These Repub­li­cans have mis­led vot­ers about our Oba­macare fact checks

The Washington Post Sunday - - POLITICS & THE NATION - GLENN KESSLER glenn.kessler@wash­post.com

Some­where, some­how, a memo must have gone out to Repub­li­can law­mak­ers who voted for the Amer­i­can Health Care Act (AHCA), the Repub­li­can bill to re­peal and re­place Oba­macare: If you are at­tacked for un­der­min­ing pro­tec­tions for peo­ple with ex­ist­ing health prob­lems, jab back by say­ing the claim got Four Pinoc­chios from The Wash­ing­ton Post.

That’s not true. Repub­li­cans are twist­ing an un­re­lated fact check and are mis­lead­ing vot­ers. We have found at least seven politi­cians who have done this.

Rep. Peter J. Roskam (Illi­nois’ 6th Con­gres­sional Dis­trict): In a de­bate Oct. 22, he said: “Sean [Cas­ten] has falsely ac­cused me of be­ing against pro­tect­ing peo­ple with pre­ex­ist­ing con­di­tions, and that was fact-checked by The Wash­ing­ton Post, who gave that Four Pinoc­chios.”

Rep. Rod­ney Davis (Illi­nois’ 13th Dis­trict): In a de­bate Oct. 18, he said: “The lies about pre­ex­ist­ing con­di­tion cov­er­age be­ing taken away have been scored a Four Pinoc­chio by The Wash­ing­ton Post. Read the bill. In the bill, it specif­i­cally says, ‘Noth­ing in this bill shall al­low in­sur­ance com­pa­nies to deny any­one cov­er­age for pre­ex­ist­ing con­di­tions.’ ”

Rep. Mike Kelly (Penn­syl­va­nia’s 16th Dis­trict): In a de­bate Oct. 8, he said: “The other thing, lis­ten, that is un­be­liev­able when you talk about pre­ex­ist­ing dis­ease or con­di­tions. The New York Post [sic] gave that a Four Pinoc­chio that it was ab­so­lutely false. We have al­ways kept pre­ex­ist­ing con­di­tions in there . . . . Watch your nose that if you keep talk­ing this way, that nose is go­ing to go the whole way out the back. If you could just stick to the truth, it’ll make a big dif­fer­ence.”

Rep. Erik Paulsen (Min­nesota’s 3rd Dis­trict): In a de­bate Oct. 22, he said: “We guar­an­teed in lan­guage — it was given Four Pinoc­chios to any­one who claims that pre­ex­ist­ing con­di­tions was not cov­ered by the non­par­ti­san fact check in The Wash­ing­ton Post — it covers pre­ex­ist­ing con­di­tions. There is a spe­cific sen­tence in the leg­is­la­tion to make sure no in­sur­ance would be able to deny that.”

Rep. John Faso (New York’s 19th Dis­trict): In a Sept. 24 news re­lease, the cam­paign dis­played Four Pinoc­chios: “Claim: Faso voted to take health care away from con­stituents with pre­ex­ist­ing con­di­tions. Rat­ing: False. A Wash­ing­ton Post Fact Checker Anal­y­sis gave this claim Four Pinoc­chios.”

Rep. Jeff Den­ham (Cal­i­for­nia’s 10th Dis­trict): An ad spon­sored by the Con­gres­sional Lead­er­ship Fund dis­played Four Pinoc­chios and de­clared: “The ads at­tack­ing Jeff Den­ham? In­de­pen­dent factcheck­ers say the charges aren’t true. Den­ham’s vote does not change the guar­an­tee of cov­er­age for those with pre­ex­ist­ing con­di­tions. Why the lies?”

Rep. Dave Brat (Virginia’s 7th Dis­trict): In an Oct. 15 de­bate, he said: “Her [Abi­gail Span­berger’s] ads, which are run­ning to­day, she got Four Pinoc­chios for the lies on my votes on pre­ex­ist­ing con­di­tions.”

There’s a slight dif­fer­ence in the ref­er­ences made by the first six law­mak­ers and the one by Brat, which we ex­plain be­low.

The Facts

Health care is a com­pli­cated topic. We find that the more com­plex an is­sue is, the more sus­cep­ti­ble it is to mis­lead­ing claims by politi­cians. Fact checks are in­tended to ex­pose mis­lead­ing rhetoric, but now these politi­cians are us­ing fact checks to mis­lead vot­ers even more.

In sum, the first six law­mak­ers are re­fer­ring to a fact check that a) fo­cused on how many peo­ple had pre­ex­ist­ing con­di­tions, not whether the bill harmed them; b) was pub­lished be­fore the non­par­ti­san Con­gres­sional Bud­get Of­fice is­sued a crit­i­cal re­port about the pos­si­ble im­pact on peo­ple with pre­ex­ist­ing con­di­tions if the bill they sup­ported had be­come law.

Sev­eral law­mak­ers re­ferred to a sen­tence in the AHCA. Davis even mis­quotes it as: “Noth­ing in this bill shall al­low in­sur­ance com­pa­nies to deny any­one cov­er­age for pre­ex­ist­ing con­di­tions.”

Ac­tu­ally, the sen­tence said: “Noth­ing in this Act shall be con­strued as per­mit­ting health in­sur­ance is­suers to limit ac­cess to health cov­er­age for in­di­vid­u­als with pre­ex­ist­ing con­di­tions.”

This sen­tence was mostly a pub­lic re­la­tions ex­er­cise, but no­tice the dif­fer­ence? It says “limit ac­cess to health cov­er­age,” not “deny cov­er­age” as Davis claimed. Ev­ery­one has “ac­cess” to buy­ing a Tesla, but it makes a dif­fer­ence whether you can af­ford to buy it.

The CBO later con­cluded that states that took ad­van­tage of cer­tain waivers in the bill could have blown up their in­di­vid­ual in­sur­ance mar­kets, re­sult­ing in spi­ral­ing costs for peo­ple with pre­ex­ist­ing con­di­tions. More­over, the agency said, the bill did not pro­vide enough fund­ing for states to aid peo­ple who could not af­ford in­sur­ance.

Con­trary to usual prac­tice, Repub­li­can lead­ers rushed the AHCA through the House with­out wait­ing for the bud­get of­fice to make an as­sess­ment. The AHCA nar­rowly passed, by a vote of 217 to 213, on May 4, 2017, with 20 Repub­li­cans vot­ing against it, in part be­cause of their un­ease about the changes pro­posed for the pre­ex­ist­ing-con­di­tions pro­vi­sions. That un­ease was con­firmed when the crit­i­cal re­port was pub­lished three weeks af­ter the vote.

Let’s back up a mo­ment and ex­plain some of the nu­ances of the Af­ford­able Care Act, or ACA, and the Repub­li­can re­place­ment.

Be­fore the ACA, in­sur­ance com­pa­nies could con­sider a per­son’s health sta­tus when de­ter­min­ing pre­mi­ums, some­times mak­ing cov­er­age too ex­pen­sive, or even un­avail­able, if a per­son was al­ready sick with a prob­lem that re­quired costly treat­ment. The ACA pro­hib­ited that, in part by re­quir­ing ev­ery­one to pur­chase in­sur­ance. The AHCA would have ended that man­date (and Pres­i­dent Trump’s tax bill essen­tially did so).

Un­der ACA, there are two other key parts that work to­gether to as­sist peo­ple with pre­ex­ist­ing con­di­tions: guar­an­teed is­sue, which means in­sur­ance com­pa­nies must sell in­sur­ance to any­one who wants to buy it; and com­mu­nity rat­ing, which means that peo­ple who buy sim­i­lar in­sur­ance and are the same age pay sim­i­lar prices. This made in­sur­ance af­ford­able for peo­ple with, say, cancer. Be­fore pas­sage of the ACA, even minor health prob­lems could have led an in­sur­ance com­pany to deny cov­er­age.

One AHCA waiver for states would have al­lowed in­sur­ance com­pa­nies to take one year to con­sider a per­son’s health sta­tus when writ­ing poli­cies in the in­di­vid­ual mar­ket if that per­son failed to main­tain con­tin­u­ous cov­er­age. An­other waiver, also lim­ited to the in­di­vid­ual and small-group mar­kets, would have al­lowed a state to re­place a fed­eral es­sen­tial-ben­e­fits pack­age with a more nar­rowly tai­lored pack­age of ben­e­fits.

The the­ory was that re­mov­ing sicker peo­ple from the mar­kets and al­low­ing poli­cies with skimpier op­tions would re­sult in lower over­all pre­mi­ums. But the CBO was skep­ti­cal that it would work with­out harm­ing peo­ple with pre­ex­ist­ing con­di­tions, in part be­cause of in­ad­e­quate fund­ing.

It is worth re­call­ing that dur­ing the de­bate over the Se­nate ver­sion of re­peal, which did not pass, Trump said the House ver­sion was “mean” be­cause it did not go far enough to pro­tect in­di­vid­u­als in the in­sur­ance mar­kets. He urged the Se­nate to add funds to cover peo­ple with pre­ex­ist­ing con­di­tions. “I want to see — and I speak from the heart — that’s what I want to see, I want to see a bill with heart,” Trump told “Fox & Friends” on June 25, 2017.

Trump’s sec­ond thoughts about the House leg­is­la­tion are cer­tainly a prob­lem. But the odd thing is that these law­mak­ers could counter a Demo­cratic at­tack on the AHCA with a con­ser­va­tive cri­tique of the ACA, ar­gu­ing that the fo­cus on pre­ex­ist­ing con­di­tions has un­der­mined care be­cause sicker pa­tients pay the same pre­mi­ums as every­body else. Some ex­perts on the right have ar­gued that the pre­ex­ist­ing-con­di­tion re­quire­ments — in ad­di­tion to rais­ing pre­mi­ums sub­stan­tially — are al­ready caus­ing in­sur­ers to dis­crim­i­nate against sick peo­ple by re­strict­ing ac­cess to care. The AHCA could be cast as a step in the right di­rec­tion to bal­ance the sit­u­a­tion.

Repub­li­cans also could have em­pha­sized that the changes were mainly lim­ited to the in­di­vid­ual mar­ket — 22 mil­lion in­di­vid­ual and small-busi­ness poli­cies sold on the ex­changes or di­rectly to con­sumers — which is one-sev­enth the size of the em­ploy­ment-based mar­ket, where most Amer­i­cans get their health in­sur­ance. But, frankly, Repub­li­cans rarely made that dis­tinc­tion when at­tack­ing Oba­macare.

In­stead, these law­mak­ers have cho­sen to hide be­hind our Pinoc­chios, falsely claim­ing that our fact checks showed that the AHCA left that as­pect of the law un­touched. But that was not the point of the fact check they are cit­ing.

The May 10, 2017, fact check con­cerned a tweet by Sen. Ka­mala D. Har­ris (D-Calif.) af­ter the AHCA passed the House: “Once again, 129M peo­ple with pre­ex­ist­ing con­di­tions could be de­nied cov­er­age and in­sur­ers could charge sick peo­ple more money.” Most of the fact check was on whether 129 mil­lion peo­ple re­ally would be af­fected — and we con­cluded that the fig­ure was much too high. As a sec­ondary mat­ter, we looked at the ques­tion of whether peo­ple with pre­ex­ist­ing con­di­tions would be de­nied cov­er­age.

At the time, there was no CBO re­port on the leg­is­la­tion. As we noted, the CBO later found that in states that sought the waivers — es­ti­mated to con­tain about one­sixth of the U.S. pop­u­la­tion — peo­ple might end up be­ing priced out of the mar­ket.

The core of the fact check, how­ever, was about Har­ris’s es­ti­mate of 129 mil­lion, not the guar­an­tee of cov­er­age. So these law­mak­ers are cherry-pick­ing the Pinoc­chio rat­ing, even though the fact check mostly ex­am­ined an en­tirely dif­fer­ent is­sue — the 129 mil­lion number. They ig­nore the fact that the CBO showed that the AHCA did un­der­mine the guar­an­tee in states that sought waivers; they just con­ve­niently pre­tend that the crit­i­cal anal­y­sis was never is­sued.

Brat’s case is a bit dif­fer­ent, though it also con­cerns pre­ex­ist­ing con­di­tions. He claimed that a Four Pinoc­chio rat­ing we gave to an ad at­tack­ing Rep. Brian Fitz­patrick (R-Pa.) on pre­ex­ist­ing con­di­tions also ap­plied to an ad aired by his op­po­nent, Abi­gail Span­berger. But Fitz­patrick was one of the few Repub­li­cans who voted against the AHCA, whereas Brat voted for it. That ob­vi­ously is a very dif­fer­ent sit­u­a­tion.

The Pinoc­chio Test

We asked these law­mak­ers whether they would be will­ing to with­draw the ci­ta­tion of the Pinoc­chios. None agreed to do so.

That’s dis­may­ing. These law­mak­ers have been put on no­tice that they are ped­dling a false­hood — and politi­cians who care about their rep­u­ta­tion should ac­knowl­edge they made a mis­take and of­fer an apol­ogy.

In­stead, they ap­par­ently be­lieve it is po­lit­i­cally ad­van­ta­geous to con­tinue to de­ceive the vot­ers in their dis­tricts. It is es­pe­cially galling be­cause many ac­cuse their op­po­nents of spread­ing lies — and then cry Four Pinoc­chios.

We urge news or­ga­ni­za­tions in the dis­tricts to high­light the brazen mis­ap­pro­pri­a­tion of our fact checks. Sun­light is some­times the best dis­in­fec­tant.

Repub­li­can mem­bers of the U.S. House, from left, Peter J. Roskam (Ill.), Rod­ney Davis (Ill.), Mike Kelly (Pa.), Erik Paulsen (Minn.), John Faso (N.Y.), Jeff Den­ham (Calif.) and Dave Brat (Va.) have all to a de­gree mis­rep­re­sented Wash­ing­ton Post fact-check­ing of an as­pect of health-in­sur­ance leg­is­la­tion.

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