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Some political talking points just never die. Like this one, used in a recent ad aired by the National Republican Senatorial Committee in the hotly contested Iowa Senate race between Democratic Rep. Bruce Braley and Republican state Sen. Joni Ernst.
"Bruce Braley voted to cut $700 billion from Medicare to support Obamacare," the ad says. "That’s just not fair. We paid in. We paid for it. That should be there for us."
Here, we’re going to look at the claim that Braley "voted to cut $700 billion from Medicare to support Obamacare." (In a separate item, we’ll look at the second half of the claim.)
It’s correct that Braley, as a House member, voted for the Affordable Care Act in 2010. However, PolitiFact has been skeptical of numerous previous claims that Obamacare cuts Medicare, rating them either Half True or Mostly False, depending on how they are worded. Other fact-checkers have concluded similarly. The claim is too sweeping and doesn’t convey fully what the law is doing.
Here’s the gist.
As Congress was debating President Barack Obama’s health care law in 2010, its backers acted to fend off one line of criticism -- that the bill was a budget-buster -- by making sure the bill didn’t add to the deficit. To do this, they wrote into the law both new taxes and new savings.
Among the spending cuts were measures aimed at reducing the increase in future Medicare costs. When the law was passed, the reductions amounted to $500 billion over the following 10 years; eventually, as the 10-year budget window shifted a year or two into the future, the cost of these reductions rose to more than $700 billion.
Over 10 years, the combined reductions are estimated to be $415 billion for traditional Medicare, $156 billion for the managed-care option known as Medicare Advantage, $56 billion in payments to teaching hospitals that serve large low-income populations, and $114 billion in other categories, according to a Congressional Budget Office estimate.
But it’s important to note a few caveats.
First, while the ad implies that the law is slicing Medicare benefits, these are not cuts to current services. Rather, as Medicare spending continues to rise over the next 10 years, it will do so at a slower pace would have occurred without the law. So claims that Obama would "cut" Medicare need more explanation to be fully accurate.
Second, the savings are focused on lowering payments to hospitals and insurance companies. They are not aimed at beneficiaries.
For instance, the law makes significant reductions to Medicare Advantage, a subset of Medicare plans run by private insurers that serves roughly 30 percent of Medicare beneficiaries. Medicare Advantage was started under President George W. Bush, and the idea was that competition among the private insurers would reduce costs. But in recent years the plans have actually cost more than traditional Medicare. So the health care law scales back the payments to participating health plans.
Hospitals, too, will be paid less if they have too many re-admissions, or if they fail to meet other new benchmarks for patient care.
Does this mean that no senior citizen today would be harmed by the law’s passage? No. It’s possible that some beneficiaries, including Medicare Advantage participants, could see additional costs passed along to them, experience reductions in services, or find fewer doctors willing to treat them under Medicare.
For instance, Brook Hougesen, the NRSC’s press secretary, pointed to news coverage in Iowa about how 9,200 state residents, "many of them in rural areas of the state," had to choose a new Medicare Advantage plan to avoid losing coverage on Jan. 1, 2014. The shifts were prompted by some Medicare Advantage plans’ determination that they could not provide the minimum number of health care providers in thinly populated areas to satisfy Medicare Advantage rules.
Still, there’s a lot of uncertainty about the extent and scope of these cutbacks -- more than the ad lets on. Also, the ad ignores some of the benefits seniors will get from the law -- for instance, $48 billion over 10 years for Medicare Part D prescription coverage from the ACA’s provisions that targeted the so-called "donut hole." It also funds illness prevention benefits and expands preventive care benefits.
We asked Gail Wilensky, who headed Medicare and Medicaid for President George H.W. Bush, whether subsequent changes in the law’s implementation would undercut our previous skepticism about claims like those made against Braley, and she said they did not. The prior critiques of the claim "remain relevant," she said.
The ad says, "Bruce Braley voted to cut $700 billion from Medicare to support Obamacare."
The law does include cost savings that could impact some beneficiaries, such as Medicare Advantage participants. But the ad overlooks some key nuances.
The statement that suggests that the law is reducing benefits now, across the board, but it’s actually reducing the future growth of Medicare spending. The law also targets these reductions at health-care providers, not beneficiaries. And the ad ignores new spending from the law that would benefit Medicare beneficiaries, such as expanded coverage for prescriptions.
The statement is partially accurate but leaves out important details, so we rate the NRSC’s statement Half True.
National Republican Senatorial Committee, "Darlene" (ad), Sept. 4, 2014
Braley for Senate campaign, "Desperate New NRSC Medicare Scare Ad Recycles False Attack to Hide Ernst’s Risky Proposals," Sept. 4, 2014
Congressional Budget Office, estimated the direct spending and revenue effects of H.R. 6079, the Repeal of Obamacare Act as passed by the House of Representatives on July 11, 2012; July 24, 2012
Congressional Budget Office, "Insurance Coverage Provisions of the Affordable Care Act—CBO’s April 2014 Baseline," April 2014
Roll call vote on H.R. 3590 (On Motion to Concur in Senate Amendments to the Patient Protection and Affordable Care Act," March 21, 2010
KCRG, "More than 9,200 Facing Nonrenewal of Medicare Advantage Plans," Oct 3, 2013
PolitiFact, "The health care law raises taxes and cuts Medicare, says Scott Brown," Nov. 3, 2013.
PolitiFact Florida, "Rick Scott says Medicare rate cuts will affect seniors’ ability to keep their doctors, hospital and prevention services," March 3, 2014.
PolitiFact Florida, "Bill Young says he opposed $716 billion Medicare cut," Oct. 30, 2012.
PolitiFact Wisconsin, "Thompson says Baldwin voted to ‘gut’ Medicare," Oct. 21, 2012.
PolitiFact, "James Capretta says Obamacare is a ‘massive income redistribution,’" Dec. 5, 2013.
PolitiFact, "Obama claims Medicare benefits will not be cut under the health care bill," Aug. 14, 2009.
PolitiFact, "Medicare ‘cuts’ in the health care law will hurt seniors, says 60 Plus Association," Sept. 20, 2010.
PolitiFact, "Paul Ryan said President Obama ‘funnelled’ $716 billion out of Medicare at the expense of the elderly," Aug. 29, 2012.
PolitiFact Virginia, "American Crossroads says Tim Kaine urged $500 billion in Medicare cuts," June 20, 2012.
PolitiFact, "Will Obamacare hurt Medicare Advantage?" Aug. 19, 2013.
PolitiFact Virginia, "Gillespie says Obamacare "cuts seniors' Medicare," Sept. 8, 2014
FactCheck.org, "Misleading onslaught by 60 Plus," Sept. 17, 2010.
Email interview with Gail Wilensky, head of Medicare and Medicaid for President George H.W. Bush, Sept. 8, 2014
Email interview with Brook Hougesen, press secretary for the National Republican Senatorial Committee, Sept. 8, 2014
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