The nearly 50 migrants Florida Gov. Ron DeSantis flew from San Antonio to Martha’s Vineyard in September were later moved to a shelter at a military base several miles away in Massachusetts. After that, most of them found housing in other parts of the state.

The migrants were not immediately “deported” after arriving at the popular vacation island off the Massachusetts coast, as DeSantis wrongly claimed this month.

DeSantis, a Republican who may run for president in 2024, made the claim during a speech in Iowa on March 10. While discussing his state’s approach to border security, DeSantis said to cheers and applause: “We even were able to deliver 50 illegal aliens to beautiful Martha’s Vineyard. They said they were a sanctuary area. They had signs saying nobody is illegal. They said all the refugees and the illegals are welcome and then they deported them the next day. Are you kidding me?”

His statement could have given his audience the false impression that the migrants, most of whom had traveled from Venezuela, were expelled from the United States. That did not happen.

In fact, because individuals working on behalf of the DeSantis administration allegedly coerced the migrants to fly from Texas to Martha’s Vineyard under “false pretenses,” according to a Texas county sheriff, the migrants may qualify for a special immigration status for victims of certain crimes.

If approved, the migrants could stay in the U.S. to assist in a criminal investigation of the flights launched by the county sheriff’s department. After several years, they could eventually apply to become legal permanent residents.

From San Antonio to Martha’s Vineyard

DeSantis took credit for using Florida funds to charter the two private planes that flew the migrants from San Antonio to Martha’s Vineyard on Sept. 14. Days earlier, in a speech to GOP donors, DeSantis teased potentially sending people who cross the U.S. border illegally to the island, where about 20,000 people live year-round. He said he might do so to help relieve southern border states dealing with a huge spike in unauthorized crossings into the country.

At a December 2021 press conference, DeSantis said the Biden administration would secure the border “the next day,” if migrants started showing up in President Joe Biden’s home state of Delaware, or in Martha’s Vineyard, where many Democrats, including former President Barack Obama, have homes. 

But local authorities on the island were given no notice prior to the migrants being dropped off at the Martha’s Vineyard airport on Sept. 14. Two days later, after local officials, organizations and residents had scrambled to provide aid to the new arrivals, then-Massachusetts Gov. Charlie Baker, also a Republican, announced that the migrants would be given the option to move about 30 miles away to a more suitable emergency shelter at the state’s Joint Base Cape Cod in Barnstable County.

“Shortly after the arrival of these individuals, Martha’s Vineyard residents joined with local and state officials to create temporary shelter and provide necessities in a moment of urgent need,” Baker said in a released statement. “However, the island communities are not equipped to provide sustainable accommodation, and state officials developed a plan to deliver a comprehensive humanitarian response. On Friday, September 16, the Commonwealth will offer transportation to a new temporary shelter on JBCC. This move will be voluntary.”

But relocating is not the same as being “deported,” as DeSantis claimed had happened.

Deportation refers to removing citizens of other countries from the U.S. for violating immigration law. The removals are carried out by U.S. Immigration and Customs Enforcement, and deportees are usually returned to their home country or another nation that will take them in.

“None of the 49 have been deported from the United States,” Rachel Self, an immigration and criminal defense attorney, told FactCheck.org by phone. Self, whose office is in Boston, has been working with several of the migrants since they were taken to the island last year.

A spokesperson for the American Civil Liberties Union of Massachusetts, which is representing nine of the migrants, told us its organization is also unaware of any migrants on those flights being deported.

We asked DeSantis’ office to clarify his deportation claim, but we did not receive a response. 

As of early October, all of the migrants had left the emergency shelter at Joint Base Cape Cod and transitioned to more long-term housing, Baker’s office announced. Two of the migrants reportedly traveled to New York, while the vast majority moved to other cities or towns in Massachusetts, including four migrants — all related — who went back to Martha’s Vineyard to live temporarily with a local family.  

Because of the methods used to get the migrants from Texas to Massachusetts, DeSantis may have helped protect them from deportation. That’s because lawyers representing the migrants, and Javier Salazar, the Democratic sheriff of the Texas county where at least some of them had been staying pending their immigration hearings, have argued that the migrants were manipulated into flying to Martha’s Vineyard with false promises of jobs and housing — making them victims of a crime. 

For example, according to a class-action lawsuit filed against DeSantis and Florida Transportation Secretary Jared Perdue in September, some of the migrants said they were told by a woman organizing their travel from San Antonio that they would be flying to either Boston or Washington, D.C. Another person told reporters that he thought he was going to Philadelphia, where he planned to stay with a family friend and was scheduled to meet with U.S. immigration officials. 

It was not until they were in the air that the migrants learned of their true destination, some of them said. 

Salazar’s office in Bexar County, Texas, launched a criminal investigation on Sept. 19, and he later signed certificates attesting that the migrants, whom members of his staff interviewed, had assisted in the investigation. The certifications made them eligible to apply for a special “U visa” that is meant for victims of “certain crimes who have suffered mental or physical abuse and are helpful to law enforcement or government officials” investigating criminal activity.

The migrants, who Self said also have applied for asylum, are unlikely to be deported while their U visa applications are being processed. And due to a backlog of more than 300,000 such petitions, it could be a while before their applications even come up for review.

If their U visa applications are approved, the migrants would be able to lawfully stay in the U.S. for at least four years, get work authorization and eventually apply for legal permanent resident status.

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The post Migrants DeSantis Flew to Martha’s Vineyard Were Not ‘Deported the Next Day,’ as He Claimed appeared first on FactCheck.org.

The nonpartisan Congressional Budget Office’s analysis of the Republican health care bill has been released — so let the spinning begin.

Democrats overstate what the CBO said about the impact on those who now have health insurance, while the White House budget director oversells the impact on premiums.

24 Million More Uninsured

In a video posted to his website and Facebook on March 13, Sen. Bernie Sanders claimed that the GOP legislation would “throw 24 million Americans off of the health insurance that they currently have,” including “14 million who will lose that health insurance next year.”

Reps. Richard Neal of Massachusetts and Frank Pallone Jr. of New Jersey, ranking members of the House Ways and Means and Energy and Commerce Committees, respectively, said in a joint statement that the bill “would rip away health insurance from 24 million Americans over the next decade.”

But those claims go too far.

The analysis by the CBO and Joint Committee on Taxation did say that 24 million fewer Americans would be insured under the American Health Care Act than under current law in 2026, and that 14 million fewer would be insured next year. But not all of them would have their insurance ripped away or would be losing “insurance that they currently have.” The numbers represent a complicated mix of some losing insurance, some deciding not to have it, others gaining it and others not having insurance in the future.

Let’s go through the CBO numbers.

In 2018, “14 million more people would be uninsured under the legislation than under current law,” most of that due to the American Health Care Act’s immediate elimination of the individual mandate to have insurance or pay a tax, CBO said. CBO doesn’t give specific numbers, but says that “[s]ome of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

Six million of that 14 million reduction comes from a decrease in those insured in the nongroup market (including the ACA marketplaces), where those who don’t have employer or government insurance buy their own coverage. Five million comes from a reduction in Medicaid coverage, and 2 million is a decline in employer-based coverage.

So some people wouldn’t be thrown off insurance, but instead they’d make the decision not to have it. Others could be affected by higher premiums brought about by the GOP plan. CBO estimates premiums in the nongroup market would go up in 2018 and 2019, due to healthy people leaving that market since they are not required to have insurance. With fewer healthy people in the nongroup market, overall costs increase.

In subsequent years, circumstances change as the GOP plan’s age-based tax credits replace the Affordable Care Act’s income-based tax credits, beginning in 2020. The CBO expects the increase in premiums to be “more than offset” in 2020 by other factors, including more young people in the nongroup insurance pool.

Older and low-income Americans on the nongroup market could see substantially higher costs in future years under the GOP plan, as insurers would be allowed to charge older people more and the age-based tax credits wouldn’t be large enough to offset those premium increases. These factors mean that the makeup of the nongroup market — who buys coverage and who doesn’t — would be “significantly” different under the GOP plan than under current law, “particularly by income and age,” CBO said. By 2026, CBO estimates that 2 million fewer would have nongroup insurance under the Republican bill.

From 2018 to 2026, the further reduction in the number of the insured, compared with current law, “would stem in large part from changes in Medicaid enrollment,” CBO said.

By 2026, Medicaid enrollment would be 14 million lower under the GOP bill than under current law, and that’s due to the Republican changes to the Medicaid expansion and funding for the state-federal program for those with low incomes. “[S]ome states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped,” CBO said.

Certainly some of those who wouldn’t have Medicaid coverage under the Republican plan — but would have had it under the Affordable Care Act — could be described as having had their insurance taken away from them. The bill phases out the Medicaid expansion under the ACA beginning in 2020. It doesn’t eliminate that expanded coverage, with enhanced federal matching funds, for those who are enrolled before that time, but if those expansion enrollees have more than a month of a break in Medicaid coverage, they can’t re-enroll under the ACA terms.

The Commonwealth Fund has written about the problem of “churning” in Medicaid, where people cycle in and out of coverage since eligibility is determined on monthly income. Seasonal work or changing jobs, for instance, can cause individuals to qualify some months but not others. The Commonwealth Fund said its survey data on gaps in coverage “indicate that millions of people with Medicaid will lose their coverage” under the GOP health care bill.

CBO agrees that this churn would occur, saying that it “projects that fewer than one-third of those enrolled as of December 31, 2019, would have maintained continuous eligibility two years later.”

Others who would not have Medicaid coverage under the GOP plan but would have it under current law are would-be future enrollees that CBO “projects would be made eligible as a result of state actions in the future under current law (that is, from additional states adopting the optional expansion of eligibility authorized by the ACA).” The CBO report (see Figure 1 on page 36) says that of the 14 million who wouldn’t have Medicaid coverage under the Republican bill in 2026, about 5 million would have been new enrollees from this future projected expansion.

And there are other complicating factors: CBO expects 7 million fewer people to have employer-provided coverage in 2026. That’s partly due to fewer employees signing up for coverage without an individual mandate enticing them to do so and partly due to fewer employers offering coverage because they no longer would face penalties for not providing it.

The continuous coverage provision of the Republican bill — which would allow insurers on the nongroup market to charge a 30 percent higher premium to those with a gap in coverage of more than 63 days — could induce about 1 million people to buy coverage in 2018 to avoid that charge in the future, CBO estimates. But in subsequent years, about 2 million fewer people would buy coverage because of this surcharge.

Here’s the CBO’s chart on the estimated changes in insurance coverage:

The CBO estimates clearly show that 24 million fewer Americans would have insurance under the GOP bill, compared with current law. But that’s a figure that involves fluctuations in coverage. Not all of them would lose insurance “that they currently have,” as Sanders said, and some would choose not to be covered.

GOP Spin on Premiums

The Democrats weren’t alone in spinning the CBO report.

Mick Mulvaney, the director of the White House Office of Management and Budget, said the CBO report confirmed the GOP philosophy that a free market would reduce premiums. “The numbers that I’ve seen in the first glance is that the CBO says that premiums will go down by at least 10 percent with this plan,” Mulvaney told reporters in a briefing shortly after CBO released its report.

Premiums, on the nongroup market, will not “go down” from what they are right now. They will just be lower than what they would be under the ACA, on average, by 2026. Also, Mulvaney ignores two other important points: Average premiums will sharply increase in the first two years, and older Americans will see substantial increases in the short- and long-run.

The CBO report says that in 2018 and 2019 “average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law.” But, by 2026, average premiums “would be roughly 10 percent lower than the estimates under current law.”

As for older Americans, the GOP plan would allow insurers to charge them up to five times as much as younger people. Under the ACA, the ratio was 3:1. That “would directly change the premiums faced by different age groups,” CBO said.

For example, CBO said that premiums would be “20 percent to 25 percent higher for a 64-year-old” by 2026, even though average premiums would be 10 percent lower compared with current law.

The post Spinning the CBO Report appeared first on FactCheck.org.

Under the Affordable Care Act, millions of the uninsured have gained Medicaid coverage. But is Medicaid good for their health, bad for their health, or does it make no difference from being uninsured? All three claims found a political champion recently, and all refer to the same study for support.

According to Republican presidential candidate Rick Perry, the health outcomes for people on Medicaid are no better than for those without insurance.

Fellow candidate Sen. Ted Cruz went further, saying health outcomes are “markedly worse when people get on Medicaid” and that “people’s life expectancy goes down on Medicaid.”

President Obama and others in his administration, meanwhile, credit the Medicaid expansion for improving people’s health and saving thousands of lives.

The academic evidence is heavily on Obama’s side. But both the president and Perry are cherry-picking from the same study, while Cruz distorts it.

Perry and Cruz claim the expansion of Medicaid through the Affordable Care Act is a waste of money because, they say, studies show Medicaid doesn’t work. The Rand Corporation estimated that 6.5 million people who newly enrolled in Medicaid from September 2013 through February 2015 were previously uninsured. Other estimates — from both the Kaiser Family Foundation and the Urban Institute — say about 4 million additional uninsured could gain coverage if all states expanded Medicaid. There are currently 21 states that have not expanded.

In a speech at the National Press Club on July 2, Perry said, “We spend $450 billion a year on Medicaid. And yet, health outcomes for those on Medicaid are no better than those who have no health insurance at all. Instead of reforming Medicaid, the president expanded it under Obamacare.” (His remarks start at the 12:15 mark).

A few days earlier in a Yahoo News interview, Katie Couric asked Cruz what would happen to the 16.4 million who have gained insurance through the ACA if the law were repealed, as Cruz has called for.

Cruz, June 29: Well, that figure is a deceptive figure. The large chunk of that is people who have been put on Medicaid. And one of the things about Medicaid — if you look at the health outcomes on Medicaid, health outcomes are markedly worse when people get on Medicaid. Medicaid is not performing well. And in fact people’s life expectancy goes down on Medicaid. It is markedly worse.

President Barack Obama, meanwhile, claimed just the opposite, saying that those states that have expanded Medicaid have “a healthier population” than those that have not.

Obama, July 1: I will tell you the states that have taken full advantage of all the federal options available, they have an even lower uninsured rate, and a healthier population, and more people signing up for the options that are available than those states that have not taken full advantage of those options. And that’s just a fact.

Interestingly, all three base their claims, at least in part, on a single study called the Oregon Health Insurance Experiment, which was published in the New England Journal of Medicine on May 2, 2013. The study took advantage of a Medicaid expansion in Oregon that was based on lottery drawings and compared data from 6,387 adults who were able to apply for Medicaid coverage to 5,842 adults who were not selected.

The Oregon Experiment

The authors of the study concluded: “This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

There was a little something for everyone in that conclusion. The White House Council of Economic Advisers, for example, highlighted the study’s findings that Medicaid coverage expanded access to medical care and improved mental health benefits.

In a June report, the CEA said that the states that have expanded Medicaid “will reduce the number of people experiencing symptoms of depression by 382,000,” and that if the other states did choose to expand Medicaid, an additional “393,000 fewer people would experience symptoms of depression.”

The Oregon study found that after two years, those covered by Medicaid had a lower probability of screening positive for depression than those who were not covered by Medicaid. The difference amounted to 9.2 percentage points, which the CEA then applies to estimates from the Urban Institute on the number gaining or not gaining insurance because of states’ decisions on Medicaid expansion.

The CEA makes similar calculations using the Oregon study’s finding that those with Medicaid coverage were more likely to self-report that they were in good, very good or excellent health (as opposed to fair or poor health). About 572,000 additional people in Medicaid-expansion states, and another 556,000 in other states, should they decide to join the expansion, would achieve that outcome, CEA said. The CEA makes other calculations on increased usage of preventive screenings by those gaining Medicaid coverage, another finding of the Oregon study.

The study also provides some backing for Perry’s claim that “health outcomes for those on Medicaid are no better than those who have no health insurance at all.” But the study wasn’t as all-encompassing as Perry suggests.

As we noted in an article last year, the study measured only three health indicators — blood-pressure, cholesterol and glycated hemoglobin levels (which measure diabetic blood sugar control) — and only over a two-year period. We pointed out then that there could be other improvements that the study didn’t attempt to measure, or that could show up once patients are covered for longer than two years.

There was nothing in the study to back up Cruz’s claim that Medicaid caused people to fare worse than if they remained uninsured, even though his campaign pointed to the Oregon study when we asked for support for his claims.

One of the authors of the study, Amy Finkelstein, told us via email that Cruz’s statement was “really not a fair characterization of the results from the Oregon Health Insurance Experiment.”

“Our randomized evaluation finds that Medicaid improves mental health (i.e. reduces depression – by 9 percentage points or 30 percent),” Finkelstein said. “We find no statistically discernible effects of Medicaid on physical health measures or mortality. But that means we don’t have evidence that Medicaid has an impact; it does not mean that we have evidence that Medicaid is bad for people’s health.”

Nor was the Oregon study the only word on this issue in the academic community.

Other Evidence

A study published on May 6, 2014, in the Annals of Internal Medicine compared mortality rates before and after the health care overhaul in Massachusetts to a control group with similar demographics and economic conditions in other states and concluded, “Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.”

“This is an important piece of the puzzle,” Katherine Baicker, a professor of health economics at the Harvard School of Public Health and a coauthor of both the Oregon and Massachusetts studies, told the New York Times. “Putting the evidence together paints a very strong picture that expanding insurance substantially improves the well-being of people who get it.”

Another study published in the New England Journal of Medicine in 2012 — also coauthored by Baicker, a former member of President George W. Bush’s Council of Economic Advisers  — compared several states that substantially expanded Medicaid (before the ACA) to neighboring states that did not expand Medicaid and concluded, “State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health.”

A 2013 report from the nonpartisan Kaiser Family Foundation looking at the breadth of academic study — including the Oregon study — concluded simply that “[h]aving Medicaid is much better than being uninsured.”

Kaiser Commission on Medicaid and the Uninsured, 2013: Consistently, research indicates that people with Medicaid coverage fare much better than their uninsured counterparts on diverse measures of access to care, utilization, and unmet need. …

A large body of studies over several decades provides consistent, strong evidence that Medicaid coverage lowers financial barriers to access for low-income uninsured people and increases their likelihood of having a usual source of care, translating into increased use of preventive, primary, and other care, and improvement in some measures of health. Furthermore, despite the poorer health and the socioeconomic disadvantages of the low-income population it serves, Medicaid has been shown to meet demanding benchmarks on important measures of access, utilization, and quality of care. This evidence provides a solid empirical foundation for the ACA expansion of Medicaid eligibility to millions of currently uninsured adults, and individuals and communities affected by the Medicaid expansion can be expected to benefit significantly.

Obama’s Council of Economic Advisers points to the 2014 Massachusetts study and the 2012 Medicaid study to claim that the risk of death will be lower in states that have adopted the ACA expansion. The Massachusetts study found a 2.9 percent reduction in mortality rates for Massachusetts counties from the four years before the 2006 health care overhaul to the three years after, as compared with other states’ counties. The 2012 Medicaid study examined five-year periods before and after state Medicaid expansions from 1997 through 2007 and found a 6.1 percent reduction in adults’ mortality rates in those states, compared with adults in neighboring, nonexpanding states.

The CEA report says that because there are uncertainties with this type of data and “in the interest of being conservative,” it uses the smaller effect found in the Massachusetts study to estimate “5,200 fewer people would die each year” if all states expanded Medicaid and that 5,000 fewer deaths per year will occur in states that have expanded the insurance program.

That Massachusetts study said it found an “absolute decrease of 8.2 deaths per 100,000 adults” and that the changes it found were “larger in counties with lower household incomes and higher prereform uninsured rates.”

The president’s claim of a “healthier population” in expansion states is vague, and the CEA analysis shows relatively small numbers for improved health outcomes compared with the millions who have gained or stand to gain Medicaid coverage under the ACA. But past studies do show some improvement in mental health, self-reported health status and mortality rates for those gaining Medicaid coverage. It remains to be seen what health impacts expansion states actually will experience.

These are only estimates, extrapolated from other studies. The CEA notes several times in its report that there are limitations to this type of research and analysis. The evidence available from studies of past policy changes “is necessarily an imperfect guide to the future, and the actual effects of Medicaid expansion under the Affordable Care Act could be larger or smaller than the estimates presented herein,” it says.

Cruz’s Previous Claims

This isn’t the first time Cruz has made claims about Medicaid increasing the risk of death. In his first-ever speech from the Senate floor, Cruz claimed that studies showed people on Medicaid were “more likely to die” and had “worse health care outcomes” than those who were uninsured (starting at the 11:10 mark).

Cruz, Sept. 18, 2013: Now, the data demonstrate that Medicaid beneficiaries face worse health outcomes than just about anybody else in the marketplace. In 2010, the Annals of Surgery issued a landmark study that examined the outcomes from nearly 900,000 individuals undergoing surgery from 2003 to 2007. The conclusion of that study was that Medicaid patients were almost twice as likely to die as those with private insurance. Medicaid patients, their hospital stays were 42 percent longer and cost 26 percent more. Even more striking, Medicaid patients, when compared to people without health insurance, people who were uninsured, Medicaid patients were 13 percent more likely to die. And they stayed in the hospital for 50 percent longer and cost 20 percent more.

In 2011, Johns Hopkins did a study of patients undergoing lung transplantations. And their conclusions were very much the same. They found that Medicaid patients were 8.1 percent less likely to be alive 10 years after the transplant compared with those with private insurance and also compared to those without any insurance at all. Overall, the Johns Hopkins study found that Medicaid patients faced a 29-percent greater risk of death, and yet Obamacare is moving more and more of the economically disadvantaged onto Medicaid, which subjects them to those worse health care outcomes.

It’s true that in the two studies Cruz referenced — one published in the Annals of Surgery and the other out of Johns Hopkins — patients on Medicaid fared worse than those who were uninsured on some measures. But neither suggests they fared worse because the patients were on Medicaid.

Rather, it has been shown that patients on Medicaid are, in general, poorer and sicker than those without insurance, according to the Kaiser Family Foundation.

KFF, 2013: Because of Medicaid’s eligibility criteria and the strong correlation between poverty and poor health and disability, Medicaid beneficiaries are poorer and have a poorer health profile compared with both the privately insured and the uninsured. This is true even within the low-income population, as Figure 2 illustrates for adults. The distinctly higher rates of poverty, chronic illness, and disability in the Medicaid population are important to bear in mind when considering the evidence on Medicaid’s impact.

Irving Kron, a coauthor of one of the studies cited by Cruz, said the Texas senator’s statement is incorrect.

“Both Medicaid and uninsured did equally poorly,” Kron told us in an email. “However the uninsured were healthier than Medicaid and should have done better than Medicaid. They did not because they had more emergency operations presumably due to lack of resources or access. The Medicaid patients were the sickest of all groups.”

Kron said the purpose of the studies was to show whether payer status is a predictor of risks of surgery faced by patients. The “purpose of the studies was not to show, and does not show, that the Medicaid program negatively affects patients’ health,” he said.

 — Robert Farley and Lori Robertson

The post Is Medicaid Bad for Your Health? appeared first on FactCheck.org.

Political leanings: Pro-environment/liberal

Spending target: Unknown

The League of Conservation Voters works to defeat “anti-environment” candidates, according to its mission statement, and elect politicians “who stand up for a clean, healthy future for America.”

The group was founded in 1969 by activist David Brower, executive director of the Sierra Club in the 1950s and ’60s and founder of Friends of the Earth. Its current president is Gene Karpinski, former executive director of the U.S. Public Interest Research Group. Several well-known environmental organizations are represented on its board, such as the Natural Resources Defense Council, Friends of the Earth and The Wilderness Society.

The League of Conservation Voters tracks the voting records of members of Congress on environmental issues in its National Environmental Scorecard, and it annually names a “Dirty Dozen,” a list of politicians whom the group aims to defeat because of their voting records on conservation issues, and their political vulnerability. (The group also names a state-level Dirty Dozen.)

The group operates a 501(c)(4), as well as a political action committee and super PAC, with the vast majority of the spending in the last few election cycles done by the 501(c)(4), which doesn’t have to disclose its donors. In 2012, the League of Conservation Voters’ 501(c)(4) spent nearly $36 million, with almost $15 million going to political campaign activities, according to the group’s filing with the IRS.

In the 2012 election cycle, the 501(c)(4) spent $8.6 million against Republicans, $524,000 against Democrats and $1.7 million in support of Democrats, according to the nonpartisan Center for Responsive Politics. (The group’s super PAC, meanwhile, spent only $2.6 million, most of that against Republicans.)

Altogether, the 501(c)(4) and PACs spent more than $2 million trying to defeat Republican presidential candidate Mitt Romney and another $2 million to defeat George Allen, the Republican Senate candidate in Virginia. The group also focused its dollars on Senate candidates Jeff Flake in Arizona and Scott Brown in Massachusetts, as well as House candidate Francisco Canseco in Texas. The group was successful in four of those five races.

That 2012 spending was a big step up from 2010, when the groups’ total independent expenditures were $5.4 million, with the vast majority of that — a little more than $5 million — spent in support of Democrats.

Among its donors are the Advocacy Fund, a 501(c)(4) nonprofit that offers strategic management services to those advocating on “issues of social justice, environmental sustainability, human rights,” which gave more than $2 million in 2013, the Sea Change Foundation, which contributed more than $5 million in 2012, and Green Tech Action Fund, which gave more than $4 million in 2011, according to the Center for Responsive Politics. Both the Sea Change Foundation and Green Tech Action Fund operate skeleton websites that say the groups give grants to further environmental causes. All of the groups are in San Francisco.

Sea Change Foundation’s 2011 IRS filing shows it gives to liberal and environmental organizations. It was founded in 2006 by Nathaniel Simons, a hedge fund manager, according to a Columbia Journalism School report on the campaign to pass climate change legislation. Simons is a principal and vice chairman of Renaissance Technologies, which was founded by his father, and works for a fund of the company, the Meritage Group, as does his wife, Laura Baxter-Simons. Green Tech Action says it is affiliated with the Energy Foundation, a philanthropy that supports clean energy projects and is chaired by former Democratic congressman Phil Sharp of Indiana. The Energy Foundation reports that it gave Green Tech Action Fund $1 million in each of the last two years (2012 and 2013).

The league also operates the LCV Education Fund, which aims to “strengthen the capacity of the environmental movement” and “mobilize citizens as informed voters,” and the LCV Action Fund, a bundling site that encourages individual contributions to candidates.

For the 2014 election cycle, the LCV’s 501(c)(4) had spent nearly $6.6 million as of Oct. 7, including more than $2 million in support of Democrat Sen. Mark Udall of Colorado and against his challenger, Republican Rep. Cory Gardner. It also had spent $1.4 million in support of Alaska Democrat Sen. Mark Begich, who is running against former state Attorney General Dan Sullivan, and $1.17 million in Iowa to help Rep. Bruce Braley in his Senate race against Republican Joni Ernst.

Separately, the LCV’s super PAC had spent more than $2.5 million in the 2014 cycle as of Oct. 7. Most of that money — more than $1.4 million — went to help Democratic Sen. Kay Hagan, who is running against Republican Thom Tillis in North Carolina.

Fact-checking the League of Conservation Voters:

Environmentalists Misuse GOP Quote, Aug. 16, 2013

The post League of Conservation Voters appeared first on FactCheck.org.

New ads from outside Democratic groups attacking Massachusetts Senate candidate Gabriel Gomez distort his positions on Social Security and taxes.

• An ad from the Democratic Senatorial Campaign Committee claims Gomez “supports protecting special tax breaks for corporations and multimillionaires – like himself.” But Gomez has supported the elimination of special tax breaks, so long as it is part of a comprehensive tax reform.
• An ad from the Senate Majority PAC shows images of worried seniors and warns that Gomez “wants to raise the retirement age.” The images are misleading. It’s true that Gomez has talked about raising the retirement age by two years, but slowly — one month each year over 24 years. Gomez has not proposed any abrupt changes for those nearing Social Security age.
• The ad also claims Gomez “supports a plan that the AARP says would cut Social Security benefits by $127 billion.” It is true that Gomez supports a new method for inflation adjustment — called the “chained” Consumer Price Index — that would slow the growth of future Social Security payments. But the ad leaves out some important context: AARP’s $127 billion estimate is over 10 years; many economists say the chained CPI is the more accurate cost-of-living adjustment; and the proposal was included in President Obama’s latest budget.

A recent poll found that Gomez is trailing his Democratic opponent, Rep. Ed Markey, by seven points, but national Democratic groups aren’t taking the race for granted. The Senate Majority PAC and the DSCC are spending hundreds of thousands on new ads attacking Gomez, trying to make the case that Gomez’s positions are too conservative for Massachusetts.

Corporate Tax Breaks

The DSCC attacked Gomez on taxes, but presents a misleading view of Gomez’s stated positions.

According to the ad, Gomez “supports protecting special tax breaks for corporations and multimillionaires – like himself.” But he has said that he supports eliminating at least two special tax breaks for multimillionaires.

In its backup material, the DSCC points to a June 3 article in The Republican in Springfield, Mass., which states:

The Republican, June 3: Gomez said he would not raise tax rates on anyone. “Raising taxes again will hurt the economy and kills jobs,” Gomez said. “Raising taxes on top earners will not solve our nation’s fiscal crisis. We need to address spending.”

The DSCC then goes on to cite a report from the left-leaning Center on Budget and Policy Priorities, which concluded:

Center on Budget and Policy Priorities, July 30, 2012: The tax cuts first enacted under President Bush in 2001 and 2003 have made the tax code less progressive and delivered a large windfall to the highest-income taxpayers. … The average tax cut that people making over $1 million received exceeded $110,000 in each of the last nine years — for a total of more than $1 million over this period. The tax cuts made the tax system less progressive. In each of the nine years from 2004 through 2012, the tax cuts increased the after-tax income of the highest-income taxpayers by a far larger percentage than they did for middle- and low-income taxpayers.

The DSCC also cites a 2004 report from yet another left-leaning think tank, Citizens for Tax Justice, which found: “Eighty-two of America’s largest and most profitable corporations paid no federal income tax in at least one year during the first three years of the George W. Bush administration — a period when federal corporate tax collections fell to their lowest sustained level in six decades.” The report blames this, in part, on expansions of corporate tax breaks in 2002 and 2003.

The problem with the DSCC ad’s backup, however, is that the story in The Republican says nothing about Gomez’s position on the Bush tax policy. Rather, Gomez was commenting on whether he would support further tax increases on the wealthy, beyond those agreed to in the “fiscal cliff” compromise in January.

The DSCC ad’s claim that Gomez “supports protecting special tax breaks for corporations and multimillionaires — like himself” is contradicted in that same news article. In the questionnaire that underpinned the article, Gomez was asked specifically if he would eliminate some corporate tax breaks.

Gomez, June 3: I would favor eliminating many corporate tax breaks in exchange for a lower rate and in the context of comprehensive tax reform, evening the playing field for all businesses.

In that questionnaire, Gomez was asked about companies that avoid paying U.S. taxes by keeping money overseas, and what the U.S. should do to “get companies to bring their profits back to the U.S. and make their earnings subject to U.S. taxes.”

Gomez, June 3: I support the idea proposed by the President’s own bipartisan Simpson-Bowles Commission, which was to move to a territorial tax system that would help put the U.S. system in line with other countries around the world and encourage U.S. corporations to bring their capital back home.

Markey, and the Obama administration, oppose moving to a territorial system, and Markey noted his support for the Stop Tax Haven Abuse Act. So the two candidates propose different approaches. The article quotes a Tufts professor criticizing both Markey and Gomez for “maximum sound bite appeal and minimum specificity” in their tax plans.

Asked by the Boston Globe to be specific about which loopholes he would eliminate, “Gomez cited two examples frequently targeted by Washington Democrats: tax breaks for corporate jet owners and a special ‘carried interest’ tax break that benefits wealthy hedge fund managers and private equity investors such as Gomez.” In other words, he would support elimination of a special tax break for “multimillionaires – like himself,” though the ad alleges the opposite.

The Chained CPI

An ad from the Democratic group Senate Majority PAC warns: “If you’re worried about your retirement, then you can’t trust Gabriel Gomez. Gomez supports a plan that the AARP says would cut Social Security benefits by $127 billion. But it’s not just that, Gomez says he wants to raise the retirement age.”

The first claim in the ad —  that “Gomez supports a plan that the AARP says would cut Social Security benefits by $127 billion” — is tied to his support for an alternative cost-of-living formula for Social Security called the “chained CPI.” As we explained in our article “Chained Explained,” leading economists have long pointed out that the traditional CPI goes up faster than the average person’s actual cost of living.

AARP argues that the chained CPI is less accurate for seniors and would result in a reduction in the growth of cost-of-living increases of $127 billion over the next 10 years (or $2,000 less for the average senior). Using the chained CPI for cost-of-living adjustments for federal benefit payments and tax brackets also has come under fire from the right. Grover Norquist’s Americans for Tax Reform objects to the slightly higher federal income tax liabilities that would result from using it to adjust tax brackets for inflation each year.

Nonetheless, President Obama’s 2014 budget proposal called for switching to the chained CPI formula, though the proposal was condemned by a group of 82 House Democrats.

While the chained CPI would grow more slowly than traditional CPI, it would be more accurate to say that Gomez supports a new cost-of-living formula that would reduce the future growth of Social Security, rather than that Gomez supports a plan to “cut” Social Security.

Retirement Age

To back up its second claim — that Gomez wants to raise the retirement age — the ad features a partial quote from Gomez at a Republican primary debate at Stonehill College on March 12: “I think you can think about increasing the retirement age … ”

But here’s the fuller context of Gomez’s statement at the debate (starting at about the 18:20 mark):

Gomez, March 12: Like I said, if you’re on Social Security or if you’re close to receiving Social Security, you’re not going to be impacted. For people of my generation and my kids’ generation, then I think you can think about increasing the retirement age. When Social Security was enacted in 1935, the life expectancy was considerably less than it is now. I mean, you have people in their 80s running marathons right now, still. … Another one of the solutions that’s out there is that you can increase the age by a month over 24 years and you can increase it by two years over 24 years. One month per year for 24 years. But this would have no impact on the current people who are receiving Social Security or those even close to receiving Social Security.

So Gomez did say he’d consider raising the retirement age by two years, albeit over a long period of time: one month per year over 24 years. The problem with the ad’s claim is that the images of senior citizens shown at the beginning of the ad are inconsistent with Gomez’s repeated assurances that his plan would not affect even seniors nearing retirement age. The ad uses a technique dubbed by our sister site, FlackCheck.org, as “Misleading Audio/Visual Cuing” — one in its list of “Patterns of Deception” in politics. The ad leaves the false impression that Gomez has proposed to raise the retirement age for those elderly residents pictured in the ad.

The DSCC ad also makes a similar claim about Gomez wanting to raise the retirement age, again showing images of worried seniors, despite Gomez’s assurance that he was not suggesting an increase in the retirement age for those currently on Social Security, or those nearing eligibility age.

— Robert Farley

The post Outside Attacks in Massachusetts appeared first on FactCheck.org.

An ad from the Obama campaign exaggerates the truth about fees and tax hikes imposed by Mitt Romney when he was governor of Massachusetts.

It lists numerous fees hiked by Romney, but we found that a number of them are misleading — seeming to be more far-reaching and broad than they really are.

The ad also repeats a misleading claim about Romney cutting taxes “on millionaires like himself,” and botches the figure for the revenue gained by Romney imposing higher fees and closing corporate tax loopholes.

The ad is part of a one-two ad punch from the Obama campaign, attacking Romney’s record as governor of Massachusetts. Called “Mosaic,” it is the latest ad using the theme: “Romney Economics: Didn’t Work Then. Won’t Work Now.”

The ad begins with a quote from Romney when he was running to be Massachusetts governor in 2002: “I’m going to reduce taxes.”

The narrator then says that, “As governor, Mitt Romney did cut taxes on millionaires like himself, but he raised taxes and fees on everyone else — $1.5 billion. Over a thousand fee hikes. On health care. On school bus rides. On milk. On driver’s licenses. On nursing homes. On lead poisoning prevention. On meat and poultry inspection. On fishermen and gun owners. On nurses. On electricians. On hospitals. On funeral homes. On mental health services. On hospice care. On elevator repair.”

The narrator’s voice trails off, implying that he could go on and on.

We’ll deal with all three claims in order.

Tax Cuts for Millionaires?

The first claim is that “as governor, Mitt Romney did cut taxes — on millionaires like himself.” We looked at this same claim when it was made in a previous Obama campaign ad, and we found it wasn’t as clear-cut as the ad would have viewers believe. More accurately, Romney opposed a plan to impose a capital gains tax retroactively.

The tax has a bit of a tortured history. In 2002, before Romney became governor, the Massachusetts Legislature enacted a package of tax increases to deal with a deficit crisis. The package included a capital gains tax that was slated to go into effect in May 2002. But that tax was challenged in court, and the state’s Supreme Judicial Court ultimately struck down the tax, ruling that it was unconstitutional for the tax to go into effect halfway through the year. That left the state Legislature with two possible remedies: have the tax kick in on Jan. 1, 2003 — and refund eight months’ worth of capital gains tax revenue — or make it retroactive to Jan. 1., 2002, adding another four months’ worth of tax revenue. The Democratic Legislature decided to make it retroactive to the start of 2002.

Romney argued it was unfair for people who made decisions, like selling their home, based on the tax law in place at the time to be forced to pay retroactively. He proposed that anyone who paid the tax in 2002 get a rebate.

The Boston Globe’s editorial page, the nonpartisan Massachusetts Taxpayers Foundation and — ultimately — the Democratic leaders of the state Legislature, agreed. Although wealthy people are disproportionately affected by capital gains taxes, what Romney did was much different than a straight tax cut for millionaires, as the ad suggests.

$1.5 billion in Taxes and Fees?

As regular readers of FactCheck.org know by now, although Romney opposed across-the-board tax increases, he did balance the state budget by raising a number of fees and closing some corporate tax loopholes. The question is whether it added up to $1.5 billion, as the ad claims.

As we have reported in the past, there is some disagreement over the amount of the annual revenues raised by those fees and the closing of corporate tax loopholes. The Massachusetts Department of Administration and Finance put the fee total at $260 million a year and the corporate tax change at $174 million a year, and the independent Massachusetts Taxpayers Foundation said both fees and taxes totaled $740 million to $750 million a year (split about evenly between fees and corporate taxes).

So how does the ad get to $1.5 billion?

The Obama campaign says that it’s a four-year figure — something not obvious to those watching the ad. And in its backup material, the campaign cites media estimates of the four-year total for only corporate tax loophole closures (excluding fees — which is the focus of the ad).

Michael Widmer of the Massachusetts Taxpayers Foundation said its policy is always to cite the annual impact of taxes and fees. You could look at the 10-year, 20-year or even the 50-year  impact, he said, if you really wanted to make the figure look huge. But where do you stop?

The Obama campaign could truthfully have said the total for both fees and loophole closings was “as high as $3 billion over four years.” But for some reason, it picked a figure that included only loophole closures — and failed to make clear this wasn’t an annual figure.

The Fees

The ad also claims Romney hiked over 1,000 fees. It then begins to list a number of them. But when we checked the backup material provided by the Obama campaign, some of the fees weren’t as far-reaching as the ad might lead a viewer to believe.

For example, the ad says Romney hiked fees:

On driver’s licenses. The backup material cites increased fees for a Class A driver’s license, from $52.50 to $60; Class B, from $40 to $50; and Class C and Class M, from $33.75 to $40. But according to the Massachusetts Department of Transportation website, those are licenses for large commercial vehicles — tractor trailers, buses and the like — as well as motorcycles. The fee hikes were not for driver’s licenses to operate a car.

On fishermen. The ad mentions fishermen in the same breath as gun owners. And while it’s true that the fee increases directly apply to any recreational hunter or gun owner, the same cannot be said for the fees that apply to fishermen. The fees applying to fishermen include those for a “Master Digger” shellfish license (for residents as well as non-residents), and a $6 charge for each half-bushel of shellfish depuration (toxin-removal). These are fees that wouldn’t apply to the average recreational fisherman in Massachusetts.

On school bus rides. This one is a real stretch. The state doesn’t impose fees for school bus service. Bus service is provided by the school districts. Rather, Romney created new powers for municipal school committees to assess students a transportation fee to cover the cost incurred by the district. Michael Gilbert, with the Massachusetts Association of School Committees, argues that Romney indirectly hiked these fees because he slashed state transportation reimbursements to local and regional districts. Local districts weren’t required to enact bus fees, but many of them had to in order to balance their constrained budgets, he said.

On milk. Although the ad pictures a girl drinking a glass of milk, Romney didn’t place a fee on the purchase of a gallon of milk from your local grocery store. Rather, as the backup material notes, Romney increased the fee for a milk dealer license from $5 to $10; increased the permit fee for a pasteurization plant from $50 to $100; and increased the fee to operate a device for the determination of butterfat content of milk from $10 to $20. Perhaps those costs are passed on to the consumer, but the effect on any single purchase would be infinitesimal.

On mental health services. The fees actually only applied to mental health counselor applications, registrations and renewals. Increases ranging from $32 to $45 in the cost of maintaining a license would be almost impossible to spot in the price of mental health services for patients, whom the ad suggests would be affected.

More broadly, the ad is simply incorrect when it says that Romney raised taxes and fees on “everyone else.”

In a debate during his first run for president in 2008, Romney defended the fees, saying they were necessary to help close a $3 billion budget shortfall, and because “we found that some fees hadn’t been raised in as many as 20 years.”

Specifically, Romney said, “these were not broad-based fees for things like getting your driver’s license or your license plate for your car, but instead something like the cost of a sign on the interstate and how much it was going to cost to publish a McDonald’s or a Burger King sign on the interstate. We went from, like, $200 a sign to $2,000 a sign to raise money for our state in a way that was consistent with the what the market had done over the ensuing years.”

Michael Widmer of the Massachusetts Taxpayers Foundation told us some of the fees were more broad-based than Romney let on — such as a fee on deeds for real estate transactions (the largest revenue producer). That fee hike hit anyone buying or selling real estate in a  given year, but it didn’t hit “everyone.”

As for the fees being outdated, that may have been the case for some fees, Widmer said, but there was never any analysis presented to justify the fee increases. Rather, he said, it was clear the overriding purpose was to raise revenue to help close the budget gap.

One last note on the ad’s contention that Romney raised taxes and fees on “everyone else” but millionaires. In 2004, 2005 and 2006, Romney proposed cutting the state’s income tax rate from 5.3 percent to 5 percent — which would have provided a bit of tax relief to everyone, including the middle class. In every case, his efforts were rebuffed by the Democratic Legislature.

Widmer notes that although Romney supported those tax cuts — which would have slashed state revenues by about $750 million — he never described a plan to reduce spending in a way that would make the cuts possible.

“From a fiscal viewpoint, it was not a fully developed proposal,” Widmer said.

— Robert Farley and Nathan Emmons

The post Stretching on Romney’s Fees appeared first on FactCheck.org.

An ad from the Obama campaign claims Massachusetts ranked No. 1 in state debt per person when Mitt Romney was governor. It’s true, but there’s less there than meets the eye. Massachusetts has historically been a high-debt state. Massachusetts has ranked either first or second in debt per capita in each of the past 11 years. It was second when Romney took office, not a far leap to first place. One could even argue that Romney slowed the growth rate of long-term debt compared with the four years before he took office.

We’re No. 1! Ugh.

The ad sets up its punch line with the opening line, “When Mitt Romney was governor, Massachusetts was number one.” The ad then says, “Number one in state debt.”

According to the ad, under Romney, Massachusetts had “$18 billion in debt — more debt per person than any other state in the country.”

First, we should note that this is not the same kind of debt we hear about with the federal government. The Massachusetts debt referred to in the ad is long-term debt for capital improvements, bonds to pay for such things as road or bridge repair, to erect new buildings at the University of Massachusetts or to expand courthouses. That’s not the same as piling up yearly deficits to support operating expenses the way the federal government is. In fact, like most states,  Massachusetts requires balanced budgets.

(Our fact-checking colleagues at the Washington Post noted that with an asterisk — saying that Massachusetts has historically shifted some operational costs, such as pay for workers on capital projects, to its capital budget. But that practice pre- and post-dates Romney.)

That being said, it’s true that the long-term debt went from $16 billion (see A-22) on Jan. 1, 2003, just before Romney took office, to $18.7 billion (see A-22) on Oct. 1, 2006, three months before he left. That’s an increase of $2.7 billion.

According to Moody’s State Debt Medians, in 2007 — the year Romney left office — Massachusetts had the highest debt per capita of any state in the country, $4,153. Connecticut ranked second, with $3,713, and Hawaii third, with $3,630.

But Massachusetts didn’t have far to go to reach the No. 1 spot. Massachusetts ranked second in 2003, the year Romney took office, according to Moody’s. And it was first in 2002.

“Massachusetts has always been a very high-debt state,” Michael Widmer, president of the nonpartisan Massachusetts Taxpayers Foundation, told us. “That was the case before Romney was governor and it’s been the case since.” (Indeed, Massachusetts ranked second behind Connecticut in 2010, 2011 and 2012.)

In fact, the pace of the state’s rising long-term debt load actually slowed during Romney’s time as governor.

In a comparable length of time before Romney took office — from June 30, 1999, to Jan. 1, 2003 — the long-term debt in Massachusetts went from nearly $12 billion to $16 billion (see A-23), a $4 billion increase. That’s a 34 percent increase, compared with the 16.4 percent increase during Romney’s years.

Widmer put it this way: “He didn’t put his foot on the accelerator any more, or really take it off.”

A few more pieces of context. In addition to looking at debt per capita, Moody’s provides data on debt as a percentage of personal income. This statistic more closely aligns with residents’ ability to pay. Massachusetts’ debt as a percentage of income rose slightly during Romney’s years in office, from 8.5 percent in 2003 to 9.4 percent in 2007. Still, Massachusetts has consistently ranked second among states with regard to debt as a percentage of income in each of the last 12 years — before, during and after Romney’s term as governor. And last, we should note that Massachusetts has maintained an excellent bond rating. It was Aa2 throughout the 2000s, considered a very low risk for potential investors.

There is some irony in the Obama campaign attack on Romney’s debt record. As the Obama campaign pointed out in backup material for the ad, while running for governor in 2002, Romney criticized his Democratic opponent, then state Treasurer Shannon O’Brien, for Massachusetts’ long-term debt. One TV ad from the Romney campaign featured a basset hound to sarcastically depict O’Brien as a failed “watchdog” because “O’Brien’s let her Beacon Hill pals spend so much money our state per capita debt has grown to the highest in the country.” During a debate, Romney ridiculed O’Brien for promising to reduce the state’s debt as treasurer, noting that Massachusetts had “the highest debt per person of any state in the nation.” Never mind that it is the state Legislature and governor, not the state treasurer, that decides how much long-term debt to assume.

In other words, this is a shaky tactic Romney himself employed when it suited him.

47th Out of 50, Again

The ad also rehashes the claim that under Romney, “Massachusetts fell to 47th in job creation, one of the worst economic records in the country.”

But as we wrote when the same claim was made in an earlier Obama campaign ad, it’s a bit misleading to say Massachusetts “fell” to 47th. The state ranking for job growth went from 50th the year before Romney took office, to 28th in his final year. It was 47th for the whole of his four-year tenure, but the ranking was improving, not declining, when he left.

According to data from the Bureau of Labor Statistics, Massachusetts added 49,100 net jobs during Romney’s tenure, an increase of about 1.5 percent. That was a far slower pace than the national average of 5.3 percent, however. In fact, looking at the entirety of Romney’s four years, Massachusetts ranked 47th out of 50 states in percentage of job growth. It had ranked 37th in the four years prior.

But as we said, a different picture emerges when one looks at year-by-year figures. In the 12 months before Romney took office, the state ranked 50th in job creation, and for his first 12 months in office, the state remained 50th. But by his final year, the state ranked 28th. That’s still mediocre, but an improvement, and not a decline.

The ad will air in the battleground states of Colorado, Florida, Iowa, North Carolina, New Hampshire, Nevada, Ohio, Pennsylvania and Virginia.

— Robert Farley

The post Spinning Romney’s Debt appeared first on FactCheck.org.

BOSTON — It has been nearly five years since Massachusetts Gov. Mitt Romney signed the state’s landmark health care law amid the political flourish of a fife and drum corps and 300 guests in Boston’s Faneuil Hall. The overhaul is largely seen as a blueprint for the sweeping federal legislation that followed, making the state a political target for critics of President Obama’s efforts.

Brian Rosman, research director for the advocacy group Health Care for All, still has his ticket from Romney’s signing displayed in his downtown office. Obviously, Rosman’s group is pleased that the state has tried to cover as many of the uninsured as possible. But the law passed with support from a wide range of stakeholders.

Massachusetts’ game plan shares several characteristics of the national legislation, but there are differences, including one major distinction: The level of vitriol directed at the federal law doesn’t exist here. Sure, there are criticisms and compromises, disagreements and disappointments — but they come with a distinct lack of the death-panel-type furor that rose up against the law Obama pushed.

Even the fiscally conservative, but nonpartisan, Massachusetts Taxpayers Foundation is on board. President Michael J. Widmer calls the law “a well thought-out piece of legislation” that his group supported because, “we believe in public investments.” Widmer says: “There have been critics from the left and the right … that have not wanted the Massachusetts experiment … to succeed from the outset for different reasons. Most of those critics are either out of state,” or academics or single-payer advocates. “And then, of course, you get the politicians on top of that.”

Yes, the politicians. The Massachusetts plan has been attacked by opponents of the national law, liberal advocates of Canadian-style single-payer insurance for all, and conservative Republicans hoping to derail Romney’s presidential aspirations. For example, former Arkansas Gov. Mike Huckabee, in a February interview with the Associated Press, said Romney should essentially apologize for the law and acknowledge that it “cost more, waiting times were higher, quality of care went down, people were greatly dissatisfied and it ended up having almost the polar opposite effect of what was intended.” We found that there’s not much truth in any of that.

As the 2012 presidential campaign gets under way in just a few months (believe it or not), we expect to see an increasing number of attacks on so-called “RomneyCare.” So as part primer and part preemptive fact-checking, this article is our attempt to set the record straight. We found:

• The major components of the state and federal law are similar, but details vary. The federal law put a greater emphasis on cost-control measures, for instance. Massachusetts is just now tackling that.
• The state law was successful on one big goal: A little more than 98 percent of state residents now have insurance.
• Claims that the law is “bankrupting” the state are greatly exaggerated. Costs rose more quickly than expected in the first few years, but are now in line with what the Massachusetts Taxpayers Foundation had estimated.
• Small-business owners are perhaps the least happy stakeholders. Cheaper health plans for them through the state exchange haven’t materialized, as they hoped.
• Despite claims to the contrary, there’s no clear evidence that the law had an adverse effect on waiting times. In fact, 62 percent of physicians say it didn’t.
• Public support has been high. One poll found that 68.5 percent of nonelderly adults supported the law in 2006; 67 percent still do.

Editor’s note: For this special report, we were able to send Managing Editor Lori Robertson to Massachusetts to conduct research on site. Her travel was made possible by donations from our readers, and is just one of the ways we put your contributions to work.

Analysis

Here are the major claims we examined, along with our detailed findings.

Blueprint for the Federal Law?

Claim: “It’s not that dissimilar to ObamaCare.” — Republican Rep. Paul Ryan of Wisconsin
Claim: “It was a template. … That work inspired our own health care plan.” — former White House adviser David Axelrod.

There are several similarities between the state and national plans, and there are several differences. When we spoke with Health Care for All’s Brian Rosman, he said that “the template is the same,” for Massachusetts and the nation, but “the details are different.”

Both laws have an individual mandate, requiring persons to have insurance or pay a penalty; subsidies for low-income persons; an expansion of Medicaid; an exchange where individuals can buy insurance; and requirements for employers. But the national law puts a greater emphasis on small businesses by providing tax credits for those who want to offer insurance, and it includes many potential cost-control measures that Massachusetts lawmakers are only now tackling in separate legislation. Yes, those are largely experimental ideas, and as we’ve said before, it’s unclear whether the bundled payments and pilot projects President Obama touts will have a big impact on costs. But the national law included many steps aimed at decreasing the growth in health spending, while the law Romney signed purposefully did not.

Massachusetts has a lower coverage requirement for employers, putting just a $295 per employee “fair share assessment” on businesses that don’t provide insurance. Small businesses may not be very pleased with that — it affects businesses with 11 or more full-time equivalents. But for larger employers, this was a big step back from a state House version of the bill that called for a payroll tax. The national law, meanwhile, has a fine of $2,000 per employee for companies that don’t offer coverage, have more than 50 workers and have at least one who receives a premium credit. (The first 30 workers are excluded.) Subsidies in the Bay State are provided for those earning up to 300 percent of the federal poverty level; national law subsidies go to 400 percent. And in Massachusetts, if your employer offers health insurance, you’re not eligible for a subsidized plan. Not true in the federal law, which allows workers to get subsidies if their premium contributions are above a certain amount.

Tim Murphy, Romney’s secretary of health and human services from 2005 to 2007, says there are many differences between the laws, but acknowledges certain mechanisms are similar. However, “unless you were going to go to single-payer, how many mechanisms really are there to use?”

There also have been plenty of changes made over the last five years. “When the original law was passed, they left a lot of the implemention up to the [state exchange]”, Rosman says.

Unique Problems, Unique State?

Claim: “Our approach was a state plan intended to address problems that were in many ways unique to Massachusetts.” — former Gov. Mitt Romney
Claim: “Different states have different problems.” — Mississippi Gov. Haley Barbour

The general problem of residents going without insurance and facing high health care costs is a nationwide issue, not unique to Massachusetts. But the state had its own circumstances, and unique opportunities, which helped make the health care overhaul a reality and kept stakeholders on board and still supportive of the law. First, there was money: $385 million from the federal government and the risk that those dollars would be taken away.

Massachusetts had some flexibility with that money in the form of a Medicaid waiver that allowed the state to use the federal funds for supplemental payments to safety net hospitals caring for the uninsured. The waiver was due to expire June 30, 2005, and the federal government said the state had to change the way it was spending the money, Murphy, then-state secretary of HHS, explains. In 2005, state officials showed then-U.S. Secretary of Health and Human Services Tommy Thompson a framework of what they wanted to do – essentially reduce the amount the state was spending on uncompensated care and instead give subsidies to the uninsured to buy their own insurance. Thompson extended the waiver for one year, but, Murphy says, told officials they needed to get a law in place.

Murphy, who now is president and CEO of Beacon Health Strategies, says the state’s uncompensated care pool, set up to reimburse hospitals and community health centers for care for the uninsured, was a “poorly designed, poorly administered program” and “a runaway train” with a lack of transparency on where these dollars were going. The philosophy behind the state government’s ideas was to “empower people” by helping them get insurance and financial security, and give the state more oversight on how the money was spent.

“Unquestionably the federal dollars have helped,” Widmer at the Taxpayers Foundation says of the matching funds Massachusetts was able to use. “There were very unique circumstances here, including the politics.”

Rosman, research director at Health Care for All, says back in 2003 the group’s then-executive director, John McDonough, wrote a memo saying that 2006 was the year for reform, citing the expiration of the Medicaid waiver, Romney’s presidential ambitions and Sen. Edward Kennedy’s interest, among other factors. Health Care for All put together a coalition of hospitals, medical advocacy groups, labor unions and community groups to push for a bill. In 2004 Romney’s then-secretary of HHS, Ron Preston, wrote a “white paper” on ways to get to universal coverage.

Beyond money and politics, Massachusetts had advantages and disadvantages in its existing health care system. The state had a lower percentage of uninsured and higher percentage of employers offering coverage than the national averages. The National Health Insurance Survey found that 14.8 percent of persons nationwide lacked insurance at the time of the interview in 2006. Massachusetts’ rate was 7.7 percent, the lowest state rate in the country. Seventy percent of employers offered insurance in the state the year before the law was passed, compared with 60 percent nationally. So, in terms of the uninsured, other states have bigger problems than Massachusetts did. Barbour’s Mississippi has an uninsured rate of 17.9 percent.

The bad news for the Bay State: Health spending per capita has been higher than the nationwide average since at least 1992. Even after adjusting for income differences and federal grants received, the state spending per person was 15 percent higher than the U.S. average in 2004, according to the state Division of Health Care Finance and Policy. Massachusetts also had a dysfunctional individual market. In 1996, the state had instituted rules requiring community rating (premiums could only vary by a certain amount based on age, geography and occupation) and guaranteed issue (no discrimination based on preexisting conditions), says MIT economist Jonathan Gruber, who advised both Romney and the Legislature in creating the health care law and is still on the board of the Health Connector, the state’s version of an exchange. Those regulations “destroyed the market,” he says. “You can’t institute those reforms without a mandate,” requiring individuals to have coverage. One of the intentions of the law was to fix what Gruber calls “a deeply broken nongroup insurance market.”

98 Percent Covered

Claim: Massachusetts has done a great job covering the uninsured.

This is undeniably true. The latest number from the state Division of Health Care Finance and Policy: 98.1 percent of Massachusetts residents had health insurance in 2010. The percentages from various surveys differ — the way the questions are asked and the definition of uninsured make a difference — but DHCFP’s statistics show the percent of residents without insurance declining from 7.4 percent in 2004 and 6.4 percent in 2006 to 1.9 percent in 2010. (That compares with national figures of 14.8 percent uninsured in 2006 and 15.4 percent last year.) Specifically, the state has added 401,000 people to the insurance rolls since June 30, 2006, excluding Medicare, leaving about 120,000 still uninsured.

MIT’s Gruber says that while numbers vary, the best estimate is that 60 percent of those previously uninsured have gained coverage. That’s a little less that DHCFP numbers, but any way you look at it, the state has made enormous strides. Sarah Iselin, president of the Blue Cross Blue Shield of Massachusetts Foundation, says the state’s goal was to get “as close to universal coverage as we could.”

Massachusetts Secretary of Health and Human Services Dr. JudyAnn Bigby, a Harvard Medical School graduate and former primary care physician, says that when the state hit 97.4 percent, “I thought we were not going to be able to do better.” She says 98.1 percent is “fairly close to the best we’ll do.”

The state does better in covering children — 99.8 percent of kids are estimated to have insurance. (Nationally, the figure is 92.6 percent.)

Here’s how those 401,000 have gained insurance, since 2006: Individuals buying their own insurance went up by 83,000, MassHealth (Medicaid and Children’s Health Insurance Program) numbers went up by 164,000, and subsidized plans sold through the state exchange went up 154,000, as of June 30, 2010. Private group insurance had grown between 2006 and 2008, but has since declined to the ’06 level, likely because of the recession. (More on employer plans later.)

Michael Doonan is executive director of the nonpartisan Massachusetts Health Policy Forum, which brings health care leaders together for discussions of policy issues, and an assistant professor at Brandeis University. He credits the individual mandate for getting most of the state’s residents on insurance. “Gov. Romney’s leadership made this possible. … But where his argument was the strongest was his support of the individual mandate,” Doonan says. Romney said it was a matter of personal responsibility. (The former governor made that argument last year, as well.) “And that was the lynchpin.” Without the mandate, coverage wouldn’t be close to 98 percent, says Doonan, who also was a member of President Clinton’s Health Care Taskforce.

Those earning up to the federal poverty level get fully subsidized coverage with minimal copays. From 100 percent to 150 percent of the poverty level, there are no premiums if individuals take the cheapest plan, and up to 300 percent of the poverty level (that’s $67,050 for a family of four), there are premiums to be paid along with the subsidies.

Who’s still uninsured in Massachusetts? Undocumented immigrants, those who are not eligible for coverage because they have an offer from an employer but the premiums are unaffordable — those individuals are given an affordability waiver — and persons who choose to pay the individual mandate penalty ($1,212 for this tax year). For tax year 2008 (when the penalty was a bit lower than that), 53,000 residents were assessed a penalty for not having insurance (see Table 1).

Those hit with the penalty can file an appeal for hardship reasons. Glen Shor, executive director of the Health Connector, told us his office approved 60 percent of the 8,000 hardship appeals individuals filed between 2007 and 2009.

Huckabee was dead wrong when he said that the law “ended up having almost the polar opposite effect of what was intended.” A major goal — if not the goal — was to reduce the number of uninsured. The state was very successful in that regard. We called and e-mailed the press office for Huckabee’s political action committee several times, asking for back-up for his claims. A spokesman told us he would get back to us, but we have not yet received a response. We will update this article if we do.

Cost Criticisms

Claim: The law “cost more.” — Huckabee
Claim: “It’s bankrupting Massachusetts.” — former Pennsylvania Sen. Rick Santorum

The question is: “cost more” than what? We’ll take that to mean, “more than was predicted.”

Unfortunately, there’s no Congressional Budget Office in Massachusetts that can give us a solid look at spending projections specifically attributable to the law. Experts we spoke to said the Taxpayers Foundation was the best source for this, and the foundation says state spending is in line with what it expected.

It certainly takes money to create a subsidy program and expand Medicaid coverage. But is the Massachusetts law “bankrupting” the state? The foundation says no. In May 2009 it put out a report called “The Myth of Uncontrolled Costs,” which concluded that the net added cost to Massachusetts taxpayers was $353 million in 2010, or roughly 1.2 percent of the state budget. (The total cost of “reform spending,” beyond what Massachusetts was already paying for uncompensated care before the law, was $707 million, with federal dollars covering half of that.)

The state Executive Office of Health and Human Services estimated that Massachusetts needed $172 million more from the general fund in 2009 than it spent in 2006 to cover “reform.” But the 2009 budget also used an unspecified number of federal stimulus dollars.

Costs for the subsidies did grow more than was expected at first. More people signed up for subsidized insurance more quickly than officials predicted — there was a point when there was great concern that the state had vastly underestimated the number of the uninsured. Costs “at the beginning rose dramatically and much faster than people assumed,” Widmer of the Taxpayers Foundation says. But enrollment in the subsidized plans leveled off. It reached 176,000 in mid-2008 and is down somewhat, to 154,000, after the state reduced coverage for legal immigrants (illegal immigrants were never covered).

To pay for the law, the state increased the cigarette tax, and had some money coming in through individual and employer penalties. It also continued a safety net surcharge on insurers and hospitals (which had been assessed before the law), and, as mentioned, it spends general funds.

Murphy, Romney’s secretary of HHS, says that the subsidized program “has worked out fairly fine,” and as expected. “I still think that the state sends too much to hospitals and community health centers for people who say that they’re not insured,” he says. But overall, “from a state budgeting perspective, anybody who makes any type of comment that this is busting the bank, this is a runaway train, this is a failure, flat-out doesn’t know what they’re talking about. Simple as that.”

So far, Massachusetts is making the numbers work for the health care overhaul, and the state remains committed. It all comes during a nationwide recession and budget crunch. Massachusetts faced about a $5.6 billion budget gap for 2010, and for 2012, the projected gap is $1.8 billion. The Connector, the state exchange, is being asked to find ways to keep its budget constant next year while facing the prospect of increasing enrollment in the down economy. Glen Shor, the Connector’s executive director, says he thinks it can be done by using “the power of competition” to drive down what insurers charge. Some cuts already have been made in the last few years because of the state’s overall fiscal situation — the Connector cut back on coverage for legal immigrants who have been in the country for less than five years, giving them reduced subsidies, and an increase in payments to providers was scaled back.

On top of the health care overhaul is the state’s Medicaid spending, the vast majority of which would exist with or without the law. It has gone from $7 billion in 2006 to $9.3 billion in 2010, according to the Taxpayers Foundation. The foundation estimates that about $487 million of the 2010 Medicaid budget, about 5.2 percent, was for expansions under the health care law. (All those figures are before federal reimbursements.)

Widmer says rising Medicaid costs are a major problem regardless of the new law. Gov. Deval Patrick’s administration “has got a major effort in 2012 to keep Medicaid [at] level funding. Do I think it’s possible? No, I don’t. Do I think it’s realistic? No, I don’t.”

And costs for the overhaul plan will also grow. Most people are insured at this point — and there are some on public insurance who might come off once the economy recovers. But there’s still medical inflation. “That’s the larger issue of cost control,” Widmer says. That’s an issue the state didn’t address in the health care law, and is now tackling.

What Happened to Premiums?

Claim: Premium costs increased.

One of the main claims Republicans make about the federal law is that it will drive up premiums. (In fact, as we’ve often noted, the Congressional Budget Office predicts the federal law won’t have a significant impact on premiums for most people.) But what has actually happened in Massachusetts?

The truth about premiums is that they’ve gone down for those who buy their own insurance (in what had been the so-called “individual market’), and the health care law is given credit for several reasons. And while premiums have gone up for large employers who buy coverage for their workers (the so-called “large group market”), there’s no clear evidence that the law was the cause. As we mentioned, the law attempted little cost control, and Massachusetts premiums, and those nationwide, have been rising for years before the law was passed. The law has had one clearly negative impact on small businesses who bought coverage in the “small group” market. Their premiums have risen faster than before, a small part of which can be attributed to the law’s workings. This has been a major disappointment because small businesses had been hoping for a decrease.

Let’s start with the individual and small group markets: After the law was passed, the state merged these markets, which benefited individual rates and hurt small business rates. It’s simply a matter of a less-healthy risk pool getting a boost from a more well-rounded risk pool. “The worst risk pool is the individual risk pool all by itself,” explains Brandeis’ Doonan. If you add the small group market to that, it’s “better for individuals and worse for small business.”

How much did that raise premiums? It’s not clear. One prediction, cited in a report conducted for the state Division of Insurance, estimated a 1.0 percent to 1.5 percent impact, but there’s not good information on what exactly the impact turned out to be. Jon B. Hurst, president of the Retailers Association of Massachusetts, told us: “It was a factor.” But, “I don’t know that there’s any one major silver bullet” for increasing premium costs.

That report for the Division of Insurance did find that a higher percentage of individuals in the merged market were dropping coverage after a major medical expense than had done so previously – this “adverse selection” drove up costs by an estimated 0.5 percent to 1.5 percent. A 2010 state law instituted open enrollment periods, which the study had suggested as a way to avoid this problem.

The individual market, meanwhile — the one MIT’s Gruber had called “deeply broken” — saw a major drop in premiums, as much as a 40 percent decline, according to some figures. The individual market itself more than doubled in size, says Gruber. Young, healthy people came into the market and bought less generous (hence, cheaper) plans than the sicker individuals who had been in that guaranteed issue market. “The typical nongroup market in the country has people buying really crappy products,” Gruber says. But in Massachusetts, the opposite was true — the sick were buying good products. With the health care law and the individual mandate, “people were buying down,” says Gruber, “not buying up.”

Premiums would show a smaller drop if adjusted for the less generous average policy, he says. But however you want to look at it, premiums went down. Let’s compare what people in the pre-merger individual market spent per person per month for a premium in 2006 and what those in the post-merger market spent in 2008. Those numbers went from $437 to $360, an 18 percent decrease. (See page 103 of this Division of Health Care Finance and Policy report.)

As for employer plans, the information is a little fuzzy. Premiums have gone up, but they had been going up in Massachusetts, since before the law was passed. Did the law cause an increase? One study published in 2010 in the Forum for Health Economics & Policy calculated that the health care law had pushed up employer-sponsored, single-coverage premiums by 6 percent over two years, based on the fact that the cost of Massachusetts premiums rose faster than premiums in the U.S. overall (by 2.2 percentage points), and that the cost of the state’s premiums hadn’t risen as much as the country’s in the two previous years. The study also calculated only a 1.5 percent increase for family plans. The authors noted that the study has limitations.

Gruber told us he doesn’t see the changes in Massachusetts employer premiums as statistically meaningful. “We cannot rule out that they found what they did purely by chance,” he says of that study, which used Medical Expenditure Panel Survey data.

The evidence is conflicting: Massachusetts premiums rose faster than premiums in the U.S. overall. But the same data show that 19 states had larger increases, including the nearby states of Vermont and New Hampshire, Gruber says. “Statistically, there is no evidence that MA is particularly different than the other states.”

The Role of Businesses

Claim: The law was bad for businesses.

It depends on which business you ask. In a 2008 poll published in Health Affairs, 52 percent of employers said they believed the health care law had been “good for Massachusetts” and 77 percent said all employers have some responsibility to offer insurance to employees. For large businesses, the law didn’t change much about how their insurance systems operate. For small businesses, there’s general disappointment that the law hasn’t done more to help them, to make insurance more affordable — but there’s also not a clear sense that this was a major goal of the final legislation.

Let’s start with big business: Employer-sponsored insurance actually increased under the law. Any fears that may have existed about companies dropping employees and sending them to state subsidized care have turned out to be unfounded.

As we mentioned, Massachusetts started off with a high percentage of employers offering insurance — 70 percent in 2005 — and that has gone up to 76 percent in 2009, according to the state Division of Health Care Finance and Policy. That’s 7 percentage points higher than the national figure. And more employees are accepting covering when offered. Seventy-eight percent of eligible employees were enrolled in insurance plans in 2005; that inched up to 80 percent in 2009.

In its 2009 report, the Taxpayers Foundation estimates that the increased cost for employers “for newly insured employees and dependents is at least $750 million,” adding that the figure is “more than double the $350 million increase in state spending under health reform.” Despite the big number, Widmer says there’s “very little outcry” from employers who have been supportive of the law. “That piece is one of the most unknown, ignored elements of health reform, and yet one of the key building blocks,” he says of the business community’s role. “It’s sort of a culture in Massachusetts, competitively,” he says. Businesses see offering coverage as a way to attract employees. “Health care is part of what your compensation is.”

Brandeis’ Doonan explains that because the state now requires individuals to have coverage, employer-sponsored insurance becomes “a more important benefit.” Employers offer coverage, Doonan says, because “they want to retain the best employees.” Also, Tim Murphy, secretary of HHS under Romney, says the legislation put into place anti-discrimination laws so employers couldn’t contribute less to lower-income workers in an effort to get them to drop insurance.

Claim: Ok, but small businesses aren’t happy.

It’s true that the small-business community is not pleased. The reason is that the tough small group insurance market hasn’t become more affordable for these employers, as was hoped. Iselin, who was commissioner of the Division of Health Care Finance and Policy from March 2007 until November 2009, says that helping small businesses wasn’t a main focus of the law. “There was a recognition that we needed to be thinking about it,” she says. “There were clearly provisions in the law that set the Connector up to begin to kind of, you know, step into that space. It was by no means the emphasis [or] the focus of the final law.”

Jon B. Hurst, president of the Retailers Association of Massachusetts, says that “small business was essentially not at the table” during negotiation of the law. But still, “we thought that the Connector … was going to be a positive thing for small businesses. … There was a feeling that there would be really robust marketplaces created for small business,” with lots of insurers and “real savings,” he says. “That hasn’t happened.”

Brian Rosman at Health Care for All also says it’s been a disappointment that the small-business offerings from the Connector haven’t attracted more interest. Small businesses are still insuring workers, he says, but “I had hoped that the Connector would bring them cheaper, more efficient coverage.”

Murphy, meanwhile, calls the lack of opportunity for small businesses “a big failure.” He and others, such as Joshua Archambault at the Pioneer Institute — a think tank that says it espouses “policy solutions based on free market principles” and “limited and accountable government” — say the Connector hasn’t focused enough on small businesses. “It is the group that we and a few others have identified as really being left out of reform as it’s been implemented,” Archambault, program manager for the Institute’s health care initiative, says. The Pioneer Institute, which did not take a position on the law, has published a report suggesting ways to make the small business market better. “We view our role again as somewhat of a mirror as saying … here’s why our choice model didn’t work. And in other states, as you implement the federal law, then you should be very aware of where, you know, our policymakers got it wrong,” he says.

Glen Shor of the Connector counters that getting more options for small businesses is a “major focus” right now. “We are very committed to using the tools at our disposal to make it easier for small businesses to find and choose affordale coverage. … It’s taken us a little bit longer to sort of perfect our model on that,” he says, explaining that the Connector has had to work very closely with health carriers and others.

For individuals using the Connector’s site to shop for insurance, there are seven insurance carriers selling plans and 34,000 people buying them. For small businesses, there are three carriers and 4,000 employees and dependents who have purchased plans in what’s called Business Express, a program that allows employers to pick one plan for all of their employees. “We want to and need to have more health plan options,” Shor acknowledges.

Hurst says the problem with the Connector plans is that they’re not a better deal. “It would be a lot more helpful if there was a real discount” — if it was like group buying and the premiums were closer to what’s offered through the subsidized program, Commonwealth Care. “Most small businesses would give their eyeteeth to be able to buy the CommCare plans.”

Small-business premiums have continued to go up — Hurst says his members have seen annual increases averaging 15 percent — and that trend was negatively affected at least somewhat by the merging of the small and nongroup markets in 2007. The merger caused an increase for small-business premiums but a drop for plans in the individual market.

The Connector has a pilot program that allowed small businesses to set up coverage and allow their employees to choose from different carriers, a system that Murphy says was more what the Romney administration envisioned. But as a pilot program, it was limited to a small number of businesses, and is closed to new enrollment, Shor says.

The national law could have more of an impact. Hurst says there was more of an emphasis in the federal law on small business (such as subsidies and only assessing a fee on non-insurance-offering employers with more than 50 workers). “We’ll see what the exchanges are … will they be more than what our Connector is?” he says.

And in Massachusetts, it’s still a work in progress. The state passed a law last year to allow small businesses to develop purchasing cooperatives. Hurst says it’s just now going into the pilot phase.

Long Waits, Worse Care?

Claim: …”waiting times were higher, quality of care went down.” — Huckabee

Most experts we spoke to said there wasn’t good data on how the law may have affected wait times. Iselin, with the BCBS of Massachusetts Foundation, called this claim one of the most misinformed or unsubstantiated she’s encountered.

Those who claim the law caused longer waiting times frequently cite annual surveys by the Massachusetts Medical Society. Its 2010 survey did find that the average wait time for internal medicine had gone up by six days since 2005 — to 53 days. But results were mixed — the average wait for family medicine went down by 15 days from the year before to 29 days. Wait times for other specialties were down too, since 2005, including those for cardiology, gastroenterology and orthopedic surgery.

Furthermore, the society’s surveys had been reporting longer wait times and physician shortages since well before the law was signed in 2006. In 2005, the society said this was a “continued” problem.

The medical society doesn’t explicitly attribute changes in wait times to the law. It also criticizes a study focusing only on the Boston area, saying it “cannot be considered determinative” and is based on interviews with only 71 practices. That limited study by Merritt Hawkins & Associates only surveyed 71 physicians in five different specialties in Boston. It did so by having someone call and pose as a new patient looking for an appointment for a non-emergency. The study compared Boston with other cities where the data was also limited. Only three orthopedic surgery offices were contacted in Detroit, for instance.

The 2010 medical society survey was based on a much larger sample. It called 885 practices throughout the state and then weighted the responses to ensure geographic representation. Its data on physician shortages came from surveys returned by 995 physicians and about 150 other medical professionals.

So, there’s far too little data to support a conclusion that the law caused longer wait times. The medical society is concerned about doctor shortages, but notes in a document about the law that this is a long-standing issue: “Primary care shortages continue in Massachusetts, but they predate health reform by many years, and mirror shortages in many other areas of the country.” Since the health care law, the number of insured individuals has gone up substantially.

Bigby, the state’s health secretary, notes that Massachusetts has more doctors per capita, including primary care doctors, than any other state. That’s according to the Association of American Medical Colleges. Even so, the state is taking steps aimed at increasing access to primary care further. These include creating a loan repayment program for doctors agreeing to work in community health centers, and regulations for limited service clinics, as well as a new payment demonstration project “to recognize the need to answer e-mail, telephone calls, that sort of thing, which they can’t bill for now,” Bigby says.

Regardless of waiting times, however, access to care and use of care overall have actually gone up, according to the Urban Institute’s Sharon K. Long, a professor at the University of Minnesota’s School of Public Health. She has conducted surveys since Massachusetts passed the law. Her June 2010 report found that:

Long, June 2010: Access to and use of health care in the state improved under health reform, with more adults reporting visits to doctors and other health care providers and fewer adults reporting going without needed health care in fall 2009 than prior to health reform. There is evidence of particularly strong gains in the use of preventive care and prescription drugs, benefits specified under the state’s new minimum creditable coverage (MCC) requirements, which outline the key benefits and cost-sharing provisions that must be included in a health insurance plan if it is to satisfy the state’s individual mandate for health insurance coverage. In addition, adults in Massachusetts were more likely to rate the quality of the health care they received as very good or excellent under health reform.

She also found that physician capacity was a continuing problem, with “about one in five adults report[ing] problems finding a doctor who would see them in fall 2009 — either because the provider was not taking new patients or the provider was not taking patients with their type of insurance coverage.” She told us she didn’t have a pre-reform statistic with which to compare that.

Nevertheless, with more people covered by insurance, more people visiting doctors and fewer people saying they are going without needed care, we conclude that Huckabee’s claim that “quality of care went down” is contradicted by the available evidence.

Plenty of Satisfaction

Claim: “… people were greatly dissatisfied.” — Huckabee
Claim: “Massachusetts has a state health insurance program that they’re happy with.” — Barbour

Score one for Haley Barbour. The state’s health care efforts haven’t been plagued by claims about grandma’s life-support, as we saw on the federal level. For now, public support and physician support are both high in the state.

Surveys by the Urban Institute and the BCBS of Massachusetts Foundation found that 67 percent of nonelderly adults in the state supported the health care law in the fall of 2009; in the fall of 2006, a few months after it was passed, 68.5 percent supported it. Another 2009 survey by the Harvard School of Public Health and the Boston Globe found 59 percent of state residents supported it, which was also similar to the poll’s 2006 number, 61 percent. In 2009, 28 percent opposed it and 13 percent weren’t sure. Support was much higher among Democrats and Independents than Republicans. Those are the most recent surveys we found.

Among practicing physicians, 70 percent supported the law in a fall 2009 survey, also from Harvard. That poll, published in the New England Journal of Medicine, also found that 60 percent of physicians said the law didn’t have much of an impact on how long patients wait to get an appointment (and 2 percent said there was a positive impact). Eighty-five percent said the law either had not much impact or a positive impact on the quality of care patients receive.

Bills haven’t been filed to repeal the individual mandate, says Rosman with Health Care for All. And there was no taxpayer revolt when the state asked residents to confirm their insurance status on their tax returns. “We were totally expecting a big issue,” particularly from libertarians, he says. “I expected people to write on their tax return, ‘Go to hell.’ ” Instead, more than 98 percent of tax filers complied.

— by Lori Robertson

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The post ‘RomneyCare’ Facts and Falsehoods appeared first on FactCheck.org.

Brown didn’t provide the source of the estimate when host Bob Schieffer inquired about it. And our calls to the senator’s office haven’t been returned. The Boston Globe reports that Brown claims the figure came from recent discussions he’s had with "industry leaders." But representatives in Brown’s Senate office told the Globe that he got the figure from the chief executive of MassMutual, an insurance company based in Springfield, Mass., who didn’t actually offer exact numbers:

Boston Globe, April 20: Brown said yesterday that his weekend prediction on national TV Sunday that tightening Wall Street rules would kill 25,000 to 35,000 jobs in Massachusetts was “based on my speaking with industry leaders’’ in recent weeks, but he did not cite any specific analysis.

That varied from an explanation offered by his representatives on Sunday, when his office said Brown was given the estimate by the chief executive of MassMutual, a large insurance company headquartered in Springfield.

MassMutual officials said Sunday, and again yesterday, that they did not give Brown any firm estimates of projected job losses in the Bay State.

Officials for the insurance company said they told Brown that the state’s financial sector had lost about 33,000 jobs since the recession began, and that Brown may have taken his figure from that. And Kenneth Cohen, senior vice president and deputy general counsel at MassMutual, said they had mentioned that future losses, as a result of the bill, could be in a "similar range of magnitude."

But according to the Bureau of Labor Statistics, there were about 222,300 employees in the state’s financial activities sector when the recession began in December 2007, while there were roughly 207,000 employees in that sector at the end of March 2010. That’s a loss of nearly 15,300 jobs — less than half of what insurance officials said they had told Brown. MassMutual officials acknowledged that they had overcounted the number of jobs lost in the financial sector, according to the Globe, but Brown said that he stands by what he said on the talk show.

It’s still not clear how, or if, the number of jobs lost since the recession began correlates to the number of jobs that could be affected by the bill to more tightly regulate the financial services industry. We have seen no jobs figures linked to the legislation by any independent source. The Globe quoted Peter Morici, a professor at the University of Maryland and former director of the Office of Economics at the U.S. International Trade Commission, saying, "I don’t see [the bill] either creating or destroying very many jobs, certainly not in numbers that are quantifiable."

We’ll have more on claims about the financial regulatory bill tomorrow.

The post Sunday Replay appeared first on FactCheck.org.

Axelrod, in an appearance alongside White House Press Secretary Robert Gibbs on MSNBC’s “The Daily Rundown” on Wednesday, was trying to play down the role of the health care issue in Brown’s upset victory. MSNBC’s Savannah Guthrie asked, “How can you interpret this in any other way that it is a total rejection of health care reform?” Axelrod responded:

Axelrod, Jan. 20: I think that there were a lot of elements to the message yesterday. Health care was part of it.

I would note that Senator Brown didn’t run one ad on health care in the entire campaign. I’m sure you know that. And he supported a health care reform similar to the one that the president was and is committed to in Massachusetts, and said during the campaign that he wouldn’t repeal it.

But that’s wrong. The Brown campaign did run a TV ad specifically highlighting Brown’s opposition to health care legislation in Congress. According to the Campaign Media Analysis Group of TNS Media Intelligence, which tracks when and where political TV ads appear, the Brown ad ran a total of 222 times from Jan. 12 through Jan. 15 in Boston, Springfield, and nearby Providence, R.I. CMAG estimates that the campaign spent $135,000 to air the spot, in which Brown states that the bill would have a “negative effect on you and your family.”

Furthermore, the recently formed Americans for Responsible Health Care also ran ads in the state emphasizing Brown’s opposition to current plans for overhauling the nation’s health care system. ARHC, according to Politico.com, spent $200,000 airing the two ads below in the Boston market just a week before the election.

During the interview, Axelrod said that he didn’t feel the election was about “that one particular issue” and that “there is a tendency in this town … to overblow things, even beyond their importance.” Nevertheless, he said, the administration gets the message sent by the outcome in Massachusetts.

The post Axelrod Wrong on Health Care Ads Claim appeared first on FactCheck.org.