHI: That is correct. Right. Now, this is important, because this number, this level, is where the Congressional Budget Office, which is nonpartisan, said that the rates would likely be around 2017. The issue is the first two years, they felt the premiums had been set too low. So we're not actually -- it's a big jump, but it's actually where we were supposed to be. These are the forecasts. [Media Matters, 10/25/16]
CNBC: Some health insurers are expanding on the Obamacare exchanges. CNBC.com reported on June 21 that a number of insurance companies, including Oscar Health and Centene, are expanding in certain states. The article included comments from one expert who confirmed that many insurance companies are interested in continuing coverage under Obamacare, but they are feeling pressure to leave because of the “‘uncertainty in the marketplace.’” [CNBC.com, 6/21/17]
LA Times: The Trump administration is “driving much of the current instability” in the insurance market, resulting in higher premiums. The Los Angeles Times reported that the Trump administration’s management of the health care system is creating uncertainty in insurance markets, forcing insurance companies to “raise Obamacare premiums or exit marketplaces.” The administration’s “erratic” handling of the health care system “undercuts a key White House claim that Obamacare insurance marketplaces are collapsing on their own,” according to the May 22 article:
Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management of the program and its conflicting signals about the fate of aid for low-income consumers and other key issues.
The growing frustration with the Trump administration’s management — reflected in letters to state regulators and in interviews with more than two dozen senior industry and government officials nationwide — undercuts a key White House claim that Obamacare insurance marketplaces are collapsing on their own.
Instead, according to many officials, it is the Trump administration that is driving much of the current instability by refusing to commit to steps to keep markets running, such as funding aid for low-income consumers or enforcing penalties for people who go without insurance. [Los Angeles Times, 5/22/17]
NPR: “It’s not clear” whether the BCRA’s solution to avoiding a death spiral would have a strong effect. NPR reported that the Senate GOP bill attempts to revise the House bill “by imposing a penalty on those who don't maintain continuous insurance coverage,” but pointed out that “it's not clear how strong that effect would be.” The piece noted that the ACA has the same penalty as well as a tax penalty, yet “even with those provisions, many insurance companies have struggled to attract a good mix of healthy and less healthy customers.” From the June 26 NPR report:
The revised bill attempts to solve that problem by imposing a penalty on those who don't maintain continuous insurance coverage: People who let their coverage lapse for at least 63 days in one year would be locked out of the insurance market for six months the following year.
The change comes as congressional forecasters are trying to predict how the Senate bill would affect insurance costs and coverage. The nonpartisan Congressional Budget Office expects the change would slightly increase the number of people buying insurance in the individual market.
It's not clear how strong that effect would be. The Affordable Care Act already includes a limited enrollment window when people can sign up for coverage, along with a tax penalty for those who don't. Even with those provisions, many insurance companies have struggled to attract a good mix of healthy and less healthy customers. [NPR, 6/26/17]
MYTH: Premiums will go down under the GOP bill
Breitbart News Daily guest: “The bill does include provisions to reduce insurance premiums ... in the short run.” A Breitbart article cited the Heritage Foundation’s Jean Morrow, who appeared as a guest on the radio show Breitbart News Daily to discuss the senate health care bill. Breitbart described her comments as saying the bill “does include provisions to reduce insurance premiums and promote access to insurance in the short run,” and it quoted her saying that the bill “does cut taxes, and it provides major Medicaid reform.” From the June 23 write-up of Morrow’s radio appearance:
Research Assistant for Domestic Policy Studies at the Heritage Foundation, Jean Morrow, spoke with Breitbart News Daily SiriusXM host Alex Marlow on Friday regarding the newly released Senate Healthcare Reform Bill.
“It falls short on repealing Obamacare,” said Morrow, going on to address some things the bill does include.
The bill does include provisions to reduce insurance premiums and promote access to insurance in the short run,” she said, adding, “It does cut taxes and it provides major Medicaid reform.” [Breitbart, 6/23/17]
CBO: Premiums Would Jump 20 Percent In 2018 And Go Down Only When Coverage Evaporates. On June 26, the CBO issued a report on the BCRA finding that premiums would increase 20 percent more than under current law in 2018 and would not start to decrease until 2020. Yet the CBO also noted that the 2020 decrease i would come from insurers reducing the amount of medical expenses covered under the benchmark silver plan from 70 percent of the expenses’ total cost to 58 percent -- less than the coverage of a bronze plan under current law. By 2026, CBO predicted, this decrease in coverage would lead to deductibles that would be greater than half the income of someone making $11,400. Vox’s Alvin Chang illustrated the CBO’s findings in a charts tweeted out by Sarah Kliff:
Kaiser Family Foundation: “Overall, marketplace enrollees would pay on average 74 percent more towards the premium ... in 2020 under the BCRA than under current law.” The Kaiser Family Foundation’s analysis of the BCRA found that overall, premiums would increase. Kaiser found that compared to current law, “younger enrollees would see modest increases on average (10 percent for those under age 18; 17 percent for those ages 18 to 34), while average premiums would more than double for enrollees ages 55 to 64.” [Kaiser Family Foundation, 6/26/17]
FACT: And any observed cut to premiums would be negligible given that the BCRA will increase deductibles and out-of-pocket costs
NBC: The BCRA includes policies “that encourage higher deductibles and dramatically raise out-of-pocket costs, in some cases by thousands of dollars per person.” NBC reported that subsidies in the BCRA are pegged to insurance plans that “cover only 58 percent of costs,” as opposed to the current 70 percent, meaning that “customers face an increase of thousands of dollars in deductibles unless they pay more in premiums.” The BCRA also includes a provision that would eliminate cost-sharing provisions under the ACA requiring that “insurers cover a large portion of out-of-pocket costs for individuals making up to 250 percent of the federal poverty level,” which would further raise out-of-pocket costs. Additionally, the cut to Medicaid would force people currently on Medicaid to purchase high-deductible private plans instead. From the June 25 NBC report:
“Our healthcare plan will lower premiums & deductibles — and be great healthcare!” [Trump] tweeted last month. A few days earlier he tweeted that Republicans would provide “much lower premiums & deductibles.” In March, he complained that “deductibles are so high you don’t even get to use [insurance]" under Obamacare.
But the Senate bill released last week and the House bill passed last month take the opposite approach: They include policies that encourage higher deductibles and dramatically raise out-of-pocket costs, in some cases by thousands of dollars per person. The president has embraced both efforts even though they violate his repeated promises.
It’s not hard to understand why deductibles would go up under the two Republican plans. There are two major provisions in the Senate bill, for example, that specifically affect deductibles and expenses.
First, the Senate bill encourages customers to sign up for plans with higher deductibles. Under Obamacare, the amount of subsidies customers receive to buy coverage are pegged to the price a “silver” plan, which covers about 70 percent of the average user’s medical costs. The average deductibles for these plans right now are about $3,500 for individuals and $7,500 for families, according to an analysis by the consumer site HealthPocket.
But the Senate bill instead pegs its subsidies to insurance plans that cover only 58 percent of costs. Similar plans on the marketplace this year have average deductibles of more than $6,000 for individuals and $12,000 for families.
That means customers face an increase of thousands of dollars in deductibles unless they pay more in premiums.
That's not the only provision that hikes deductibles, though. Both the House and Senate bills eliminate subsidies that were created just to lower deductibles for low-income customers.
Under Obamacare, insurers cover a large portion of out-of-pocket costs for individuals making up to 250 percent of the federal poverty level — about $30,000 for an individual and $61,000 for a family of four. In exchange, the federal government reimburses them for the difference. The theory is that customers in this income range would otherwise struggle to benefit from a silver plan with deductibles of $7,500.
But the House and Senate bills each eliminate these cost-sharing provisions — and the effects would be dramatic, according to a Kaiser Family Foundation analysis. If you’re an individual making around $18,000 a year, your effective deductible would be about $255 under Obamacare. Under the Senate bill, though, that number would jump to over $6,000 — almost 24 times higher.
The Senate bill also eliminates Obamacare’s Medicaid expansion and reduces the program’s overall growth over time, meaning millions of people currently paying little in out-of-pocket expenses through the government program would be expected to purchase high-deductible private plans instead. There are currently over 11 million people who qualify for Medicaid and have signed up thanks to the expansion, which covers individuals who make up to about $16,000 a year.
A number of conservative health experts said this week they were skeptical young, healthy people would purchase plans knowing the deductibles are so high to start, however, especially at lower incomes. If they don’t show up in droves, premiums could increase further. [NBC News, 6/25/17]
MYTH: People with pre-existing conditions will be covered under GOP bill
Nicole Saphier: “Pre-existing conditions will be covered under the Senate health care bill.” According to frequent Fox News guest Nicole Saphier, “Pre-existing conditions will be covered under the Senate health care bill. … Despite what you might hear.” From the June 26 edition of Fox News’ Fox & Friends:
STEVE DOOCY (HOST): And the final question, real quick, please: Insurance companies are required to accept all applicants regardless of pre-existing conditions?
DR. NICOLE SAPHIER: Oh, notorious pre-existing conditions, which may be the weakest link in the bill, to be honest, but it still remains. Pre-existing conditions will be covered under the Senate health care bill.
DOOCY: Despite what you might hear on TV.
SAPHIER: Despite what you might hear.
DOOCY: It’s in there.
SAPHIER: It’s there. [Fox News, Fox & Friends, 6/26/17]
LA Times’ Jon Healey: The Senate GOP bill “wouldn’t amend the ACA’s protections for people with preexisting conditions directly, [but] it would leave them open to indirect attack.” According to the LA Times’ Jon Healey, because the Senate bill allows “insurers [to] offer cheap policies that exclude coverage for potentially costly risks and preexisting conditions … as well as extremely expensive comprehensive policies that any resident can access — but not necessarily afford,” the bill does not “directly” remove coverage for pre-existing conditions, but it “would leave” those with pre-existing conditions “open to indirect attack by state officials eager to cut insurance premiums the easy way: by allowing insurers to cater to the customers they really want to serve, which are the ones who don’t need healthcare.” From the June 23 article:
Under the ACA, a.k.a. Obamacare, insurers are required to sell a comprehensive insurance policy to anyone who wants it, and their premiums have to be based on the expected needs of an entire community, not each individual applicant. Those three elements — “guaranteed issue,” mandatory coverage of “essential health benefits” and “community rating,” in the parlance of the insurance industry — are collectively the shield that protects people with preexisting conditions who aren’t covered by a large employer’s insurance plan.
The Senate’s “Better Care Reconciliation Act” wouldn’t repeal that part of the ACA — Senate rules don’t allow that sort of legislating on a budget reconciliation bill. But it does include a provision giving states carte blanche to waive the essential health benefits, as long as they don’t increase the federal deficit.
So, under the Senate bill, it would be perfectly fine for a state to let insurers offer cheap policies that exclude coverage for potentially costly risks and preexisting conditions (for example, by omitting maternity care and cancer drugs) as well as extremely expensive comprehensive policies that any resident can access — but not necessarily afford. Or a state could offer the comprehensive policies itself through a high-risk pool, an approach that’s been tried and failed repeatedly because of its high costs. Either way, average premiums would drop, which the state could argue would be expected to boost enrollment.
So, while it’s technically true that the Better Care Reconciliation Act wouldn’t amend the ACA’s protections for people with preexisting conditions directly, it would leave them open to indirect attack by state officials eager to cut insurance premiums the easy way: by allowing insurers to cater to the customers they really want to serve, which are the ones who don’t need healthcare. [Los Angeles Times, 6/23/17]
The Atlantic: The Senate GOP bill “will open the door to states forcing people with pre-existing conditions into segregated markets that will lead them to pay far, far higher costs than everyone else.” According to The Atlantic’s Gene Sperling and Michael Shapiro, while the proposed plan “may not allow insurers to discriminate against a pre-existing condition through the front door,” Senate Republicans “created a backdoor way in.” By waiving requirements that were put in place under the Affordable Care Act that all insurance plans cover “Essential Health Benefits,” the Republican proposal “drives straight through these carefully crafted guardrails” by removing “careful conditions on quality” insurance plans, and sets “a bare-minimum requirement that the alternative [insurance plan] doesn’t increase the federal budget deficit.” Therefore, according to Sperling and Shapiro, states “may not explicitly say they are making those with pre-existing conditions pay more, but that will be the impact.” From the June 23 article:
As they argue for the bill, Republicans are going to claim that it will not allow insurance plans to discriminate against people because they have a pre-existing condition. But that just isn’t the case. The Republican plan may not allow insurers to discriminate against a pre-existing condition through the front door, but they’ve created a backdoor way in.
So what is this backdoor for discriminating against those with pre-existing conditions and how does it work?
Answering that question requires understanding the importance of a key protection in the Affordable Care Act, what is known as the “Essential Health Benefits” requirement. These Essential Health Benefits rules require insurance companies to cover critical care, such as treatment by doctors, hospital stays, and prescription-drug costs. The guarantee of Essential Health Benefits means that no insurer can provide any health plan that excludes these critical benefits. Perhaps it goes without saying, but if these benefits are not covered, a plan is all but worthless to those with serious pre-existing conditions.
The Affordable Care Act does allow, through Section 1332, for states to have some flexibility to waive these and other requirements, but only if they meet very rigorous conditions or “guardrails” that ensure coverage remains available, affordable, and high-quality. This is where the new Senate bill makes significant—and dangerous—changes. The bill drives straight through these carefully crafted guardrails. Today, to waive requirements like essential benefits, a state must show that the alternative insurance being provided is “comprehensive,” and “will provide coverage and cost-sharing protections against excessive out-of-pocket spending.” These careful conditions on quality are removed in the Senate bill, replaced with a bare-minimum requirement that the alternative doesn’t increase the federal budget deficit. States will be able to easily waive the requirement to cover Essential Health Benefits, without any careful conditions to ensure the quality and affordability of coverage.
The state may not explicitly say they are making those with pre-existing conditions pay more, but that will be the impact. Many of those families will simply not be able to afford the care they need. And it could get worse. A thoughtful analysis by Matt Fiedler at the Brookings Institution found that where states can waive Essential Health Benefits, insurance companies and employers could reinstate annual and lifetime limits on coverage.
Simply put, the Senate bill will open the door to states forcing people with pre-existing conditions into segregated markets that will lead them to pay far, far higher costs than everyone else. [The Atlantic, 6/23/17]
MYTH: The CBO is “dishonest” and its scoring of the health care bill isn’t reliable
Newt Gingrich: The CBO “is a dishonest bureaucratic organization” that “should be abolished.” After the CBO scored the House of Representatives’ version of the Republican health care bill, Fox News contributor Newt Gingrich attempted to smear the nonpartisan agency’s evaluation of the bill as “corrupt, dishonest, misleading, [and] not defensible at all.” Gingrich went on to profess that he has “no respect for the Congressional Budget Office” and assert that “Republicans should be clear this is a dishonest bureaucratic organization [that] should be abolished.” From the May 13 edition of Fox Business Network’s Lou Dobbs Tonight:
NEWT GINGRICH: One of my great disappointments with the Republicans in Congress has been their failure to abolish the Congressional Budget Office. I helped balance the budget for four years in a row, the only time in your lifetime it was done. We fought the bureaucrats at the Congressional Budget Office every day. They brought in the architect of Obamacare to be their adviser when they scored Obamacare. Their score was wildly, I think, corrupt, dishonest, misleading, not defensible at all, and if you go back and look at the record you’d say to yourself, “Any private sector institution that was this wrong would be fired, they’d be abolished." So I have no respect for the Congressional Budget Office. I think Republicans should be clear this is a dishonest bureaucratic organization, it should be abolished, save the money, hire outside professional firms, get three to five scores on major bills, and let’s be honest about the fact that no group of bureaucrats can accurately tell you in a complex world what is going to happen over the next five or 10 years. [Fox Business Network, Lou Dobbs Tonight, 5/13/17]
Fox’s Ainsley Earhardt: “Didn’t the CBO report say that Obamacare was going to do well and be successful? Wasn’t it wrong?” Prior to the CBO’s evaluation of the Senate Republicans’ health care bill, Fox & Friends hosts Ainsley Earhardt and Brian Kilmeade pre-emptively attacked the agency, saying that the “CBO report” on the ACA in 2009 was “wrong” and included evaluations that were, according to Brian Kilmeade, “flat-out erroneous.” From the June 26 edition of Fox News’ Fox & Friends:
AINSLEY EARHARDT (CO-HOST): You have Senator [Susan] Collins [(R-ME)\ who’s saying, “I want to see the CBO report,” but didn’t the CBO report say that Obamacare was going to do well and be successful? Wasn’t it wrong?
BRIAN KILMEADE (CO-HOST): Absolutely. That’s a great point. There’s a lot of things that CBO said and promised that was going to happen with Obamacare were flat-out erroneous. [Fox News, Fox & Friends, 6/26/17]
FACT: While “no prediction will ever be perfect,” “the CBO’s analyses and forecasting are regarded as good or better than others doing similar work”
PolitiFact: The “big picture” evaluation of the Affordable Care Act “was on point,” and “experts who have studied the CBO have found their projections to be largely sound.” According to the nonpartisan political fact-checking site PolitiFact, the CBO’s “big picture” estimation for the Affordable Care Act “was on point.” The piece noted that while “no prediction will ever be perfect, … for the most part, experts who have studied the CBO have found their projections to be largely sound.” From the March 12 article:
Still, experts said CBO’s forecasts were reasonable at the time.
"With respect to precise quantitative point estimates, the differences between CBO's estimates and actual experience are well within the range that I would expect given the scope of the change CBO was being asked to analyze," said Matthew Fiedler, a fellow with the Center for Health Policy in Brookings' Economic Studies Program.
Fiedler also noted that CBO's "big picture" assessment of the impact of the ACA on insurance coverage was on point. Specifically, the agency estimated a significant decrease in the number of people without health insurance that would leave the uninsured rate at a historic low, which is what occurred, he said.
No prediction will ever be perfect, but for the most part, experts who have studied the CBO have found their projections to be largely sound.
Even the CBO released its own report in November 2015 that looked at how accurate their predictions have been, as well as what factors have contributed to forecasting errors.
On average, between 1982 and 2014, the CBO overestimated two-year revenue forecasts by 1.1 percent and six-year projections by about 5.3 percent. [PolitiFact, 3/12/17]
LA Times’ Don Lee: “The CBO’s analyses and forecasting are regarded as good or better than others doing similar work.” According to the LA Times’ Don Lee, not only was the CBO’s director, Keith Hall, appointed by Republicans in Congress in 2015, but past work has shown that “the CBO’s analyses and forecasting are regarded as good or better than others doing similar work.” From the May 24 article:
Even before the Congressional Budget Office released its cost estimates in March on the House proposal to overhaul Obamacare, the Trump administration and GOP lawmakers were trying to discredit the much-anticipated report, or CBO score, as it’s familiarly called.
“Really been meaningless,” said Gary Cohn, Trump’s top economic advisor. “Consistently inconsistent,” added Sen. Tim Scott (R-S.C.). “A red herring,” chimed Rep. Larry Bucshon (R-Ind.).
Never mind that the CBO works for Congress and that its director, Keith Hall, was appointed by their own party leaders in the House and Senate in 2015.
Although there’s no comprehensive measure on the hundreds of cost estimates on bills it does every year, the CBO’s analyses and forecasting are regarded as good or better than others doing similar work.
It’s true that on economic forecasting, the CBO in recent years has been overly optimistic about growth while underestimating the rate of job creation, but so was almost every other private forecaster. And economists say that the CBO’s economic projections generally compare favorably against other outfits, and its long-term budget estimates have been fairly accurate. [Los Angeles Times, 5/24/17]
MYTH: Medicaid is not being cut
Fox’s Steve Doocy: “If you are currently getting Medicaid through the expansion program, through the Affordable Care Act, it will continue in the future going forward.” From the June 26 edition of Fox News' Fox & Friends:
STEVE DOOCY: Here's what you have to keep in mind: If you are currently getting Medicaid through the expansion program, through the Affordable Care Act, it will continue in the future going forward. At least that's what [White House counselor] Kellyanne Conway was trying to convince George Stephanopoulos of yesterday when he was essentially interrogating her over potential cuts to that program. [Fox News, Fox & Friends, 6/26/17]
CBO: Senate Bill Would Deny Medicaid To 15 Million People And Take $772 Billion Out Of The Program. The CBO scoring of the Senate health care plan found total federal spending on Medicaid would decrease by $772 billion relative to current law and 15 million fewer people would be enrolled in Medicaid by 2026, meaning that over time the gap in spending on Medicaid compared to current law would increase:
[Congressional Budget Office, 6/26/17]
Kaiser Health News’ Julie Rovner: The Senate GOP plan caps “federal funding for the Medicaid program,” which “would basically erode the ability of states to pay for their Medicaid programs.” According to Kaiser Health News’ Julie Rovner, the Republican plan to “cap ... federal funding for the Medicaid program,” would, in effect, “erode the ability of states to pay for their Medicaid programs.” From a transcript of the June 24 edition of NPR’s All Things Considered:
JULIE ROVNER: Of course, the other big piece of this bill that has nothing to do with the Affordable Care Act is a capping of federal funding for the Medicaid program, which is something that Republicans have been trying to do since Ronald Reagan was president.
MICHEL MARTIN (HOST): This is also a longtime goal, mainly Republicans but also some Democrats, to kind of rein in this very significant entitlement program. How would it work under this Senate bill?
ROVNER: It's somewhat similar to the House bill, although the cuts would go even deeper. At some point, over a period of years, the federal government would basically limit what it pays for Medicaid, which has always been a shared program between the states and the federal government. It covers whatever people are eligible - for basically whatever they need medically.
And the federal government says yeah, states, we're going to pay this much and no more. And that amount is going to go up every year slightly, but in the Senate bill would be based on just regular inflation, whereas medical inflation has always been faster. So it would basically erode the ability of states to pay for their Medicaid programs.
MARTIN: How would this work at the state level? Essentially the state governments become the primary decision makers on who gets Medicaid now as opposed to having it be available to everybody who meet certain criteria?
ROVNER: Exactly. States would have, you know, a number of choices, none of them would be very pleasant. We're already seeing governors complain. They could cut benefits. They could cut who's eligible. They could raise taxes. They could lower what they pay healthcare providers, which is already pretty low for the Medicaid program. That's pretty much the options that would be on the table for states, and none of them are very pretty financially. [NPR, All Things Considered, 6/24/17]
CNN’s Tami Luhby: Medicaid cuts will force states to “tighten up eligibility, reduce benefits, or cut payments to doctors and hospitals.” CNN senior writer Tami Luhby explained on Inside Politics that the House version of the health care bill proposes a 24 percent decrease to Medicaid at a time when many states “are cash-strapped as it is.” Luhby also cited the National Association of Medicaid Directors board’s statement, which warns, “No amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would occur as a result of this bill.” From the June 26 edition of CNN’s Inside Politics:
JOHN KING (HOST): The Trump White House is trying to help sell the Senate Republican health care plan. And as they do, they’re using some only-in-Washington math and this bold promise: "If you like your Medicaid, you can keep your Medicaid."
KELLYANNE CONWAY: These are not cuts to Medicaid, George. This slows the rate for the future and it allows governors more flexibility with Medicaid dollars because they're closest to the people in need. If you are currently in Medicaid, if you became a Medicaid recipient through the Obamacare expansion, you are grandfathered in. We're talking about in the future.
KING: Now, does that pass the fact check? CNN Money's Tami Luhby joins us to separate the spin from the substance. Tami, you just heard Kellyanne Conway. She says if you’re in Medicaid now, you can keep your Medicaid. Is there such an ironclad clause?
TAMI LUHBY: Well the real issue here, John, is federal funding for Medicaid. The House bill would continue paying states more for low-income adults on Medicaid expansion at that time. So it's likely that many of those folks could stay enrolled at least for a few years. The Senate bill, however, does not do that. But what a lot of people may not realize is that both the Senate and the House would greatly reduce federal support for the overall Medicaid program, which covers more than 70 million people. And states will have to decide how to handle this drop in funding.
KING: So walk us through those numbers, then, or "slower growth," as Kellyanne Conway says. Conservatives say it’s all about giving flexibility to the states. Does that work?
LUHBY: Well let me read you what the National Association of Medicaid Directors board said about the Senate bill today. “No amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would occur as a result of this bill.” So yes, states would get more flexibility, but they’d get a lot less money, too. The CBO says the House bill would mean an $834 billion cut over the next 10 years compared with current law. That's a 24 percent decrease. We're waiting for the CBO score of the Senate bill later today. But look, many of these states are cash-strapped as it is. So they would likely have to tighten up eligibility, reduce benefits, or cut payments to doctors and hospitals just to deal with these cuts from D.C.
KING: And so as you look ahead to that possibility, what's the scope of the universe of people we're talking about? How many people get their health care through Medicaid and Obamacare's Medicaid expansion?
LUHBY: Well, the largest group covered by Medicaid is children, nearly 35 million of them. That’s two in every five kids in America. There are also 27 million adults, 11 million of whom were part of the Medicaid expansion program. And there are nearly 19 million who are disabled or elderly. But most of the money is spent on the disabled or elderly. More than 60 percent of all Medicaid dollars go to care for these two groups. [CNN, Inside Politics, 6/26/17]
MYTH: Able-bodied adults don’t need Medicaid
WSJ’s Mary Kissel: Medicaid “was supposed to help … people who really needed help. What Obamacare did is it simply said, ‘Let's expand this program to people who don't need it.’" The Wall Street Journal’s Mary Kissel asserted that under Obamacare, Medicaid has become “an open-ended entitlement,” diverging from what she believes was the original intention of the program, which is to assist “people who really needed the help.” Kissel then went on to claim that it has “never been true” that individuals in the United States “go uncovered” without health insurance. From the June 23 edition of Fox News’ Happening Now:
MARY KISSEL: Let's talk about who Medicaid was originally supposed to help. It was supposed to help the poor, it was supposed to help children, handicapped people, people who really needed the help. What Obamacare did is it simply said, "Let's just expand this program to people who don't need it." That was actually the bulk of Obamacare. Now, you've had some states, Indiana and Rhode Island being a couple of examples, where it hasn't been an open-ended entitlement. The governor said, "Just give us the money and let us construct the program to help the people in our states." That's what Republicans are trying to do while also lifting the restraints on insurers to get more competition in there and to offer, for instance, catastrophic policies.
For those who say, "Look, somebody's going to go uncovered in America," that's never been true.
JULIE BANDERAS (HOST): This is America. We wouldn't allow that to happen.
KISSEL: This is America, you wouldn't. But we're trying to give more people more options.
BANDERAS: The message of "people are going to die." I mean, that is beyond the worst message. That is a scare tactic.
KISSEL: That's just trying to shut down the debate. And look at the facts. Look, we wouldn't even be having this discussion if Democrats passed health care reform that actually worked. [Fox News, Happening Now, 6/23/17]
FACT: Low-income Americans and vulnerable communities -- not just disabled people and poor mothers and children -- depend on Medicaid, which reduces health care costs for everyone
Kaiser: Nearly 75 Million Americans Are Assisted By Medicaid. On June 19, the Kaiser Family Foundation reported that almost 60 percent of Americans surveyed said “Medicaid is important for them and their family.” In analysis of data collected in 2015 and 2016 found that 20 percent of Americans’ health insurance was covered by Medicaid or the Children’s Health Insurance Plan (CHIP), including half of low-income Americans and three in five nursing home patients. Kaiser’s most up-to-date data showed that by April 2017, nearly 75 million people were enrolled in Medicaid or CHIP. [Kaiser Family Foundation, 6/19/17, accessed 6/27/17]
Women, People Of Color, And The LGBTQ Community Are Disproportionately Harmed By Medicaid Cuts. On March 13, HuffPost reported that 58 percent of Medicaid enrollees are non-white and on May 8, Kaiser reported that the majority of enrollees in Medicaid are women. Also, according to Stephen Forssell, director of George Washington University’s graduate program in LGBTQ health policy, the program is “hugely important” for members of the LGBTQ community, which is more likely than the non-LGBTQ population to rely on Medicaid. [HuffPost, 3/13/17; Kaiser Family Foundation, 5/8/17; Media Matters, 6/5/17]
Time: “Medicaid coverage helps hold down health care costs for everyone else.” Time magazine reported that a 2016 report by the Department of Health and Human Services found that Medicaid helped reduce premiums by 7 percent because “Medicaid absorbs the costs for expensive coverage … that would otherwise be shifted to the private insurance market and Medicare.” [Time, 1/26/17; Department of Health and Human Services, 8/25/16]
MYTH: GOP process is as secretive as the Democrats were with the ACA
Fox’s Jesse Watters: “Did [Democrats] have hearings or open negotiations when you guys cobbled it together? No. You bribed senators.” On the June 21 edition of Fox News’ The Five, co-hosts Greg Gutfeld and Jesse Watters said Democrats “passed the [Affordable Care Act] in secret,” arguing that the Republican legislative process in 2017 “is the opposite -- the opposite -- of how Obamacare was rolled out.” From the June 21 edition of Fox News’ The Five:
GREG GUTFELD (CO-HOST): Think about this -- this didn’t happen with Obamacare. I mean, talk about dead of night, hammered it through, they walked with the big gavel. I mean, it was ridiculous, it was absurd, and it was built on a pyramid of lies. You're going to keep your doctor. At least this is messy. And don’t think -- and people saying that he’s doing it in secret. He does nothing in secret. We know exactly what he's doing. This is the opposite -- the opposite -- of how Obamacare was rolled out. And it's messy, it's going to take time, it might be a little clumsy, but that's because they’re human beings and we are watching it.
JUAN WILLIAMS (CO-HOST): But Greg, it’s been totally in secret.
JESSE WATTERS (CO-HOST): Come on. Juan, you have no credibility on health care.
WATTERS: You guys passed the thing in secret, it was lied about, it was expensive, you broke the website, and then it bombed. You guys have no credibility on health care.
WILLIAMS: Now you have them, in the Senate, not having open negotiations, not having hearings, not having the committees meet to discuss, nothing --
WATTERS: Did they have hearings or open negotiations when you guys cobbled it together? No. You bribed senators in Nebraska to get it through --
WILLIAMS: That’s not true. You are revising history.
WATTERS: And lied about it. [Fox News, The Five, 6/21/17]
Sunlight Foundation: “The legislative process Majority Leader Mitch McConnell has created is fundamentally different from the ways in which previous fundamental legislation has been considered.” According to the Sunlight Foundation’s John Wonderlich, Senate Majority Leader Mitch McConnell’s “Senate procedure” on the health care bill “is designed, from start to finish, to minimize transparency” and “is fundamentally different from the ways in which previous fundamental legislation has been considered” in the Senate in the past. From the June 20 article:
The United States Senate is currently committing an outrageous violation of our norms for policymaking in a democracy: that laws should be drafted in a way that allows for public scrutiny and bipartisan consideration.
The legislative process Majority Leader Mitch McConnell has created is fundamentally different from the ways in which previous fundamental legislation has been considered. He is using every procedural artifice available to prevent any public knowledge of the bill. Instead of holding hearings and markups, the Senate is legislating through secrecy and crisis, treating requests for public information by journalists and even Senators as the enemy of progress.
McConnell’s Senate procedure is designed, from start to finish, to minimize transparency. Republican leadership is hiding the healthcare bill, and thus preventing health care policy journalists and analysts from informing constituents, voters, and reporters about the impact of the proposals.
Secrecy around the Senate health care bill is the opposite of how the legislative process in a democracy should work, much less the chamber populated with Senators who like to tout it as the greatest legislative body in the world.
The larger that a gap between public knowledge and private legislative action is, the more impact upon trust in an institution will result.
Every bill should be disclosed to the public online in a machine-readable format, marked up in open committee, and debated, much less a proposed reform that would affect the health care of tens of millions of Americans. [Sunlight Foundation, 6/20/17]
Vox’s Sarah Kliff: “The Senate is running a remarkably closed process” in drawing up the Republican health care bill. According to Vox’s Sarah Kliff, as opposed to the legislative process for the Affordable Care Act, the process of writing the Republican health care proposal was “remarkably closed,” with “no committee hearings” and “no floor speeches defending the policy provisions of the bill.” For Republicans, Kliff argues, the “biggest priority seems to be just passing a bill, regardless of what the bill actually looks like.” From the June 15 article:
My professional life in 2009 and 2010 was an endless string of Affordable Care Act hearings aired on C-SPAN. I lived in New York at the time. It became a regular ritual to sit down in my cubicle, plug my headphones into my laptop, and listen to an entire day of Senate debate.
There isn’t much C-SPAN to watch these days because the Senate is running a remarkably closed process. There are no committee hearings. There are no floor speeches defending the policy provisions of the bill. Senate Majority Leader Mitch McConnell instead has assembled an ad hoc working group to hash out the details of Obamacare repeal in private meetings.
The biggest priority seems to be just passing a bill, regardless of what the bill actually looks like. Tierney Sneed, a reporter for Talking Points Memo, recently asked Sen. Orrin Hatch, who chairs the Senate Finance Committee, whether it was important to get the bill out a few days before the vote, so the public could review its provisions.
His response was telling. “Well, I think we’re not worried so much about that as we are getting it together so we can get a majority to vote for it,” he said. [Vox, 6/15/17]
Kaiser Health News’ Julie Rovner: “I’ve never seen a bill that’s been done this way, and I think that’s primarily because I've never seen a bill that actually creates more losers than winners.” Kaiser Health News’ Julie Rovner noted that she has “never seen a bill that’s been done this way,” referring to how the bill was crafted. Rovner went on to say that “this really is a bill that helps far fewer people than it would hurt, and I think the Republicans know that that’s what they’re resulting in.” From the June 26 edition of MSNBC’s All In with Chris Hayes:
CHRIS HAYES (HOST): Have you ever seen legislation of this magnitude on this subject area undertake this trajectory, process-wise, ever?
JULIE ROVNER: No, never. I’ve stood outside a lot of closed meetings in the Capitol and in the office buildings, but I’ve never seen a bill that’s been done this way, and I think that’s primarily because I've never seen a bill that actually creates more losers than winners. Often you get bills that create winners and losers, but this really is a bill that helps far fewer people than it would hurt, and I think the Republicans know that that's what they're resulting in. [MSNBC, All In with Chris Hayes, 6/26/17]
MYTH: Democrats refused to cooperate with Republicans on health care
Fox’s Steve Doocy: “If [the Democrats in Congress] really wanted to help with health care, they would be in there right now trying to do something.” Fox host Steve Doocy chastised Democrats for their perceived resistance to the proposed Republican bill, saying that if Democrats “really wanted to help with health care, they would be in there right now trying to do something about” aspects of the proposed bill. From the June 26 edition of Fox News’ Fox & Friends:
BRIAN KILMEADE (CO-HOST): Until [Sen.] Chuck Schumer sees the polls that show that the only way Democrats can be successful is start working with the president, he probably won't start working with the president.
STEVE DOOCY (CO-HOST): That’s my point. It’s not going to work right now. Even though they’re saying, “We want jobs.” It’s like the healthcare thing --
KILMEADE: Well the polls made him switch his tone already.
DOOCY: If they really wanted to help with health care, they would be in there right now trying to do something about, “OK, what do we do Medicaid, what do we do about Planned Parenthood?” All that stuff. But instead, they’re going --
AINSLEY EARHARDT (CO-HOST): They continue to say, “Russia, Russia, Russia.” [Fox News, Fox & Friends, 6/26/17]
FACT: Democrats wrote a letter to President Trump saying they were open to working to improve the Affordable Care Act, but were shut out of process
Wash. Post: Senate Democrats “signed a letter to President Trump signaling they are open to working with him on health care — but not before he ends his effort to attack the Affordable Care Act.” According to The Washington Post, Senate Democrats sent a letter to President Trump saying t they “remain ready and willing to work with [the administration and Republicans] on policies that would improve the stability of the individual insurance market,” but it stipulated that the “administration must commit to putting an end to all efforts to unravel the ACA, undermine the health care system, increase costs, or hurt patients, providers and families.” From the Post’s March 29 article:
Forty-four members of the Senate Democratic caucus have signed a letter to President Trump signaling they are open to working with him on health care — but not before he ends his effort to attack the Affordable Care Act.
“Members of the Democratic caucus remain ready and willing to work with you on policies that would improve the stability of the individual insurance market,” the senators write in the letter shared with The Washington Post. “We ask that you begin the work of improving health care for millions of Americans by rescinding your January 20th executive order.”
Trump signed an executive order that day giving federal agencies broad powers to unwind regulations created under the ACA, which is also widely known as Obamacare.
“Your administration must commit to putting an end to all efforts to unravel the ACA, undermine the health care system, increase costs, or hurt patients, providers and families,” the letter tells Trump. [The Washington Post, 3/29/17]
CNN: The Senate bill was drawn up by “a group of 13 Republican senators from 10 states, all white men,” and it was “closely guarded.” According to CNN.com, the Senate GOP health care bill was written by “a group of 13 Republican senators from 10 states, all white men.” Not only were all Senate Democrats totally shut out of the process, but the process was “closely guarded and no one, including many of their GOP colleagues, [could] comment with any certainty on what the closed-door process will ultimately produce.” Additionally, “Republican Majority Leader Mitch McConnell shrugged off a request for more than 10 hours of open debate.” From the June 20 article:
There's a good chance that somewhere on Capitol Hill right now, a group of 13 Republican senators from 10 states, all white men, are drawing up a bill that could reshape health care in America for generations.
The deliberations have been closely guarded and no one, including many of their GOP colleagues, can comment with any certainty on what the closed-door process will ultimately produce. For the tens of millions of people who stand to be affected by the plan, the future is increasingly uncertain.
Unlike the long and often fiery national argument that preceded the passage of Obamacare, there have been no public hearings on the Trumpcare measure. Prodded by Democratic Minority Leader Chuck Schumer on Monday, Republican Majority Leader Mitch McConnell shrugged off a request for more than 10 hours of open debate. [CNN.com, 6/20/17]
MYTH: People will not die if the BCRA is implemented
Fox’s Melissa Francis: It's "ridiculous" to say that people will die for lack of medical care. Fox’s Melissa Francis claimed on the May 24 edition of Fox’s Outnumbered that the budget cuts in the health care plans are “not about trying to kill children, which is ridiculous because we don't let anyone die in this country for lack of medical care":
MELISSA FRANCIS (CO-HOST): I think [Office of Management and Budget director] Mick Mulvaney, who we heard at the beginning -- I am such a huge fan. He is so terrific at messaging. Because the problem that the right has is with expressing why there is compassion in what they're doing and why it's not about trying to kill children, which is ridiculous because we don't let anyone die in this country for lack of medical care. But the way he said it when he says we are going to judge compassion by how many people we have off these programs as opposed to how many people we keep on these programs. We have to have compassion for the people, for the taxpayer, for the people who are sending -- balance that with compassion for the people who are getting services. [Fox News, Outnumbered, 5/24/17]
Fox’s Julie Banderas: Saying people will die because of the GOP health care plan is an “awful” “scare tactic.” On the June 26 edition of Fox’s America’s News Headquarters, guest host Julie Banderas called it a “scare tactic” to say people will die because of the Republican health care plan, saying, “Nobody is going to be rejected with an emergency situation or any kind of major health ailment or anything that’s potentially life-threatening. I mean, to say that people are going to die is awful”:
JULIE BANDERAS (HOST): Emily, hearing Nancy Pelosi saying that hundreds of thousands of people are going to die. That's before the CBO comes out and talks about exactly how many people will potentially lose their insurance, what these premiums will do to the American people. All of this information needs to come out first, before the Democrats can go and make their assessments, but yet, they are throwing the scare tactic out there.
Nobody is going to be rejected with an emergency situation or any kind of major health ailment or anything that’s potentially life-threatening. I mean, to say that people are going to die is awful. [Fox News, America’s News Headquarters, 6/26/17]
Study Finds Senate Health Care Bill Could Kill 28,600 People Each Year. According to research by Dr. Steffie Woolhandler in the Annals of Internal Medicine published on June 27, those without health insurance have an increased chance of mortality compared to those with health insurance. Woolhandler told Democracy Now’s that “if you take health insurance away from 22 million people” -- the number of additional people expected to go without by 2026 -- “about 29,000 of them will die every year.” [Annals of Internal Medicine, 6/27/17; Democracy Now, 6/27/17]
New England Journal of Medicine: “Policies that reduce coverage will produce significant harms to health, particularly among people with lower incomes and chronic conditions.” According to The New England Journal of Medicine, evidence suggests “that coverage expansions significantly increase patients’ access to care and use of preventive care,” and the idea that increased “health insurance coverage doesn’t improve health is simply inconsistent with the evidence.” Moreover, researchers found that the “modest but cumulative changes” that come with increased coverage “ultimately help tens of thousands of people live longer lives.” It notes, Conversely, the data suggest that policies that reduce coverage will produce significant harms to health, particularly among people with lower incomes and chronic conditions.” [The New England Journal of Medicine, 6/21/17]
New England Journal of Medicine: Mortality Rates Saw “Significant Reduction” In Medicaid Expansion States. According to researchers, including Katherine Baicker, a former member of the Council of Economic Advisors for President George W. Bush, in The New England Journal Of Medicine, three states that expanded Medicaid in the early 2000s saw significantly lower mortality rates for adults ages 20 to 64. [The New England Journal Of Medicine, 9/13/12]
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