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Chalk up Sen. David Perdue, R-Ga., as someone who was unhappy about the Senate’s failure to pass a bill to repeal and replace the Affordable Care Act.
After the Senate fell one vote short of overturning key elements of President Barack Obama’s signature health care law, Perdue offered a statement, reprinted here in part:
"Throughout this entire process, we have witnessed everything that’s wrong with Washington. The Senate had a real opportunity to dismantle the most damaging parts of Obamacare. As Republicans have railed against the failures of Obamacare for the last seven years, Democrats have failed to acknowledge any shortcomings of Obamacare and refused to try to fix a broken system.
"Now, due to an unworkable budget process and politicians who put their political self-interests ahead of national interest, Obamacare remains the law of the land. This means that the poorest among us will continue to be fined because they can’t afford Obamacare. This means more than 300,000 Georgians below the poverty line will still not have access to the insurance Obamacare promised. Additionally, this means the Medicaid expansion will continue as an open-ended government program that cannot be sustained."
We wondered whether Perdue was right that the failure to pass the repeal bill means that "more than 300,000 Georgians below the poverty line will still not have access to the insurance Obamacare promised."
Perdue’s office told PolitiFact that he correctly stated that even with Obamacare in place, 300,000 Georgians below the poverty line can’t get insurance. The data we found showed that to be the case.
However, in decrying the demise of the GOP bills, Perdue glosses over the fact that independent experts say the Republican replacement bills would not have solved this problem; in fact, they would have made it worse.
According to the Kaiser Family Foundation, 309,000 people in Georgia are in the "coverage gap" -- a no-man’s-land where their income puts them above current Medicaid eligibility for their state but below the lower limit for premium tax credits for plans purchased on the ACA’s online marketplaces.
The House and Senate bills would have addressed this, but only in a limited way.
"Both the House and Senate bill would have offered these individuals tax credits," said Christine Eibner, a senior economist at the RAND Corp. But while these tax credits are "arguably better than nothing," Eibner said, it’s not really a viable policy solution for insuring hundreds of thousands of additional Georgians. That’s because the policies available would have such large deductibles that they’d either offer little protection from health care costs or scare off customers from buying a plan in the first place.
While the tax credits in the Senate bill would have required relatively small premiums for those in poverty, the independent Congressional Budget Office estimated that the deductible for a typical plan under the Senate bill would be $6,000, likely making it "unaffordable for a person with income under the poverty level," Eibner said.
And for the House bill, Eibner said, the CBO estimated that a low-income older person "could face net premiums in the range of $13,600 to $16,100, even after accounting the tax credits available."
Such realities played into the CBO’s conclusion that the Senate bill nationally would leave 22 million fewer Americans insured by 2026 than if current law continued. The CBO’s estimate for the House bill was 23 million fewer Americans insured.
As for Georgia specifically, the Senate bill would have increased the number of uninsured Georgians by 376,000 in 2022, according to an analysis by the Urban Institute. For the House bill, the Urban Institute projected an additional 304,000 uninsured Georgians in 2022.
Bottom line: Those Georgians might have "access" to policies, as Purdue put it, but that’s a far cry from actually getting insurance, much less adequate insurance. The reality, independent experts say, is that the coverage they’d have access to doesn’t offer out-of-pocket costs that are affordable enough to get many new people on the insurance rolls. In fact, any of the repeal-and-replace proposals would have decreased the number of people with insurance substantially compared to current law.
There’s another problem: Georgia turned down an opportunity under the Affordable Care Act to expand Georgia’s eligibility for Medicaid. The state would have had to pick up about 10 percent of the bill, with the federal government paying about 90 percent.
The most recent analysis by the Urban Institute found that Medicaid expansion in Georgia -- which is still on the table if the GOP-led state wanted to accept it -- would reduce the number of uninsured Georgians by between 460,000 and 556,000 people in 2021.
In other words, the state could have covered even more low-income Georgians than Perdue’s 300,000 by expanding Medicaid under Obamacare. (And, as we noted above, it’s unlikely that the Republican bills would have covered those 300,000.)
"To blame the ACA for the state government of Georgia’s decision not to expand Medicaid eligibility is a tremendous distortion," said Urban Institute health policy specialist Linda Blumberg.
Perdue said that because of the failure to pass a repeal bill, "Obamacare remains the law of the land ... This means more than 300,000 Georgians below the poverty line will still not have access to the insurance Obamacare promised."
Perdue has a point: Even with Obamacare in place, 300,000 Georgians below the poverty line can’t get insurance. However, in the context of decrying the failure of the Republican bills to advance in Congress, this observation is misleading.
While the Senate and House bills would have offered tax credits to low-income Americans, independent analysts agree that these tax credits wouldn’t open the door to affordable insurance for low-income Americans.
Perdue’s criticism of Obamacare is also problematic. In reality, the ACA’s Medicaid expansion could have covered even more than 300,000 low-income Georgians had it not been rejected by Perdue’s fellow Republicans in Georgia.
We rate the statement Half True.
David Perdue, statement, July 28, 2017
Kaiser Family Foundation, "The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid," Oct 19, 2016
Kaiser Family Foundation, "Status of State Action on the Medicaid Expansion Decision," Jan. 1, 2017
Urban Institute, "State-by-State Coverage and Government Spending Implications of the American Health Care Act," June 2017
Urban Institute, "Effects of Revised BCRA on the Uninsured and on Federal Health Care Funding for the Nonelderly, 2022," accessed Aug. 2, 2017
Urban Institute, "The Cost of Not Expanding Medicaid: An Updated Analysis," April 2017
Congressional Budget Office, analysis of "H.R. 1628, American Health Care Act of 2017," May 24, 2017
Congressional Budget Office, analysis of H.R. 1628, Better Care Reconciliation Act of 2017, June 26, 2017
Email interview with Christine Eibner, senior economist at the RAND Corp, Aug. 2, 2017
Email interview with Timothy Jost, emeritus law professor at Washington and Lee University, Aug. 2, 2017
Email interview with Linda Blumberg, senior fellow at the Urban Institute, Aug. 2, 2017
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