UPDATE x2: Fiorina/Jindal become first to say anything substantive re. ACA during a GOP debate!
UPDATE 11/11/15: I've gone back through and annotated both Fiorina and Jindal's statements this morning.
UPDATE x2 11/11/15: PolitiFact is using a bunch of my stats in their own thorough debunking of Fiorina's claims.
Wow! After 3 1/2 Republican debates spanning upwards of 13 hours or so (7 debates, actually, if you include the "Kiddie Tables" separately), a few hours ago FOX Business Channel's Maria Bartiromo finally asked a substantive question regarding the Affordable Care Act, and Carly Fiorina was the first Republican candidate to actually say anything substantive about it (note: I'm not counting the boilerplate "we need to repeal/replace Obamacare!" bits tossed on the plate like croutons by Marco Rubio and Jeb Bush).
Of course, just because her response was "substantive" doesn't mean it was accurate. Here's the (only) ACA question and her response; I see several flat-out lies (along with a few points which are actually valid):
BARTIROMO: We go back to Facebook. Dewayne Wesley Cato asks on Facebook, how do we get rid of regulations choking our businesses? Ms. Fiorina? Specifically, under the president's Affordable Care Act, employers with 50 or more employees are required to offer health insurance, or be fined. Many are opting to pay the fine. Others are cutting back employee hours to duck the law altogether. What specific ways will you alleviate the pressure on small business?
Notice that the premise that regulations "choking" businesses is presumed to be an accepted fact right off the bat. Obviously, this is a Republican debate moderated by FOX, so that's not much of a shock.
Also note that Bartiromo gives some statements about cutting hours/refusing to comply with generic, non-specific clarifiers ("many", "others are"), with good reason:
Employers have not been cutting workers' hours to escape having to provide them with health insurance, a new ADP Research Institute report has found.
"For all the talk, there have been very small shifts in part-time hiring...almost statistically insignificant," said Christopher Ryan, vice president of strategic advisory services at ADP, a human resources consulting firm.
Anyway, that was the question; here's Fiorina's response:
FIORINA: Well, first Obamacare has to be repealed because it's failing...it's failing the very people it was intended to help, but, also, it is croney-capitalism at its worst. Who helped write this bill? Drug companies, insurance companies, pharmaceutical companies, every single one of those kinds of companies are bulking up to deal with big government. See, that's what happens. As government gets bigger, and bigger -- and it has been for 50 years under republicans and democrats alike -- and business have to bulk up to deal with big government.
- How is the ACA "failing"? She doesn't say. One major goal of the law is to reduce the uninsured; it's doing an excellent job on that front.
- Another is to stop the worst abuses of the insurance industry; it's also succeeded there (no more denials for pre-existing conditions; no more rescission; the 80/20 medical loss ratio; discouraging "junk policies"; etc etc).
- In terms of keeping costs down for low-income enrollees it's kind of a mixed bag so far (Medicaid expansion, APTC & CSR are doing a great job for those under 250% FPL, not so great for those above that threshold).
- Finally, in terms of cost containment of healthcare in general, that's probably the ACA's weakest point; there was a historic slowdown in the rate at which overall healthcare spending has grown for a couple of years, along with a slowdown in premium rate growth...but both of these may have been temporary, and it doesn't mean much to the average employee if their employer is still shifting more of their insurance cost onto them anyway.
- Fiorina is correct, however, that yes, the drug & insurance companies were heavily involved in writing the ACA. Then again, as Emergency Physician Alison Haddock noted last night:
@charles_gaba Imagine the R outrage if Obama had NOT involved the free-market innovator/"crony capitalist" private corps in #ACA discussions!
— Alison Haddock (@AdvocacyMD) November 11, 2015
So, we have to repeal it. It's tens of thousands of pages long, no one can possibly understand it except the big companies, the lawyers, the accountants, the lobbyists that they hire to protect their interests. Then, we have to give back to states the responsibility to manage a high risk pool.
- Actually, while the ACA is indeed a pretty big law, the actual text of it is only 906 pages (961 if you include the reconciliation act which goes with it). Now, there are several thousand pages of regulation specifics, but that's likely true of any law which impacts (directly or indirectly) 1/6th of the nation's economy, which I suppose is Fiorina's point. Health insurance is complicated; that's hardly a revelation.
- Um...a lot of states did have "high risk pools" which they were responsible for managing. They didn't do such a great job. "High Risk Pools" are very expensive by definition (since the whole point is to separate out the most expensive patients to treat), and those programs were massively underfunded.
We need to try the one thing in health insurance we've never tried. Health insurance has always been a cozy, little game between regulators and health insurance companies. We need to try the free market. The free market. Where people actually have to compete.
- Um..."the free market" is what we already had prior to the ACA. That's what led to people being denied coverage for pre-existing conditions, people being kicked off their policies for missing a dotted "i" or crossed "t", people being sold junk "policies" which really didn't cover anything and so forth.
- Furthermore, the ACA exchanges are a "free market" where insurance companies do have to compete for customers. They just have to do so on a level playing field now, that's all.
And, we 'ought to have the government ensure that you must -- and I don't use that term often, that government 'ought to do something, but every healthcare provider 'ought to publish its costs, its prices, its outcomes, because as patients we don't know what we're buying.
- I actually agree with her on this one...healthcare providers should have to publish their costs/prices/etc. That's called "government regulation". Glad to have you on board, Carly!!
BARTIROMO: Just to be clear, you want to repeal Obamacare...but, what's the alternative?...and how does that help small business...?
FIORINA: The alternative is to allow states to manage high risk pools for those who really need help. Look, I'm a cancer survivor, OK? I understand that you cannot have someone who's battled cancer just become known as a pre-existing condition. I understand that you cannot allow families to go bankrupt if they truly need help. But, I also understand that Obamacare isn't helping anyone.
- Again with the high risk pools, which were an abject failure.
- Nice to hear that Carly, a cancer survivor herself, understands the concept of being denied coverage for having a pre-existing condition (not that she was ever denied, I don't imagine, and with her $40 million golden parachute payment for nearly destroying Hewlett-Packard, I don't suppose she has to worry about going bankrupt, but she apparently grasps the concept)
- I'm pretty sure the millions of other people with pre-existing conditions who have healthcare coverage now, as well as the millions who have Medicaid and low-income folks who are receiving substantial financial assistance to cover their private policies, all thanks to the ACA, would disagree that it's "not helping anyone".
We're throwing more, and more people into Medicaid, and fewer, and fewer doctors are taking those payments.
- As Jeffrey Young notes over at the Huffington Post, "while physicians are more likely to see patients with private insurance or Medicare, 75 percent of Medicaid beneficiaries told Gallup they were satisfied with their coverage, a higher rating than given by people with health plans provided by employers or unions."
The point is Obamacare is crushing small businesses, it is not helping the families it was intended to help. So, let us allow states to manage high risk pools. Let us try the one thing in health insurance we've never tried, the free market. Let us ensure that as patients, and customers...that we have information to shop wisely for our health care.
- In short: No, it's not "crushing" small businesses. Yes, it's helping (most of) the families it was intended to help (below a certain threshold). No, state-run high risk pools don't work. Yes, we've already tried the "free market" and it was a disaster without reasonable regulations/restrictions. However, yes, we, as patients should indeed have the information necessary to "shop wisely" (the ACA does a pretty good job of this on the insurer front, not so much on the provider front).
By my count, that's about 7 flat-out lies/misstatements by Fiorina, along with 2 truthful statements (one of which is very unflattering for the private, profit-based market; the other of which supports more government regulation).
UPDATE: WHOOPS!! I almost forgot about Tuesday's "undercard" (aka "Kiddie Table") debate; it turns out Bobby Jindal did go off on an anti-ACA rant of his own (with an assist, of sorts, from Chris Christie):
JINDAL: Records -- records matter. Yes, we've got to beat Hillary Clinton. But Chris, it's also true that you expanded food stamps at a time that we've got record numbers of Americans on food stamps. It's also true you caved into ObamaCare. You expanded Medicaid.
...CHRISTIE: You know, the fact is, he's done -- done a nice job down in Louisiana, and I don't have any problem with the job he's done. I've cut spending $2 billion dollars, except for our pension and health care in New Jersey, which was driven predominantly by Obamacare. We have reduce the number of employees we have on the state payroll by 15%, but, you know what? The people out there don't care about any of that.
...REGAN: ...Let me get in here, because the next question, it's to you, and it's on Obamacare. It is still unpopular with the American people. You've seen the polls, they've shown nearly half the country still opposes this law. You have been critical of your GOP opponents, some of them standing on the stage tonight, others later. Notably, Ted Cruz, for not having comprehensive plans.
You say you do. What specifically makes your plan to replace Obamacare better than the opponents, some of them standing next to you.
- While the snarky response here for me would be "if 'nearly half' oppose the law, that suggests that 'more than half' support the law, which means it's not unpopular by definition...but the reality is that it's more like 40% approve, 40% disapprove, 20% aren't sure, so it's sort of a mixed bag.
JINDAL: Well, look, only one other opponent, actually, one other candidate, actually, has a plan. That's Jeb Bush, and he creates a new entitlement program. My plan actually gets rid of all of Obamacare, it's great that Senator Cruz will shut down the government over Obamacare, but he still hasn't given us his plan to get rid of it. It's great that other republicans talk about getting rid of it.
- OK, so far all Jindal has stated is that his "plan" would "get rid of" the ACA. OK....
You go to a town hall in Iowa, or New Hampshire, ask them how they're actually going to get rid of it -- my plan has been online for over a year. It gets rid of all of Obamacare, it reduces the cost. It actually puts Americans, their patients, their doctors back in control. And, it actually helps those that really need this help -- but, this is one of the most critical issues we face domestically.
- Um..."Reduce costs! Put people/patients/doctors in control!" is not a "plan". That's a goal, not a plan. That's like me saying that my "plan" to solve the Syrian crisis is to "Make the people living there stop fighting!"
I think I -- look, right now, I think I am the only candidate running that refused to expand Medicaid. I'm the only one that turned down -- that did what we could to fight Obamacare. This is an important point, and, look, I appreciate Chris's nice compliments to me. And, Chris, you look to me very well, I love Mary-pat, but this isn't about me and Chris. This is about the country, and this is about what direction -- this is the most important election in our lifetimes.
- Bobby Jindal is now actually bragging about screwing over nearly two hundred thousand of his own constituents as if this is something to be proud of; in GOP circles, apparently this is the case.
Folks, a couple of years ago they told us give them the republican majorities in the House and the Senate, they'd stop Obamacare, and amnesty, and the bad Iran deal -- nothing changed. If they fooled us once, shame on them. If they fooled us twice, shame on us. Don't let them fool us again.
Finally, switching to Chris Christie for a moment:
...CHRISTIE: Yeah, listen. We stopped Obamacare in New Jersey because we refused to participate in the federal exchange. But, here's the bigger issue. What do you think's going to happen when Hillary Clinton's elected president of the United States? The woman who tried to impose healthcare on this country over 20 years ago? And, she was stopped then by a strong group of republicans, and an American public that said, "No, thank you."
- First of all, Chris, you didn't "stop" Obamacare in New Jersey. You are participating in the federal exchange. What you're refusing to do is participate in setting up your own exchange...and while that's a shame, in the post-King v. Burwell environment that doesn't really impede the ACA whatsoever beyond not allowing for some local control on your part.
- Finally, thanks for reminding the entire country that Hillary Clinton tried very hard to "impose" healthcare coverage on the country...and that it was the Republicans who stopped the country from receiving healthcare coverage. Having healthcare coverage is a good thing; I'd think that you of all people would know that.
OK, did I miss anything?