THE PROGNOSIS

President Trump has made 901 false or misleading claims related to health care since taking office three years ago, a Washington Post database shows.

His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.

Trump’s pronouncements on a range of health-care topics — such as preexisting condition protections, the effects of Medicare-for-all and the state of the Affordable Care Act — are among the more than 16,200 false or misleading claims he has made in his three years since taking the oath of office.

That’s the tally from The Post’s stellar fact-checking team, which in the administration’s first 100 days started a database for analyzing, categorizing and tracking every suspect statement Trump utters. At the request of readers, they kept it going. 

Now the database shows Trump made 8,155 suspect claims in 2019, up from 5,689 claims in 2018 and 1,999 claims in the first year of his presidency.

“In a single year, the president said more than the total number of false or misleading claims he had made in the previous two years,” our colleagues Glenn Kessler, Salvador Rizzo and Meg Kelly write. “Put another way: He averaged six such claims a day in 2017, nearly 16 a day in 2018 and more than 22 a day in 2019.”

Here are Trump’s top five misleading health-care claims, in order of how frequently he has repeated them:

1. Trump is particularly fond of making bold claims about how the Veterans Affairs Mission Act came about and what it did. He has claimed the legislation was all his idea. He has suggested Congress couldn’t get the measure approved for 44, 45 or even 48 years. He has made these claims — or iterations of them —113 times, according to the Post database.

For example, Trump said this at his reelection kickoff last June:

“We passed VA Choice so they can see their doctor. Our veterans were waiting online for two days, seven days, three weeks, five weeks. ... We passed VA Choice. You go out now, you get a doctor. You fix yourself up. The doctor sends us the bill. We pay for it. ... VA Choice for the veteran? They’ve been trying to get that passed also for about 44 years.”

The actual history of the VA Choice program goes like this: Congress passed the program under Obama as a way of addressing the 2014 scandal in which Veterans Affairs facilities were found to be obscuring long wait times for medical appointments. The program allowed one-third of veterans to get government-paid health care in private settings.

But because Choice was heavily criticized as being too unwieldy and bureaucratic, Congress tried to reform it by passing the Mission Act in 2018 under Trump. The Mission Act loosens the restrictions around when a vet may seek private medical care, allowing it if they live more than 30 minutes from a VA clinic or face wait times of more than 20 days for most health-care appointments.

So Trump is incorrect when he says Congress passed Choice under his watch — that credit goes to Obama.

And as to his claims about how long veterans were waiting for care previously, the Government Accountability Office found in April 2018 that the “VA cannot systematically monitor the timeliness of veterans’ access to Choice Program care because it lacks complete, reliable data to do so.”

2. Trump has made all sorts of dubious claims about the 2010 Affordable Care Act, calling it “crazy,” “a disaster” and “not working.” He has made such claims 80 times.

Even if one factors in all the struggles the health-care law has faced, these are rather extreme statements. The ACA cut the uninsured rate by about half (although lately the uninsured rate has been creeping back up) by providing subsidized coverage to millions of Americans. It ensured more comprehensive coverage to those with employer-sponsored plans. It allowed states to expand Medicaid.

It’s true the ACA marketplaces had a rough website rollout in 2013 and struggled in subsequent years to attract enough insurers to offer affordable coverage. But things have been looking better lately. The Congressional Budget Office has said the individual market would be largely stable for the next 10 years, mostly because a majority of the enrollees are eligible for subsidies and are thereby sheltered from premium hikes.

There’s a reason, after all, why Republicans couldn’t manage to repeal the law in 2017, despite controlling both the House and the Senate — the law benefited too many voters by that point.

3. The president has another favorite overstatement related to veterans health care: that a June 2017 measure he signed allowed underperforming VA workers to be fired for the first time ever.

Glenn — who awarded Trump “Three Pinocchios” for this claim he’s made 73 times — writes that this assertion is “simply wrong.” 

Hundreds of VA workers were fired every month, even before Trump signed the bipartisan Veterans Affairs Accountability and Whistleblower Protection Act. And in 2014, Congress passed a law aiming to make it easier to remove senior officials because of poor performance or misconduct.

According to The Post’s review of federal data, 2,619 VA employees were fired in the 12 months before the law, compared with 3,473 in the 12 months after the law.

“Trump ignores the fact that hundreds of VA employees every month already were being fired before the law was passed; in fact, he falsely suggests that firings were not possible before, even if employees ‘stole or were sadists,’ ” Glenn writes.

4. Trump’s claims around patients with preexisting health conditions (including one that Glenn gave “Four Pinocchios”) have attracted the most ire from Democrats. That’s because it was they who first passed such protections within Obamacare — the law Trump tried initially to repeal and subsequently modified through regulatory action.

Trump has misled the public about his approach to patients with preexisting conditions a total of 73 times, our fact checker says. He frequently alleges that Republicans — not Democrats — are the longtime champions of such protections.

As we’ve documented extensively in The Health 202 (check out our recent history of preexisting condition protections), Trump’s administration has taken repeated steps to undermine the ACA’s ban on insurers from refusing coverage to patients with preexisting conditions or charging them more. 

In 2018, the administration announced it wouldn’t defend the ACA in a legal challenge from GOP-led states. At the time, the Justice Department filed a brief saying the law’s preexisting condition protections can’t exist without the law’s penalty for lacking coverage (which Congress had repealed).

The following year, the administration took an even deeper stance against the ACA, saying it believes the entire law must be toppled now that the penalty for lacking coverage is gone.

And there’s more evidence that Trump hasn’t prioritized protecting patients with preexisting conditions. Back when congressional Republicans tried to replace Obamacare in 2017, they came up with plans that would have weakened those protections — which the president supported.

5. This attack — that Democrats want to eviscerate the Medicare program — was popular among Republicans in the 2018 election as they tried to turn the health-care issue to their advantage. Trump has repeated such claims 56 times.

If Trump were merely arguing that many Democratic candidates are seeking big changes to Medicare, he’d be right. But in contrast to his claims — which make it sound as though Democrats are trying to cut benefits — the idea under Medicare-for-all is to dramatically expand the program and its benefits to all Americans.

There are plenty of fair critiques of Medicare-for-all, as envisioned by Sens. Bernie Sanders (I-Vt.), Elizabeth Warren (D-Mass.), Rep. Pramila Jayapal (D-Wash.) and other liberal Democrats. It would massively inflate federal spending and could prompt provider shortages if the payment rates were set too low. 

But it’s also not fair for Trump and Republicans to characterize Democrats as trying to eliminate Medicare, when what they want to do is make the popular program accessible to everyone.

AHH, OOF and OUCH

AHH: The Trump administration is expected to issue guidance on allowing states to convert Medicaid funding into block grants as soon as this month. The move would follow the Office of Management and Budget’s signal in November that the initiative had been dropped or delayed, the Wall Street Journal’s Stephanie Armour reports

“Approving state waivers to change Medicaid funding to block grants would be among the administration’s most controversial moves to reshape Medicaid, a federal-state program that provides health coverage to one in five low-income Americans. Medicaid is the main source of long-term care coverage for Americans and is a guaranteed benefit, or entitlement, for eligible individuals,” she writes. 

“Lawmakers in Tennessee, Alaska and Oklahoma have already expressed an interest in pursuing block grants. Supporters of block grants say the change would free states from federal requirements and give them more flexibility to try new ways to increase coverage and cut costs.” 

OOF: President Trump chided HHS Secretary Alex Azar in a campaign meeting for failing to do more to address health care and drug pricing concerns. The confrontation happened after the president was briefed on polling from battleground states showing the public trusts Democrats more than Republicans on the issue, our colleagues Josh Dawsey and Yasmeen Abutaleb report.

“Trump reacted furiously and said the Democrats would ‘kill us’ on health care, according to the four people, who requested anonymity to candidly describe the private meeting. The president then picked up the phone, called Azar and put him on speakerphone in the middle of the meeting,” Josh and Yasmeen write. 

Trump told Azar he’s “not getting it done,” and that he needs to “hurry up” to lower drug prices and to allow for cheaper drugs to be imported from Canada. 

“Trump also asked Azar for an update on HHS’s work on lowering drug pricing, and the two discussed the fact that drug importation was popular with the public," Josh and Yasmeen write. "They also shared frustration about the number of health-care regulations that had been stopped by the courts — including a rule that would require drugmakers to post the list prices of their medications in television ads and state requirements that Medicaid recipients work to maintain their coverage — and by the lack of media coverage of the administration’s health-care and drug pricing policies."

“Azar told Trump he was doing everything he could but that much of his work was being stopped or hampered," they add.

HHS spokeswoman Caitlin Oakley responded this way: “We do not comment on conversations or meetings between Secretary Azar and the president. The Trump administration has done more than any other administration in history to lower the high cost of prescription drugs and we fully anticipate this momentum will continue.”

OUCH: The National Archives admitted it made numerous changes to a photo of the 2017 Women’s March showcased at the National Archives exhibit celebrating the centennial of women’s suffrage.

At least four of the photos were found to be altered, our Post colleague Joe Heim reports. A placard that proclaims “God Hates Trump” has “Trump” blotted out so that it reads “God Hates.” A sign that reads “Trump & GOP — Hands Off Women” has the word Trump blurred out.

Words on signs that referenced women’s anatomy were also blurred. One sign blurred the word “vagina” from a sign that originally read, “If my vagina could shoot bullets, it’d be less REGULATED.” Another sign that read “This Pussy Grabs Back” has the word “Pussy” erased.

Archives spokeswoman Miriam Kleiman said  the changes were made because the museum hosts young people and the messages could be deemed inappropriate and because, as non-partisan federal agency, the archives was trying to stay away from political controversy.

But prominent historians expressed dismay when told about the action taken by the Archives, 

"There's no reason for the National Archives to ever digitally alter a historic photograph," Rice University historian Douglas Brinkley said. "If they don't want to use a specific image, then don't use it. But to confuse the public is reprehensible. The head of the Archives has to very quickly fix this damage. A lot of history is messy, and there's zero reason why the Archives can't be upfront about a photo from a women's march."

INDUSTRY RX

— The American College of Physicians, the second-largest physician group in the country, for the first time says it supports a single-payer health-care approach, Modern Healthcare’s Rachel Cohrs reports

“ACP senior vice president Robert Doherty said ACP released its policy framework intentionally for discussion in political debates in the 2020 election cycle,” Rachel writes. “The medical specialty society still envisions a limited potential role for private supplemental insurance in its preferred single-payer model, and supports a public insurance option available to all, including individuals with employer-sponsored insurance.”

But the group doesn’t plan to endorse any 2020 candidate’s plan. 

“ACP recommends transitioning to a system that achieves universal coverage with essential benefits and lower administrative costs through two potential approaches: a single payer financing system or a publicly-financed coverage option with regulated private insurance,” the group writes in a policy framework. 

MEDICAL MISSIVES

— U.S. District Judge Amy Totenberg has cleared the way for a new transplant policy to take place. The method would push scarce organs to people in metropolitan areas where there is high demand, our Post colleague Lenny Bernstein reports

The judge refused to permanently block new rules for assigning livers that the federal government approved in December 2018. 

“Totenberg, an Atlanta judge appointed by President Barack Obama, wrote that the government and the nonprofit agency that runs the U.S. transplant system had provided the plaintiffs due process and an opportunity to have their views heard, even if the new policy did not work in their favor,” Lenny writes. “Those patients and hospitals, in places such as Georgia, Kentucky, Kansas and Virginia, have said they would face the prospect of fewer available organs under the new rules, as more livers are taken by transplant centers in cities with greater demand and higher insurance payments.”

— Federal health officials announced they would start screening passengers arriving at three international airports, in Los Angeles, San Francisco, and New York’s John F. Kennedy, to determine if they have a new virus from central China. 

Centers for Disease Control and Prevention staffers will ask questions and check for fever and other symptoms, our Post colleague Lena H. Sun reports

The new mysterious, pneumonialike virus has sickened dozens and as of Saturday, three people have died. Authorities don’t know what the virus is but say it’s a type known as a coronavirus. There’s been a surge of infections, which has convinced some experts that the virus can be transmitted from person to person, as our Post colleague Anna Fifield reports. 

The three airports “receive most of the travelers on direct and connecting flights from the central Chinese city of Wuhan, a major transportation and business hub where a cluster of pneumonialike illnesses was first identified last month, officials said,” Lena reports. “ … The announcement comes as millions of people in China are already traveling across the country and overseas for Lunar New Year, which officially starts Jan. 25.”

The screening is the first time such a system has been implemented for an infectious disease since the 2014 Ebola epidemic. 

— Meanwhile, the World Health Organization announced it would convene an emergency meeting to decide whether to declare the virus a global health emergency. “The news came as China reported confirmed cases in Beijing and in Guangdong province, 14 cases in health care workers — a first — and a confirmed incident involving human-to-human spread of the new virus, known provisionally as 2019-nCoV,” Stat’s Helen Branswell writes. 

 

— And here are a few more good reads:

AGENCY ALERT

The U.S. Centers for Disease Control and Prevention has moved away from a broad recommendation that people consider refraining from vaping altogether during the investigation into the outbreak of lung illnesses linked to the practice.
Wall Street Journal
Business
Proposed new rules would allow schools to cut the amount of vegetables and fruits required at lunch and breakfasts while giving them license to sell more pizza, burgers and fries to students.
Laura Reiley
National
Bill Marler, who represented hundreds of Jack in the Box victims in the 1990s, wants to ban dozens of strains of salmonella, some of the most virulent bacteria on meat.
Kimberly Kindy

HEALTH ON THE HILL

Politics
The Vermont senator also conceded that an anti-Biden video one of his aides promoted used a misleading video clip.
Sean Sullivan

STATE SCAN

Maryland Politics
Lawmakers in Annapolis aim to tweak already strict laws with new leadership on board.
Erin Cox
Changes in state laws could usher in even more confusion for law enforcement and escalate the pressure on Congress to act.
Politico

REPRODUCTIVE WARS

The justices will weigh Trump administration regulations allowing employers to refuse to provide access to birth control on religious or moral grounds.
New York Times
Mississippi is likely to ask the U.S. Supreme Court to consider the case.
Associated Press

DAYBOOK

Coming Up

  • The National Academies of Sciences, Engineering, and Medicine holds a public session of the Committee on Implementing High-Quality Primary Care on Wednesday. 

SUGAR RUSH