Some Facts about the Health Care Reform Bill

Summary

As the election draws near, some conservative groups are making ever-wilder claims about the new health care law:

  • An elderly man in a Crossroads GPS ad makes the death-panel-esque claim that the law “threatens our lives.”
  • The 60 Plus Association has a World War II veteran evoking the Normandy invasion and claiming that “your freedoms will be chipped away,” unless the legislation is repealed.
  • The American Action Network made the false statement that “jail time” would be the punishment for not having insurance, when the law in fact forbids any criminal penalties.

In addition, we continue to see claims from the Republican side that the law creates “government-run” health care, or will cause a steep rise in premiums for typical families, or will give health insurance to illegal immigrants, or will lead to widespread cuts in Medicare benefits. As we’ve written before, none of that is true. We also see claims that the law allows tax dollars to be used to fund abortions, despite specific language in the law forbidding that.

Misrepresenting the health care law has been perhaps the single most dominant theme of attack ads by GOP candidates, party groups and independent conservative organizations. A record estimated $4 billion is being spent on both sides in this midterm election, according to the Center for Responsive Politics. And from our observations, a large part of that is being spent to discredit the health care legislation and the Democrats who voted for it. In this article we wrap up all this health care spin, examining both the latest claims and those that have been repeated most often.

Analysis

The midterm campaigns have been ripe with false and misleading claims about — what else? — the health care law. By our count, this is the fourth roundup of claims about the legislation that we’ve written. And it very well may not be the last.

A Government-Run Threat to Life and Freedom?

Some of the more outrageous recent claims appear in ads that call the new law “government-run” health care or a “government takeover.” But much to the chagrin of a minority of lawmakers who wanted a true, government-run, single-payer system, that’s not what the law delivers. Yes, there’s an expansion of Medicaid, but the law builds on the country’s private insurance system, creating more business, in fact, for those private companies by requiring individuals to have coverage.

That hasn’t stopped opponents of the law from making this claim — and going much further than that. In an ad attacking Democratic Sen. Patty Murray of Washington, Crossroads GPS harkens back to pull-the-plug-on-grandma claims by having an elderly man say the law “threatens our lives.”

How exactly does it do that? A spokesman for the group told us this was a reference to $500 billion in Medicare cuts in the law. That’s $500 billion in cuts in the future growth of spending over 10 years — more on this later — and the move, if it happens, puts Medicare on much better financial footing. The program’s board of trustees reported that [t]he financial status of the [hospital insurance] trust fund is substantially improved by the lower expenditures and additional tax revenues instituted by the Affordable Care Act,” and that the savings would extend the life of the trust fund by 12 years. But there’s a big caveat. That’s only if Congress sticks with the reductions in the legislation and previously scheduled cuts in payments to physicians, set up by a late 1990s law, and that’s not likely. Legislators postponed the physician cuts until December this year, and they’ve repeatedly canceled them in recent years.

So, either the cuts the man in the ad fears won’t happen, or Medicare would be in much better shape financially. Either way, we fail to see how this “threatens” anyone’s life, so we judge this claim to be false.

Crossroads GPS ad attacking Sen. Patty Murray of Washington: “Problem with Patty,” first aired Oct. 7

⬐ Click to expand/collapse the full transcript ⬏

Multiple Speakers: We sent Patty Murray to DC almost 20 years ago. That’s plenty for Patty Murray. We trusted her to fix things. Heck, Patty’s become part of the problem. The debt that Patty has supported is going to affect our children for generations. Her bailouts have done nothing. For heaven’s sake, she supported Obamacare and that threatens our lives. She’s been there too long. We can’t afford six more years of Patty Murray.

Announcer: Crossroads GPS is responsible for the content of this advertising.

Speaking of over-the-top claims, this week the 60 Plus Association launched a minute-long spot that has a World War II veteran claiming “your freedoms will be chipped away” if the health care law isn’t repealed. Philip Storer tells viewers that he “was one of thousands that landed on D-Day. We fought to protect something we all hold very dear, our freedoms.” Now, Storer says, those freedoms are “threatened” by this “government takeover of health care.” We contacted 60 Plus to ask what basis the group had for those claims. We haven’t yet received a response.

This is the same group, readers may recall, that had former U.S. Surgeon General C. Everett Koop on camera making the bogus assertion that the United Kingdom considers seniors “too old” to qualify for artificial joints, pacemakers and coronary stents. We put the “freedoms” claim in the growing category of unsubstantiated hyperbole.

60 Plus Association Ad: “Still Believe”

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Announcer: June 1944. D-Day. Allied troops land at Normandy. Their mission: save the world from a deadly and growing oppression.

Philip Storer, WWII and D-Day Veteran: I was one of thousands that landed on D-Day. We fought to protect something we all hold very dear, our freedoms. Today, our freedoms are threatened by a very different kind of enemy. The enemy is big government, wasteful spending, and crushing debt. Nowhere is this threat more apparent than in the attempted government takeover of healthcare. The first step has been taken. If we don’t repeal the healthcare bill, government will grow, debt will explode, choices will become fewer and your freedoms will be chipped away. I still believe our freedoms are worth fighting for. The fight to repeal the government takeover of health care is up to you.

No ‘Jail Time’ Here

A group called American Action Network resurrected an old falsehood that the law calls for “jail time” for anyone who fails to get health insurance. It doesn’t. As we wrote in May, the law nullifies the possibility of prison time for those who don’t get coverage and refuse to pay a fine. It specifically says: “In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.” The AAN ad ignores what the final law said, instead referring to an outdated news item from Politico from September 25 of last year. The bill was amended soon after.

The false “jail time” claim appeared in an ad that first aired Oct. 22 against Democratic Rep. Chris Murphy of Connecticut. And the assertion raised eyebrows at one TV station. AAN Communications Director Jim Landry told us that a station questioned the ad, prompting AAN to revise it to remove the reference to “jail time.” Landry told us the ad was updated sometime on Oct. 26 or 27. According to the Campaign Media Analysis Group, a unit of Kantar Media, the original “jail time” version aired 92 times through Oct. 25. CMAG hadn’t captured a revised ad yet. That version says that those who didn’t get insurance would be subject to “penalties.” That’s true.

The ad also says the law requires “thousands of IRS agents.” That’s based on a partisan analysis using false assumptions. We knocked down that whopper in an earlier item, pointing out that the law requires the IRS mostly to hand out tax credits, not collect penalties.

American Action Network Ad: “Mess”

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Announcer: A government health care mess, thanks to Nancy Pelosi and Chris Murphy. 500 billion in Medicare cuts. Free health care for illegal immigrants. Thousands of new IRS agents. Jail time for anyone without coverage. And now a 47 percent increase in Connecticut health care premiums. 47 percent. Call Chris Murphy. Tell him to repeal his government health care mess. American Action Network is responsible for the content of this advertising.

Coverage for Illegal Immigrants?

We haven’t heard much about this claim since Republican Rep. Joe Wilson’s “you lie” moment. But American Action Network’s ad above, and another from the group, resurrects the charge, saying the health care law provides “free health care” or “spends our tax dollars on health insurance” for illegal immigrants. The ad below is airing against Reps. Mark Critz of Pennsylvania and Stephanie Herseth Sandlin of South Dakota.

The law doesn’t provide any “health insurance” for illegal immigrants. In fact, it stipulates that insurance plans sold on the state-based exchanges are available only to citizens and lawful residents.

Patient Protection and Affordable Care Act: ACCESS LIMITED TO LAWFUL RESIDENTS.—If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

It also doesn’t provide any subsidies for illegal immigrants or any new “free” care for them. What American Action Network objects to is Senate Democrats’ rejection of an amendment to require some type of verification system of legal status. AAN also points to the fact that citizens are required to have insurance, while illegal immigrants aren’t — but those here illegally can still get emergency care at hospitals. However, that was the case before the health care law was passed. Illegal immigrants, and others who aren’t insured, are able to get treatment for emergencies (but not non-emergencies, unless they pay for it). U.S. law requires that.

The change that might occur is which pot of government money is used to reimburse hospitals for this uncompensated care. We called the Centers for Medicare & Medicaid Services and talked with spokeswoman Mary Kahn, who explained how this works. Hospitals either get payments for emergency care through what’s called Emergency Medicaid (for patients who would be eligible for Medicaid but don’t have it) or the disproportionate share hospital (DSH) funds, provided for hospitals that treat a lot of uninsured people, Khan explained. The health care law expands Medicaid eligibility, so hospitals may find themselves filing paperwork for more money through Emergency Medicaid than DSH, whether those who are treated are illegal immigrants or not. Either way, it’s government money. And either way, illegal immigrants get treatment for emergencies and hospitals get reimbursed.

AAN also referred us to two news reports that undercut its own claim. A 2007 Reuters report said: “Less than 1 percent of Medicaid spending went to health care for illegal immigrants, according to a study that the researchers said defied a common belief that they are a bigger drain on taxpayer money.” And the group cites a January 2008 USA Today article (yes, that’s a year before Obama was even sworn in) that states: “The sweeping overhauls of the nation’s health care system proposed by Democrats Hillary Rodham Clinton, Barack Obama and John Edwards would not provide coverage for illegal immigrants.”

By the way, about half of illegal immigrants actually had health insurance before the law was passed, according to the Pew Hispanic Center.

American Action Network Ad: “Repeal”

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Announcer: Obamacare. A trillion dollar health care debacle. Yet Congressman Mark Critz says he opposes repealing it. It means $500 billion in new job-killing taxes, cuts billions from Medicare for seniors, and spends our tax dollars on health insurance for illegal immigrants. Yet Congressman Critz says he wants to keep it. Tell Congressman Critz to vote for repeal in November. The American Action Network is responsible for the content of this advertising.

Medicare Cuts

This might be the most common line of attack of them all. We’ve seen many versions of the claim that the health care bill cuts Medicare by $500 billion. That’s actually a reduction in the future growth of spending over 10 years, not a slashing of the current budget, as we’ve pointed out. To put that in context: The Congressional Budget Office estimates that federal Medicare spending will be $519 billion this year, and $929 billion in fiscal year 2020, even with these cuts. The health care law calls for a reduction in the currently projected growth of federal outlays of about 7 percent over the decade.

Claims that these cuts will “hurt the quality of our care” — like the one below from the 60 Plus Association — ignore the fact that the law adds some benefits to Medicare, such as free preventive care and more prescription drug coverage. And the law (section 3601) says that guaranteed Medicare benefits can’t be reduced. But one group of seniors — those on Medicare Advantage plans, about 10 million beneficiaries — will likely lose the extra benefits they receive, such as gym memberships or spare eyeglasses. These private plans currently get paid more by the government per enrollee than traditional Medicare, and the law brings those payments in line with the regular program, over time. 60 Plus ran ads similar to this one, which targets Rep. Steve Kagen of Wisconsin, against 15 other House Democrats.

60 Plus Association Ad: “Hurts – Kagen”

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Person #1: Steve Kagen betrayed Wisconsin seniors.
Person #2: Instead of protecting us , he supported Nancy Pelosi’s liberal agenda.
Person #3: Kagen voted for Pelosi’s health care bill…
Person #1: …which cuts $500 billion from Medicare.
Person #2: That threatens our ability to keep our doctors…
Person #4: …and keep our health plans like we were promised.
Person #5: These cuts will hurt the quality of our care.
Person #2: Steve Kagen voted against Wisconsin seniors…
Person #1: …now it’s time for us to vote against him.

Announcer: 60 Plus Association is responsible for the content of this advertising.

More Expensive Premiums?

Other ads, such as these from Revere America and American Crossroads, have claimed that under the law “costs will go up” or families will see “higher insurance premiums.” But for most Americans with health insurance, premiums are expected to stay the same or decrease a bit, compared with what would have happened to costs without the new law.

According to the nonpartisan Congressional Budget Office, those in the large group market would see between no change and a 3 percent decrease in the average premium in 2016. The small group market would see between a 1 percent increase and a 2 percent drop in the average premium. Again, that’s in comparison to what premiums would do without the health care law.

For those who buy insurance on their own, the average premium would go up by between 10 percent and 13 percent. Why? Because the benefits in this non-group market would improve. Plus, 57 percent of those in this market would get federal subsidies — the extra money would entice them to buy more expensive plans than they normally would, says CBO.

On one point the ads make a valid criticism: The overall cost of health care is projected to rise because of the new law — but barely. In April, the chief actuary of the Centers for Medicare & Medicaid Services, Richard Foster, projected an increase of less than 1 percent in overall health spending over the next decade:

CMS Chief Actuary Foster, April 22: “[W]e estimate that overall national health expenditures under the health reform act would increase by a total of $311 billion (0.9 percent) during calendar years 2010-2019.

Foster predicted that the slight increase would come about largely because 34 million persons who would otherwise be uninsured will gain coverage under the new law, and that others will gain improved coverage, and all will make greater use of health care services.

This is one area where President Obama has conspicuously failed to meet campaign promises that his health care overhaul would reduce costs in addition to expanding coverage. Foster noted: “Although several provisions would help to reduce health care cost growth, their impact would be more than offset through 2019 by the higher health expenditures resulting from the coverage expansions.”

Revere America Ad: “Defeat Hall”

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Announcer: Congressman Hall voted for Obamacare. Government-run health care, it’s a bad plan. Government bureaucrats will benefit. Seniors will get hurt. Costs will go up. Care will go down. Longer waits in doctors’ offices. Your right to keep your own doctor may be taken away. It’s a plan we didn’t want and don’t need. But Hall voted for it anyway. Defeat Congressman Hall. Revere America is responsible for the content of this advertising.

(For more on the Revere America ad, see our article “Pataki’s Bogus Health Care Claims.”)

American Crossroads: “Far Enough”

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Announcer: Not only does Ami Bera support Obamacare he says it doesn’t go far enough. Obamacare’s 525 billion dollars in job killing taxes Isn’t far enough? The higher insurance premiums aren’t far enough? What about the 500 billion dollars cut from Medicare? And reduced benefits for 1.5 million California seniors? Ami Bera and Obamacare. They’re bad medicine for California. American Crossroads is responsible for the content of this advertising.

Taxpayer-funded Abortions?

This emotional issue was a major point of contention in the final days of debate on the health care bill, and neither the anti-abortion or pro-abortion rights camp walked away happy. Does the law use ”our tax dollars” to pay for abortions, as claimed by the following ad from CitizenLink, a family advocacy group, and the anti-abortion rights group Susan B. Anthony List?

As we’ve said before, strictly speaking, it does not, except in cases of rape, incest or danger to the mother’s life, the same government restrictions that have applied to Medicaid recipients, federal workers and the military. The controversy stems from how the law aims to guarantee those rules are followed when the government provides subsidies to purchase insurance.

The law says that those receiving subsidies to buy insurance through state-based exchanges must submit a separate payment to cover abortion services (if they choose a plan that covers abortions), and insurance providers must keep federal money separate from private payments to ensure the federal money does not go toward abortion coverage. President Obama also signed an executive order reaffirming the federal rules on only funding abortion in cases of rape, incest and danger to the mother’s life. Does that go too far or not far enough? That depends on one’s viewpoint, and we’ll let readers be the judge.

The CitizenLink/Susan B. Anthony List ad (this one, targeting Rep. Joe Donnelly of Indiana) also makes the unfounded claim that the law is the “biggest expansion of abortion in decades.” But that’s conjecture. We looked at the question of whether more women would get abortions if more had insurance that covered the procedure, and we found the evidence didn’t support that claim.

CitizenLink/Susan B. Anthony List Ad: “Choice”

⬐ Click to expand/collapse the full transcript ⬏

Announcer: The fate of Obamacare came down to a few key votes, legislation that uses our tax dollars to pay for abortion, and Joe Donnelly had a choice to make. Protect life or side wth President Obama and Speaker Pelosi. And he chose them. Joe Donnelly betrayed you and voted for the biggest expansion of abortion in decades. Votes have consequences, Congressman. Citizen Link, Susan B. Anthony List, and Indiana Family Action are responsible for the content of this ad.

– by Lori Robertson

Sources

2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Centers for Medicare & Medicaid Services. 5 Aug 2010.

Lillis, Mike. “Trustees report finds healthcare reform to extend Medicare’s life.” The Hill. 5 Aug 2010.

Kaiser Health News. “Obama Signs 6-Month Fix For Medicare Reimbursements To Doctors.” 25 Jun 2010.

Henig, Jess. “Imprisoned for Not Having Health Care?” FactCheck.org 13 Nov 2009.

The Patient Protection and Affordable Care Act. Thomas.gov, Government Printing Office. 2010.

Brown, Carrie Budoff. “Ensign receives handwritten confirmation.” Politico. com. 25 Sep 2009.

Jackson, Brooks. “IRS Expansion.” FactCheck.org. 30 Mar 2010.

Landry, Jim, American Action Network communications director. E-mails to FactCheck.org. 27 Oct 2010.

Jonathan Collegio, American Crossroads communications director. E-mails to FactCheck.org. 28 Oct. 2010.

U.S. Senate. S.Amdt. 3701, amends H.R.4872. proposed 25 Mar 2010. Thomas.gov

Kahn, Mary, Centers for Medicare & Medicaid Services spokeswoman. Phone interview with FactCheck.org 28 Oct. 2010.

Dunham, Will. “Medicaid spends 1 pct on illegal immigrants: study.” Reuters. 13 Mar 2007.

Wolf, Richard. “Rising health care costs put focus on illegal immigrants.” USA Today. 22 Jan 2008.

Congressional Budget Office. “Key Issues in Analyzing Major Health Insurance Proposals.” Dec 2008.

Congressional Budget Office. “The Budget and Economic Outlook: An Update.” Aug 2010.

Congressional Budget Office. Letter to Sen. Evan Bayh. 30 Nov 2009.

Foster, Richard. Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended. Centers for Medicare & Medicaid Services. 22 Apr 2010.

Obama, Barack. Executive Order — ENSURING ENFORCEMENT AND IMPLEMENTATION OF ABORTION RESTRICTIONS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. 24 March 2010.

Side-by-Side Comparison of Major Health Care Reform Proposals. Kaiser Family Foundation. accessed 1 Apr 2010.

Robertson, Lori. “The Abortion Issue.” FactCheck.org 1 Apr 2010.

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