Five Misleading Republican Claims About Health Care

By LINDA QIU JULY 3, 2017

Senator Mitch McConnell, left, the majority leader, and Senator John Cornyn, the majority whip, spoke last week after meeting with President Trump to discuss health care legislation. Doug Mills/The New York Times

Republican lawmakers have their own version of the facts about the impact of their replacement for the Affordable Care Act. Here is an assessment.

Senator Patrick J. Toomey of Pennsylvania said falsely that the bill "does not pull the rug from anyone currently covered by Obamacare, and keeps the Medicaid expansion."

A reader asked The New York Times to examine Mr. Toomey's claims specifically as they related to Pennsylvania, where more than 700,000 people gained insurance through the Medicaid expansion and 360,000 through the exchanges set up by the Affordable Care Act.

While the Senate bill does not revoke expanded Medicaid eligibility, it does gradually reduce the federal government's contributions, while also capping future funding on a per-enrollee basis. The bill's changes to premium tax credits and its elimination of cost-sharing subsidies would affect all age groups, but especially older Americans.

This would lead to 15 million fewer Medicaid enrollees and seven million fewer in the individual market within the next decade, the Congressional Budget Office estimated.

According to the Kaiser Family Foundation, a nonpartisan health research group, Pennsylvanians would see a 72 percent increase in out-of-pocket premium costs under the new bill, compared with a national average increase of 74 percent.

Senator Lamar Alexander of Tennessee argued that the bill actually "increases Medicaid funding" at the rate of inflation, though current funding exceeds that.

Mr. Alexander's carefully worded statement is technically accurate, but leaves a misleading impression.

The bill places a limit on the federal government's share of Medicaid spending for different groups at different times. In 2020, it pegs funding growth to the medical inflation rate for children and adults at 3.7 percent, and at 4.7 percent for disabled adults and older Americans. In 2025, growth for all groups would be tied to the Consumer Price Index.

But Medicaid spending for adults and children under the current law is expected to grow faster, at 4.9 percent per year - a "substantial" difference in funding, the budget office said.

Senator Mitch McConnell, the majority leader, said the bill would "reduce taxes on the middle class," but most of the benefits go to high-income earners.

The budget office estimated that the bill includes tax cuts totaling $700 billion over the next decade. People at all income levels would see some of the money, but characterizing the cuts as a boon for the middle class is misleading.

More than $230 billion comes from repealing two taxes that apply only to individuals making over $200,000 a year. The bill would also eliminate a tax on health insurers, amounting to a cut of $145 billion.

Middle-class households would see an average tax cut of $280, according to the nonpartisan Tax Policy Center. In contrast, a household in the top 0.1 percent would get a cut of $250,000. Looking at overall distribution, two-thirds of the $700 billion would line the pockets of the richest one-fifth of Americans.

The White House and President Trump used a flawed report to claim the Affordable Care Act led to premiums' doubling and tripling.

A reader asked The Times to check a graphic circulated in the White House's newsletter, Your 1600 Daily, stating that premiums "are up by 105 percent" since the A.C.A.'s enactment. Mr. Trump later bemoaned a 206 percent (actually 203 percent) increase in Alaska specifically.

The figures come from a May report from the Department of Health and Human Services that said premiums increased to $476 this year from $232 in 2013, before the health care law took full effect. According to the report, average premiums in Alaska jumped to $1,041 from $344.

As The Times explained in a fact-check of Mr. McConnell, the comparison is imperfect - and Mr. Trump errs further by selectively choosing the second-highest increase to exaggerate the report's findings.

Mr. Trump compares two fundamentally different universes of plans: all the plans on the individual market in 2013 and those only on the federal exchange in 2017. The plans are different, with Affordable Care Act plans covering more and sicker people and offering more comprehensive benefits.

The report also does not take into account premium tax credits that most Obamacare enrollees - 93 percent in Alaska, according to a different Health and Human Services report - receive to help blunt the cost of premiums. Subsidies in Alaska this year averaged $976 a month, so people actually paid significantly less under the current bill than they did in 2013.

Senator Ron Johnson of Wisconsin suggested misleadingly that the A.C.A. "caused" a gap in Medicaid coverage.

An estimated 2.6 million people are uninsured because they live in states that did not expand Medicaid, but earn too little to qualify for premium tax credits in the Affordable Care Act markets. Blaming the health care law for the coverage gap distorts a chain of causality.

As written, the law provides subsidies for marketplace insurance for people with moderate annual incomes, from 100 to 400 percent of the poverty level (about $22,160 for a family of four). It simultaneously increases Medicaid eligibility for low-income individuals, to 138 percent of the poverty level from the previous threshold of 44 percent.

But the Supreme Court ruled in 2012 that the federal government could not compel states to expand their programs, with 19 states then declining to do so. In those states, people making 44 to 100 percent of the poverty level did not qualify for Medicaid or marketplace subsidies.

"The A.C.A. intended to provide coverage across the income spectrum," said Rachel Garfield, a Medicaid expert at the Kaiser Family Foundation. "The only reason that gap exists is because of those state decisions."

Correction: July 7, 2017

An article on Tuesday about Republican tax-cut proposals misstated the percentage of households that would get a tax cut of $250,000. It is the top 0.1 percent, not the top 1 percent.

Hear a claim from a politician or public official that made you wonder? Email factcheck@nytimes.com. Get politics and Washington news updates via Facebook, Twitter and in the Morning Briefing newsletter.

A version of this article appears in print on July 4, 2017, on Page A12 of the New York edition with the headline: False Claims and Flawed Reports.