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Kathy Manning, democratic candidate for the the 13th Congressional District of North Carolina, during an election rally in Greensboro, N.C., on Oct. 19, 2018. (AP/Gerry Broome) Kathy Manning, democratic candidate for the the 13th Congressional District of North Carolina, during an election rally in Greensboro, N.C., on Oct. 19, 2018. (AP/Gerry Broome)

Kathy Manning, democratic candidate for the the 13th Congressional District of North Carolina, during an election rally in Greensboro, N.C., on Oct. 19, 2018. (AP/Gerry Broome)

Bill McCarthy
By Bill McCarthy October 22, 2018

Fact-checking Kathy Manning’s ad on Ted Budd and pre-existing conditions

Two years ago, Republicans were attacking Democrats for backing the Affordable Care Act. But the tables have turned.

These days, Democrats across the country are citing the popularity of the ACA, also known as Obamacare, and blasting Republicans for their repeated efforts to chip away at it.

In North Carolina’s 13th Congressional District, which includes Statesville, High Point and parts of Greensboro, a 30-second television ad from Democratic congressional candidate Kathy Manning targets incumbent Republican Rep. Ted Budd for his vote on a "repeal and replace" bill.

The ad cites the case of a woman named Lilly who "worked her way through UNC while living with a tumor that radiation and surgery could not cure."

"But Lilly’s congressman, Ted Budd, voted to gut protections for pre-existing conditions like hers, letting insurance companies deny coverage for the treatment she needs," the ad says.

Budd is not the first Republican to see this attack. In the last several weeks, PolitiFact’s state affiliates have awarded Half True ratings to nearly identical ads and statements from Democrats in Wisconsin, Florida, Virginia and California.

Manning’s ad has been active on Facebook for more than a month, and the Manning campaign even set up a special website to showcase it. So we decided to give it a fresh look and see how it stacks up against the facts.

The American Health Care Act and the MacArthur amendment

The Manning campaign declined to comment, but its website cited articles from Time, CNN and the AARP to back up the claim.

The website noted that the vote in question was related to the American Health Care Act of 2017, a Republican plan to overhaul Obamacare. The AHCA, as the bill was called, passed the House with a 217-213 margin before ultimately failing in the Senate.

The AHCA would have retained some components of Obamacare while eliminating the individual mandate and making other modifications.

Budd voted yes on the AHCA, and while it did not allow states to refuse coverage to people with pre-existing conditions, it did open the door for insurers to hike premiums for those people under certain circumstances.

Specifically, an April 2017 amendment from Rep. Tom MacArthur, R-N.J., would have allowed states to apply for waivers to some requirements of the Affordable Care Act.

As PolitiFact noted in its guide to the MacArthur amendment, the amendment would have let states seek waivers from the AHCA’s "continuous coverage" provision, which was supposed to require that Americans continuously carry health insurance or else face higher premiums for one year.

Insurers in states receiving waivers would have been permitted to consider a person’s health status when setting premiums in the individual market for the year of penalty. In other words, they would have been able to raise the premiums, for one year, of a person with a pre-existing condition so long as that person had been uninsured for 63 consecutive days the previous year.

Currently under Obamacare, premiums can only vary based on certain conditions, such as age, location or tobacco use. Any person without employer or government-provided health insurance is guaranteed access to coverage in the individual market — regardless of his or her health status — and cannot be charged a higher rate because of a pre-existing condition.

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What would the AHCA have meant for pre-existing conditions?

Elizabeth Oglesby, Budd’s campaign manager, said Manning’s claim about protections for pre-existing conditions was inaccurate.

"Not one person would be denied health insurance for pre-existing conditions, and (Manning) should apologize for her false, smear campaign and take down her ad," she said.

Indeed, the MacArthur amendment explicitly stated that "nothing in this Act shall be construed as permitting insurers to limit access to health coverage for individuals with pre-existing conditions."

But there’s more nuance to unpack here.

As we mentioned before, the amendment would have allowed insurers to consider pre-existing conditions when writing policies for people who had lapses in their coverage the previous year.

The Kaiser Family Foundation estimated that could mean that 6.3 million people could have faced higher premiums under the AHCA because of pre-existing health conditions.

That’s a significant number, but a small portion of the estimated 50 to 120 million people under 65 with pre-existing conditions. That means somewhere between 4 and 13 percent of people under 65 with pre-existing conditions could have experienced heightened premiums under the AHCA.

As PolitiFact has noted before, many low-income people have trouble staying covered without lapses, and the waiver system could have led insurers to drive premiums too high for these people during penalty years.

The ACHA would have appropriated $8 billion over five years to assist people who could not afford the penalty premiums. The waivers would have also allowed states to set up high-risk pools or participate in a federal invisible risk-sharing program to reimburse insurers for taking on high-risk individuals.  

But it’s not clear how effective either measure would have been. In a press release, the American Medical Association warned that the AHCA’s waiver program "could make coverage unaffordable for people with pre-existing conditions."  

That’s why, when President Donald Trump and North Carolina Republican Rep. Robert Pittenger said the AHCA included coverage for pre-existing conditions, PolitiFact gave them both Mostly False ratings.

Our ruling

Manning’s ad said Ted Budd "voted to gut protections for pre-existing conditions … letting insurance companies deny coverage for the treatment (Lilly) needs."

The bill included a line stating that insurers would not have been allowed to restrict access to healthcare for people with pre-existing conditions.

But in a limited way, the AHCA would have rolled back protections for pre-existing conditions by letting some insurers raise premiums based on a person’s health status under certain circumstances. This could have led to somewhere between 4 and 13 percent of people under 65 with pre-existing conditions facing higher premiums.  

Overall, Manning’s ad is partially accurate, but leaves out important details and context. We rate this statement Half True.

This story was produced by the North Carolina Fact-Checking Project, a partnership of McClatchy Carolinas, the Duke University Reporters’ Lab and PolitiFact. The NC Local News Lab Fund and the International Center for Journalists provide support for the project, which shares fact-checks with newsrooms statewide.

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PolitiFact rating logo PolitiFact Rating:
Half True
Says Ted Budd "voted to gut protections for pre-existing conditions … letting insurance companies deny coverage for (necessary) treatment."
in a television ad
Tuesday, October 9, 2018

Our Sources

Kathy Manning on YouTube, "Kathy Manning: ‘Lilly,’" Oct. 9, 2018, "H.R.1628 — American Health Care Act of 2017," accessed Oct. 18, 2018

H.R. 1628, "FINAL VOTE RESULTS FOR ROLL CALL 256," May 4, 2017

U.S. House of Representatives, "Amendment To H.R. 1628 Offered By Mr. MacArthur of New Jersey," accessed Oct. 18, 2018

CNN, "House takes first step towards repealing Obamacare," Jan. 13, 2017

Time, "50 Health Issues That Count as a Pre-existing Condition," May 4, 2017

AARP, "New House Health Plan Threatens Coverage for Preexisting Conditions," April 27, 2017

The Washington Post, "Kamala D. Harris’s claim that 129 million people with preexisting conditions ‘could be denied coverage,’" May 10, 2017

USA Today, "Fact check: The pre-existing conditions debate," May 7, 2014

Henry J Kaiser Family Foundation, "Compare Proposals to Replace The Affordable Care Act," accessed Oct. 18, 2018

Henry J Kaiser Family Foundation, "Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA," Dec. 12, 2016

Henry J Kaiser Family Foundation, "Analysis: 6.3 Million People with Pre-Existing Conditions Would Be at Risk for Higher Premiums under the House’s Health Bill," May 17, 2017

Centers for Medicare and Medicaid Services, "At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans," accessed Oct. 21, 2018

American Medical Association, "AMA Urges Congress to Oppose Amended Health Care Reform Bill," April 27, 2017

PolitiFact, "Does the GOP's new health care bill still cover pre-existing conditions, as Trump claims?" April 30, 2017

PolitiFact, "Fact-checking an attack on Ron DeSantis about pre-existing conditions and Affordable Care Act," Oct. 18, 2018

PolitiFact: "Pre-existing conditions: Does any GOP proposal match the ACA?" Oct. 17, 2018

PolitiFact, "Does Leah Vukmir support letting insurers deny coverage to people with pre-existing conditions?" Oct. 8, 2018

PolitiFact, "Scott Walker says he would cover pre-existing conditions, but backs plans that would end protections," Oct. 18, 2018

PolitiFact, "Health care in five charts: A midterm guide," Oct. 14, 2018

PolitiFact, "PolitiFact’s guide to the GOP amendment to health care bill," April 28, 2017

PolitiFact, "Spanberger ad on Brat's vote on pre-existing conditions lacks context," Oct. 11, 2018

PolitiFact, "Democrats attack Rep. Mimi Walters on health care vote, insurance interest donations," Oct. 9, 2018

PolitiFact, "Does new version of the AHCA protect coverage for pre-existing conditions?" May 4, 2017

Email correspondence with a spokesperson for Kathy Manning for Congress, Oct. 19, 2018

Email interview with Elizabeth Oglesby, campaign manager for Ted Budd for Congress, Oct. 19, 2018

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