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Amy Sherman
By Amy Sherman October 9, 2012

American Crossroads attacks Bill Nelson on health care and Medicare, and that oft-repeated "deciding vote"

American Crossroads makes multiple claims about health care and Medicare in a recent ad attacking U.S. Sen. Bill Nelson, D-Fla.

The ad shows a bleak photo of an empty examining table: "This is where seniors could find out their Medicare benefits have been rationed or don’t cover their treatments," states the narrator.

Then the scene moves to a boardroom table: "And this is where 15 unelected bureaucrats could decide to cut Medicare spending, cuts that could go into effect without Congressional approval. And this is where Sen. Nelson cast the deciding vote for Obamacare cutting Medicare spending by $700 billion and letting an unelected board decide what gets covered here," showing pictures of the U.S. Capitol and a hospital hallway.

The claims by the conservative PAC are similar to other claims we’ve fact-checked, but the wording is slightly different. We will evaluate whether Nelson cast the deciding vote for Obamacare cutting Medicare spending by $700 billion and letting an unelected board make coverage decisions. (We contacted American Crossroads for their evidence, but we didn't hear back.)

Deciding vote?

Accusing Nelson of casting "the deciding vote" on the health care law has become a conservative talking point as he faces U.S. Rep. Connie Mack IV, R-Fort Myers. Ads from outside spending groups such as American Commitment, the 60 Plus Association and Mack himself have all made similar claims.

As we explained in an earlier fact-check, the health care law was passed with several very close votes. One of the key votes happened on Dec. 24, 2009, when 59 Democrats and one independent voted together in favor of the bill. (Sixty votes were needed for a preliminary cloture vote to prevent filibusters.) The ad cites a vote on Dec. 23 on a cloture motion which passed 60-39 with Nelson voting in the majority to move the bill forward.

Opponents of the law have argued that any of those 60 cast the deciding vote, because every vote was needed to pass the bill.

We find that argument unpersuasive (see our previous report), because there’s evidence in the record to show that some of those votes were more critical than others. On the health care law, some senators did hold out until the last minute -- but Nelson -- as in Bill Nelson of Florida -- wasn’t one of them.
The Los Angeles Times, which wrote extensively about the negotiations in passing the law, reported that some of the most crucial votes came from Sen. Joe Lieberman, I-Conn.; Sen. Ben Nelson, D-Neb.; and Sen. Russ Feingold, D-Wis.

Nelson was initially quiet about health care reform, angering some Democratic activists. But in October 2009, Nelson joined other Democrats on the Senate Finance Committee in voting for the health care plan. Nelson wasn’t a leading early activist of the bill, but he wasn’t a last minute supporter, either. This part of the ad claiming that Nelson cast "the deciding vote" is wrong.

Does the health care law cut Medicare spending by $700 billion?

We’ve seen a long list of claims about the health care law and a $700 billion Medicare cut. How accurate the claims are depend on the wording.

As we explained in our previous fact-checks, neither Obama nor his health care law literally cut a dollar amount from the Medicare program’s budget.

Rather, the health care law instituted a number of changes to try to bring down future health care costs in the program. In its most recent estimates, the CBO looked at the years 2013 to 2022 and determined the health care law reduced Medicare outlays by $716 billion.

The reductions include the amount of annual increases health care providers would receive from Medicare, administrative changes and alterations to Medicare Advantage.

PolitiFact has repeatedly ruled that these don’t represent cuts, but rather an attempt to curtail future Medicare spending. The program is still projected to grow, the Congressional Budget Office predicts, just at a slower rate under the so-called Obamacare guidelines.

An unelected board

The ad also says that the health care law is "letting an unelected board decide what gets covered here" and says Medicare patients could find out their benefits have been "rationed."  

We’ve checked a whole slew of claims about the health care law and the Independent Payment Advisory Board, or IPAB. (The nonpartisan Kaiser Family Foundation has a good primer about the board and a longer paper.)

In many cases, political ads have falsely claimed that the board will ration care and deny treatments to patients.

We have previously explained  that the health care law directs the new board — with 15 members who are political appointees — to identify Medicare savings. It's forbidden from submitting "any recommendation to ration health care," as Section 3403 of the health care law states. It may not raise premiums for Medicare beneficiaries or increase deductibles, coinsurance or co-payments. The IPAB also cannot change who is eligible for Medicare, restrict benefits or make recommendations that would raise revenue. Finally, the board only makes recommendations if Medicare is exceeding its budget targets.

What it can do is reduce how much the government pays health care providers for services or recommend innovations that cut wasteful spending. Some may argue that because the IPAB can reduce the money a doctor receives, this could lead to reductions in services.

But the board wouldn't make any health care decisions for individual Americans. Instead, it would make broad policy decisions that affect Medicare's overall cost.

The does mean the board decides what gets covered, at least in some cases. We should note, though, that Congress can override the board’s decisions if it makes up the cuts some other way.

Our ruling

American Crossroads packs a bunch of claims into one sentence in its ad: "Sen. Nelson cast the deciding vote for Obamacare,cutting Medicare spending by $700 billion and letting an unelected board decide what gets covered here."

Let’s summarize on the three points:

• Nelson cast a vote in favor of the health care law, but news reports suggest he was not even one of a few final hold outs. He did not cast "the" deciding vote.

• The health care law cuts future growth of Medicare spending by about $700 billion but it still grows. This part of the ad has some truth to it but requires further explanation.

• The unelected IPAB board is tasked with finding Medicare savings. It can reduce how much government pays for services, and some fear that could lead doctors to not order certain treatments. It does not make decisions for individual patients, but it can recommend changes to bring down costs, including about what gets covered. Its powers are limited, however, and its decisions can be changed by Congress if Congress is willing to identify other savings.  

The Crossroads ad phrases its statements more carefully than some others we’ve seen, but it still gives a misleading impression about what the health care law means for Medicare beneficiaries. We rate this claim Mostly False.

Featured Fact-check

Our Sources

Tampa Bay Times The Buzz blog, "Crossroads attacks Bill Nelson on Medicare in new attack ad," Sept. 25, 2012

PolitiFact, "Another outside group says Bill Nelson was the deciding vote," July 11, 2012

PolitiFact, "Was Florida’s Bill Nelson ‘the deciding vote’ on the health care law?"June 14, 2012

PolitiFact, "Bill Nelson, health care and ‘the deciding vote,’"June 14, 2012

PolitiFact, "NRSC attacks Michael Bennet for casting ‘the deciding vote’ for stimulus, health care,"Oct. 26, 2010

PolitiFact, "Mitt Romney said Barack Obama robs Medicare of more than $700 billion to pay for Obamacare,"Aug.  15, 2012

PolitiFact, "Rhetoric rises over payment advisory board,"April  2, 2012

PolitiFact, "$500 billion from Obamacare for Medicare, Mitt Romney says,"June 16,  2011

PolitiFact, "NRSC attacks Michael Bennet for casting ‘the deciding vote’ for stimulus, health care,"Oct. 26, 2010

U.S. Senate, roll call vote on the motion to invoke cloture on H.R. 3590 (health care bill), Dec. 23, 2009

Govtrack,H.R. 3590 Senate vote 396, Dec. 24, 2009

Los Angeles Times, "How Harry Reid threaded a needle," Dec. 24, 2009 (accessed via Lexis-Nexis)
Miami Herald, "Bill Nelson enters healthcare reform debate," Sept. 29, 2012
The Hill Healthwatch blog, "GOP aims for focused IPAB attack,"July 13, 2011

Cato,"The Independent Payment Advisory Board," June 14, 2012

Miami Herald’s Naked Politics blog,"Connie Mack video response to Nelson ad: Senator’s a ‘typical politician wants to talk about Hooters and what I did as a kid,’"Aug. 9,  2012

Congressional Budget Office,CBO's Analysis of the Major Health Care Legislation Enacted in March 2010, March 30, 2011

Congressional Budget Office, Letter to House Speaker John Boehner about health care law, July 24, 2012
The Kaiser Family Foundation, "The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending," April 2011

The Kaiser Family Foundation, "Explaining health reform: Medicare and the New Independent Payment Advisory Board,"May 2010

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American Crossroads attacks Bill Nelson on health care and Medicare, and that oft-repeated "deciding vote"

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