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’s 6th District): In a debate on 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’s 13th District): In a debate on 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 on 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 be 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 on 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 pre-existing 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 fact-checkers 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 will explain below.
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. Rep. 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 uneasiness with 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 more 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 is 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 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 pre-existing 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 figure was much too high to be credible. 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 Congressional Budget Office report on the legislation. As we noted, the office later found that in states that sought the waivers — estimated to contain about one-sixth 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 the critical analysis was never issued. (A spokesman for Kelly insisted he thought his opponent, Ron DiNicola, was referring to the 129 million figure because DiNicola said the AHCA would “marginalize and eliminate coverage for preexisting conditions.”)
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 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. [Update: Five of seven of these lawmakers lost their bids for re-election. Davis and Kelly narrowly beat their opponents.]
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