PolitiFact, Wrong Again on Health Care

by Ramesh Ponnuru

Getting rid of fines for people who lack health insurance would lead around 14 million fewer people to choose to get it: That’s what various Congressional Budget Office reports this year imply, as I wrote on NRO recently.

A reader writes in to tell me, “Paul Ryan said the same thing and Politifact has already debunked it.” He goes on to tell me to stop being a Republican hack, spreading lies, etc. He also sends me the PolitiFact link.

My reader’s faith in PolitiFact is misplaced.

In late June, Ryan spoke to Fox News about the CBO’s projections about the health-care bill then before the Senate. He said that the CBO was “basically” saying that a lot of people would choose not to buy health insurance once freed from the threat of fines, and that changes to Medicaid would keep some states from expanding their programs and letting people join the rolls. Jon Greenberg of PolitiFact graded Ryan’s claim “mostly false.”

As it happens, I’ve criticized Greenberg’s work on health care for PolitiFact before. On this occasion, too, Greenberg was just mistaken. The root problem is that Greenberg assumed that the fines on people without insurance—Obamacare’s “individual mandate”—operate only in the market for individually purchased health insurance and that getting rid of them has no effect on Medicaid enrollment. So he thinks that all of the decline in Medicaid enrollment that CBO projects are the result of reforms to Medicaid that would have kept people who want it from getting it, and Ryan is exaggerating the effect of the fines.

That’s not at all what CBO assumes, and the very CBO report to which Greenberg links says so (twice, on p. 19). Subsequent CBO reports have made the point even clearer. In late July, the CBO estimated the effects of a “skinny bill” that made no reforms to Medicaid but got rid of the fines for people without insurance. CBO found that the bill would cause 7 million fewer people to enroll in Medicaid in 2026.

It is, perhaps, to Greenberg’s credit that a finding this implausible did not occur to him. But that is what the CBO was saying: Get rid of the fines, and 7 million people will refrain from signing up for a benefit that is effectively free to them.

The CBO’s report on the skinny bill also knocks out a second argument from Greenberg. The CBO had projected that the fatter Senate bill would lead to 7 million fewer people having insurance in the individual market, too. Greenberg said that Ryan was wrong to say these people would “basically” be leaving the market because Republicans gave them the option to do it without being fined. Many of those people, Greenberg said, would leave the market because the bill reduced their subsidies. The skinny bill didn’t change the subsidies, though, and the CBO revised its number from 7 million to. . . 6 million.

Ryan was right, and PolitiFact just doesn’t understand what it’s talking about. We should remember that if health-care legislation comes back from the dead—or, really, any time that the website grades anyone for accuracy.

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