Fact checkers, Medicaid & the individual mandate

Glenn Kessler, aka “The Washington Post Fact Checker”

The Washington Post Fact Checker

We found three articles from the Fact Checker dealing with bills that include a repeal of the individual mandate.

In its March 14, 2017 fact check of White House press secretary Sean Spicer, the Fact Checker quoted Spicer’s claim questioning the CBO’s projection that 14 million would lose insurance by 2018. Spicer said the number made no sense as a response to to repealing the ACA’s individual mandate.

The Fact Checker chided Spicer over his grasp of math, then launched into a description that failed to make clear the role of the individual mandate:

Spicer seems to be having trouble with the math here, so we will help him. Table 5 of the CBO report explains exactly how this works. First of all, the 14 million number reflects the second year (2018), not the first year. In the first year, the number of uninsured increases by 4 million compared with current law. In the second year, CBO projects that 5 million fewer will have Medicaid coverage, 6 million fewer will have individual coverage and 2 million fewer will receive insurance from employers. (The tax credits in the proposal creates some incentives for employers to stop providing coverage.) That rounds up to 14 million when including marginal effects in other insurance coverage.


Was Spicer’s skepticism of the numbers caused by the false assumption that the individual mandate would not affect Medicaid enrollment?

The Fact Checker mentions the 5 million drop in Medicaid enrollment but does not explain to readers why the CBO projects lower Medicaid enrollment after repealing the individual mandate. Readers like PolitiFact’s Jon Greenberg could have used some help.

The Fact Checker’s next fact check that might have addressed the issue, from March 17, 2017, also mentions lower enrollment in Medicaid but again fails to explain to readers why repealing the mandates would result in lower Medicaid enrollment. Note how the Fact Checker describes the insurance losses:

The CBO estimated that under the GOP replacement bill, 14 million fewer people would be insured in 2018 than under the current health-care law and 24 million fewer people insured by 2026.

But this does not mean all of the 14 million or 24 million will be “thrown off” health insurance or “lose” health insurance.

Some of the people who would be uninsured would choose not to have insurance, because they had decided to obtain health insurance only to avoid a penalty under the ACA’s individual mandate; the replacement bill eliminates the mandate. Others, such as elderly Americans, would not get insurance because the premiums are too high. (The replacement bill would allow the elderly to be charged five times as much as the youngest insured, compared with a 3:1 ratio under the ACA.) Many of the uninsured people would lose insurance because of reductions in Medicaid enrollment — after some states discontinue the Medicaid expansion under Obamacare.


“Some” would choose not to have insurance to avoid the shared responsibility payment (the Fact Checker revised this wording in September 2017, arguably improving it slightly). “Others” would find themselves priced out of the market. “Many” would lose insurance when some states drop the ACA’s Medicaid expansion.

The Fact Checker closely paraphrases the CBO, but simply omits any mention that millions of people will stop signing up for Medicaid when the threat of the mandate penalty disappears. That omission would encourage the Fact Checker’s readers to conclude that lower projected enrollment in Medicaid occurs simply because of states moving away from the ACA’s Medicaid expansion. Readers led to believe that were misled.

The Fact Checker’s March 20, 2017 version, a “Recidivism Watch” article, repeated the same analysis from the March 17, 2017 version, minus a paragraph stating the CBO’s opinion that “most” of the projected decline in insurance enrollment stemmed from repeal of the mandate penalty.

None of the Fact Checker’s three attempts describe the effect on Medicaid enrollment stemming from repeal of the individual mandate.

And what of FactCheck.org, the gold standard among the “elite three” mainstream media fact checkers?

See Page 3.

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