“Three hundred and seven thousand veterans have died waiting for health care.”

“We need to care for our veterans so 307,000 aren’t dying waiting for health care.”

–Business executive Carly Fiorina, the second GOP debate, Sept. 16, 2015

Readers asked us to fact-check this figure that Fiorina cited twice during the second GOP debate, hosted by CNN, at the Ronald Reagan presidential library in Simi Valley, Calif. The number of veterans who were believed to have died while waiting for care in one Arizona facility was estimated in to be in the “dozens.” Yet this figure that Fiorina used was significantly higher. Is it accurate?

The Facts

Fiorina’s campaign pointed to news reports of a Sept. 2, 2015, report by the Department of Veterans Affairs’ Office of Inspector General. Various outlets, including CNN, reported that 307,000 sick veterans had died while waiting for the VA to approve their health-care benefits. (The Washington Post’s report on this study did not use this figure.)

In response to a request by the House Committee on Veterans’ Affairs over whistleblower allegations that there was a backlog of health care applications, investigators reviewed alleged mismanagement at the Veterans Health Administration’s Health Eligibility Center. The center is the VA’s “central authority for eligibility and enrollment processing activities.” There are about 22.3 million records in this system.

They found significant weaknesses in the data system, which impede the VA’s ability to monitor, report and process health care enrollments.

There were about 867,000 records in a “pending” status as of Sept. 30, many of them inactive for more than five years. “Pending” means a veteran had applied for enrollment, but the VA needed additional information (often financial) before the veteran is found to be eligible for benefits. Of the pending records, 307,173 were for people who were reported as deceased by the Social Security Administration.

This may appear to confirm that 307,000 veterans died waiting for health care. But let’s dig further.

The VA began its health care enrollment process in 1998, but the system includes records of veterans who died before then. (In one example, a veteran had a blank enrollment status that changed to “pending” in November 2014. But the person had died in 1988.)

Pre-1998 records are in the system because millions of records from a different VA data source were entered into it in December 2013. This also caused records of veterans who never sought care from the VA to be entered into the system.

Because of a software glitch, the application dates do not show in the system. That makes it impossible to know which records are associated with someone applying for health care benefits, the report said.

Further complication: The enrollment system is like a customer list of people who had any encounter with the VA. It receives automatic data feeds from VA medical centers and other systems that are not related to health care, like disability benefits and home loans. The system also keeps records of veterans’ family members who qualify to receive health care, employees participating in the employee health program, patients receiving humanitarian care and patients whose military service was not confirmed.

These problems have rendered the VA’s health enrollment database “virtually unreliable,” the OIG found. OIG officials said the report’s data do not support claims that 307,000 veterans died waiting for health care.

Scott Davis, the whistleblower and program specialist at the VA Health Eligibility Center in Atlanta, flagged the issue to the House committee and testified about the backlog in pending records. In an interview with The Fact Checker, he said the primary purpose of the Health Enrollment Center is to maintain health care enrollment data, and that non-health care data comprise a small portion of records in the system.

The VA’s OIG officials could not identify what proportion of the 22.3 million records in the system were not related to health care enrollment.

The VA has disputed claims like Fiorina’s, saying they wrongly “link these pending records with access-to-care issues for fully enrolled veterans that have chosen to use, and who are receiving, VA health care. They are separate issues,” according to Janet P. Murphy, the Veterans Health Administration Operations and Management’s acting deputy undersecretary for health.

The Pinocchio Test

The OIG’s report points out many serious problems with the VA’s enrollment records system. But its finding about the 307,000 figure is much more nuanced than the way Fiorina made it sound during the debate. She said that 307,000 veterans died “while waiting for health care.” That figure represents the number of veterans whose records were marked as “pending” in the enrollment system, but who were marked deceased in the Social Security Administration’s records.

It is possible that all 307,173 veterans applied for health care. But that’s an absolute worst-case scenario, and the OIG said it could not confirm how many veterans with “pending” statuses had applied for health care.

The VA system’s weaknesses limit us in the public from knowing exactly what the pending records mean and what they reflect about veterans’ access to health care. But we do know that the database includes records of people who had applied for other, non-health care benefits with the VA. It includes records of qualified family members and VA employees who are enrolled in employee health care. It also includes records of people who sought health care or who died before 1998, when the VA actually started its health-care enrollment system.

We wavered between Two and Three Pinocchios. But Fiorina’s claim is rooted in misconstrued reports by reputable news outlets that her campaign cited as sources for her claim. We will give her the benefit of the doubt on this figure, but this is warning to politicians who repeat this figure — especially in such a high-profile setting as a GOP debate. As we often say, don’t believe everything you read in the media.

Two Pinocchios

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