Fact checkers, Medicaid & the individual mandate

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By our reckoning, FactCheck.org did the best of the “elite three” in avoiding false or misleading statements in its fact checks touching on repeal of the individual mandate.

We found two articles dealing with the subject. One of them, from March 15, 2017, at least hinted at the CBO’s view that repealing the individual mandate would lower Medicaid enrollment (bold emphasis added).

Let’s go through the CBO numbers.

In 2018, “14 million more people would be uninsured under the legislation than under current law,” most of that due to the American Health Care Act’s immediate elimination of the individual mandate to have insurance or pay a tax, CBO said. CBO doesn’t give specific numbers, but says that “[s]ome of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

Six million of that 14 million reduction comes from a decrease in those insured in the nongroup market (including the ACA marketplaces), where those who don’t have employer or government insurance buy their own coverage. Five million comes from a reduction in Medicaid coverage, and 2 million is a decline in employer-based coverage.

 

We think FactCheck.org’s presentation likely hides from readers the degree to which the CBO tied Medicaid enrollment to the individual mandate.

FactCheck.org later did a May 8, 2017 fact check on the House GOP health care overhaul, looking at estimates of insurance losses for 2018 and 2026.

For the CBO’s 2018 projection, FactCheck.org offered its readers no real clue that the CBO said repealing the individual mandate would lower Medicaid enrollment.

FactCheck.org (bold emphasis added):

In 2018, “14 million more people would be uninsured under the legislation than under current law,” most of that due to the American Health Care Act’s immediate elimination of the individual mandate to have insurance or pay a tax, CBO said. CBO doesn’t give specific numbers, but says that “[s]ome of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

Six million of that 14 million reduction comes from a decrease in those insured in the nongroup market (including the ACA marketplaces), where those who don’t have employer or government insurance buy their own coverage. Five million comes from a reduction in Medicaid coverage, and 2 million is a decline in employer-based coverage. Six million of that 14 million reduction comes from a decrease in those insured in the nongroup market (including the ACA marketplaces), where those who don’t have employer or government insurance buy their own coverage. Five million comes from a reduction in Medicaid coverage, and 2 million is a decline in employer-based coverage.

 

For the CBO’s 2026 projection, FactCheck.org strongly implied that all the 14 million fewer receiving Medicaid were without coverage for reasons other than the repeal of the individual mandate:

CBO said that 14 million fewer people would have Medicaid coverage by 2026, compared with current law. That’s due to two major changes that the Republican legislation would make to the program. It would phase out the Affordable Care Act’s Medicaid expansion, with enhanced federal funding, and it would cap Medicaid spending per-enrollee, starting in 2020.

 

FactCheck.org’s fact checks agree with the narrative from the other fact-checkers: GOP health care reform efforts would force 14 million from insurance with some exceptions not warranting the descriptor “millions.” FactCheck.org, like the others, simply neglected to mention the CBO’s later explanation (bold emphasis added):

Changes Before 2020. Under current law, the penalties associated with the individual mandate apply to some Medicaid-eligible adults and children. (For example, the penalties apply to single individuals with income above about 90 percent of the federal poverty guidelines, also known as the federal poverty level, or FPL). CBO estimates that, without those penalties, fewer people would enroll in Medicaid, including some who are not subject to the penalties but might think they are. Some people might be uncertain about what circumstances trigger the penalty and others might be uncertain about their annual income. The estimated lower enrollment would result in less spending for the program. Those effects on enrollment and spending would continue throughout the 2017-2026 period.

 

FactCheck.org erred primarily by leaving out important context rather than by making overtly false statements. But its readers deserve the full story on the mandate’s effects on Medicaid enrollment.

On Page 4, we will review why each of the three fact checkers have good reason to know that their older fact checks misled their readers.

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