“I actually tried to get my son signed up through the Kentucky exchange, you know, that the Democrats have said is so good. And I have here my son’s Medicaid card. We didn’t try to get him Medicaid, I’m trying to pay for his insurance. But they automatically enrolled him in Medicaid.”
– Sen. Rand Paul (R-Ky.), interview on ABC’s “This Week,” Jan. 5, 2014
This column has been updated with a new Pinocchio rating.
This is an odd story — the saga of how Rand Paul’s oldest son tried to get health insurance via the Kentucky version of Obamacare, and ended up on Medicaid, the federal-state health-care program for the poor. Paul held up the card on television to prove it, saying the system was “a mess.”
Our colleagues at PolitiFact beat us to the punch with a comprehensive look at what Paul says happened — and ultimately concluded it was a “he-said-she-said” situation that could not be fully adjudicated.
Let’s take a close look, and see if Paul’s story adds up.
Rand Paul’s son, William H. Paul, is a 20-year-old full-time student at the University of Kentucky, according to the Lexington Herald Leader.
In an appearance on Fox’s “On the Record” on Jan. 8, Paul gave a more detailed version of what he says happened. He explained he was having trouble signing up for the Washington exchange, and eventually discovered it would cost an additional $6,000 to add his son to his policy. (Note: as far as we can tell, no individual policy in the DC SHOP exchange, which is used by members of Congress, for someone as young as Paul’s son costs $500 a month, even at Platinum plan rates.)
Paul then said his son could not be signed up online and had to go to the “welfare office” to present his ID to “prove his existence.” According to Paul, “So he got there. He didn’t sign up for anything. And two days later, he got his Medicaid card. So he’s got Medicaid.”
(Actually, unless forms were incorrectly filled out, Paul’s son should not qualify for Medicaid because he is listed as a dependent on Paul’s tax return. As a senator, Paul’s $174,000-a-year salary is too high for Medicaid, which in Kentucky is limited to individuals below 138 percent of the federal poverty level.)
Paul added that when he went on the Web site of the Kentucky insurance exchange, Kynect, he encountered the same issue:
“Sure enough, he does automatically enroll in Medicaid. And there’s a big button about this big on the screen. And there’s a tiny little button that says QHP, which I’m not sure anybody would know what that means, but that’s how you opt out of Medicaid. Otherwise, if you just keep going, you get Medicaid.”
Okay, given the problems with the exchanges, some sort of software glitch is entirely possible. But there are some factors that raise questions about Paul’s account.
1. Kentucky, unlike some states that expanded Medicaid, decided not to allow automatic enrollment into Medicaid, according to Gwenda Bond, spokeswoman for the Kentucky Cabinet for Health and Family Services.
Instead, you must fill out income and family information, and then the system will decide whether or not you can purchase a health plan but qualify for a subsidy, or whether you qualify for Medicaid. “No one is automatically enrolled in Medicaid unless they apply for it,” she said, adding that she could not comment specifically on individual applications.
At the beginning of the process, Bond says, there is an option to go directly to a qualified health plan — that’s apparently the QHP that Paul mentioned — if you think you don’t qualify for subsidies. But as for Paul’s description, “that doesn’t seem like a screen that I am familiar with,” she said.
Update, Jan. 10: Here’s the opening screen shot. This is the first thing an applicant sees after creating an account on the exchange; it’s clear that you can purchase a plan without payment assistance if you like. There is no “QHP” button. “We tried to keep the language very simple and clear throughout,” Bond said. “Everything is written at a sixth grade reading level, if possible.” The full process after this screen is embedded below.
2. Kynect’s paper application for financial assistance specifically tells the applicant to stop if you are claimed as a dependent. (See question 27.)
“Senator Paul and his son were attempting to enroll in a non-Medicaid plan through the exchange Web site,” said Paul spokesman Brian Darling. “They did not fill out this form, nor were they asked to provide household income information online or otherwise.”
But Bond says this is impossible, unless a mistake was made: “An application for coverage would need to be completed and submitted before an individual would receive Medicaid coverage.”
3. There is another wrinkle. As a full-time student, Paul’s son is eligible to get insurance through the University of Kentucky, which has an excellent medical center. UK students already pay a mandatory health fee that covers most university services, but the university recommends insurance for procedures not covered by the fee. UnitedHealth Plan charges about $1,900 for an annual plan, or about $150 a month. So why didn’t Paul’s son take that route?
“Senator Paul was attempting to use the Kentucky health insurance exchange Web site to explore plan options for his family when his son was automatically enrolled in Medicaid,” Darling said. “He has not made a final determination about health insurance coverage at this time and continues to explore possible options for purchasing coverage.”
Update, Jan. 10: Kynect provided a series of screen shots that take you through the process. If the option to not seek payment assistance is made on the first screen, then most of the remaining information (especially related to income, etc.) would not be required, because no application would be made to determine eligibility for subsidies or Medicaid. The system is designed to only take applicants through the steps they need to go through based on the initial selection or their answers as they progress through the application.
Update, Jan. 16: After waiting almost a week for a response to these screen grabs, The Fact Checker received the following statement from Darling: ”Regardless of which option Sen. Paul might have selected on the screenshot in question, individuals should have to affirmatively select a Medicaid plan in order to be enrolled in that plan, which Sen. Paul did not do. The process is very confusing, yet they never selected a Medicaid plan.”
Not to be argumentative, but the screen shots show that a) the applicant can go directly to the exchange if he or she clicks a clearly marked button that a person knows he or she does not qualify for subsidies (that’s the second choice) and b) if Paul wanted to see all of the options (first choice) and if he had correctly filled in his salary, it would have said he was not eligible. So there would have been no option to select Medicaid unless information was incorrectly entered.
The Pinocchio Test
Like PolitiFact, we initially found it difficult to reach a firm conclusion, but we had many questions before we obtained the screen grabs.
It is certainly a conundrum that what Paul says happened — automatic enrollment into Medicaid without filling out income information — is something that Kynect says is not supposed to happen. Obviously, there could be a software glitch — but at the same time Paul’s son supposedly did not take the key steps needed to enroll, so it’s unclear how the glitch could happen in the first place.
Update, Jan. 16: The screen shots provided by Kynect cast serious doubt on the details of Paul’s story. Thus we are revising the ruling from Verdict Pending to Two Pinocchios.
That may appear to some readers to be a bit generous but apparently Paul’s son did end up with a Medicaid card. (Paul’s office, however, said it could not provide an image of it.) The available evidence suggests this happened because of an error on the part of either Paul or his son, but there are enough uncertainties that a definitive conclusion cannot be reached. Paul earns the Pinocchios because the process he described on television does not match up with the Kynect screen shots.
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