In an interview with Fox & Friends on Thursday morning, Vice President Pence rolled out a popular conservative talking point while discussing the existing Affordable Care Act (or “Obamacare”) and Republican plans to repeal and replace it.
One problem: The talking point is completely false.
“Almost anything would be better than Obamacare. Obamacare is imploding. It’s collapsing all across the country. It’s remarkable to see the pattern,” he said, when asked about the debate over the existing Graham-Cassidy bill. “You’ve got thousands of counties across the country where there is either only one choice or no choice. Literally, these Obamacare exchanges are collapsing before our eyes.”
This is simply not true. According to the non-partisan Kaiser Family Foundation, as of September 15, 2017, there were zero counties in the United States with no insurer on the marketplace.
Earlier in the month, 63 counties in Virginia had been at risk of becoming “bare” counties with no insurance options. On Friday, Anthem — which in August had “pulled out of all but a handful of localities in Virginia, citing the uncertainty of federal ‘cost-sharing reductions’”, according to The Virginian-Pilot — agreed to remain in those counties to prevent that from happening. Previous to that decision, both UnitedHealthcare and Aetna announced they would exit the state’s marketplace entirely, and Optima Health announced it would scale back its coverage to 30 localities. Most officials had agreed that the destabilization of Obamacare by the Trump administration had created a volatile environment that provided them with no safety net.
“Anthem will remain focused on developments in the individual marketplace and will continue to advocate for solutions that will stabilize the market and allow us to once again, offer individual insurance coverage throughout the state of Virginia in the future,” Anthem spokespersons stated in a release, adding that the decision would help some 70,000 Virginians.
With Anthem’s promise to remain in Virginia, the Centers for Medicare and Medicaid Services reported, around 1,472 counties nationwide are able to offer one insurance option; the remaining 1,670 counties will more than likely provide two or more options.
It’s possible that Pence on Thursday meant those 1,472 counties with one marketplace insurer were unable to provide consumers with a competitive choice — but given that conservatives and Republicans have long used the bare counties argument as a reason to gut the ACA, using similar language, it’s more likely that Pence’s offhand statistics were simply out of date.
As recently as August, House Speaker Paul Ryan was using that claim to buff up his own arguments against Obamacare.
“The status quo is not an option. Obamacare is not working,” Ryan said at a town hall that month. “…We’ve got dozens of counties around America that have zero insurers left.”
In fact, that same day, the Kaiser Family Foundation had reported that only one county was at risk of having no insurers on the marketplace. As ThinkProgress’ Addy Baird wrote at the time, Ryan’s comments appeared to be yet another attempt to paint Obamacare as broken, despite the raw numbers telling a different story.
On Thursday, Pence also used his home state of Indiana as an example of how an effective Obamacare replacement might look.
“From the very first conversation I had with President Trump, he spoke favorably of what we did in the state of Indiana,” Pence said, referring to his decision as governor to expand Medicaid on his own terms. “What we did was go to the federal government and we said, ‘look, we want to expand Medicaid but we want to do it the Indiana way. So for the first time we got the most significant flexibility in the history of Medicaid. People in Indiana today on Medicaid have health savings accounts. They’re able to choose their own doctor. They are able to be in primary care. They are given incentives for engaging in wellness like quitting smoking and losing weight. People love it.”
Unfortunately, according to NPR, that claim is also a stretch. Although Indiana did expand Medicaid access for its citizens, it did so under the guise of its Healthy Indiana Plan (HIP) 2.0 plan, which forces “poor people contribute to savings accounts which are then applied to the portion of the bill that insurance covers (not the co-pay),” the outlet reported. If those people are unable to pay their monthly contribution, they subsequently “lose their health insurance and are locked out of re-applying for coverage” for a period of six months.
“People below the poverty line are on something called HIP Basic, which excludes dental and vision, and requires hefty co-pays. They’re also encouraged to pay a monthly premium into and get on HIP Plus. If they neglect to pay the premium, they get knocked back down to HIP Basic,” NPR reported.
This presents a major problem, argued Joan Alker, executive director of the Center for Children and Families (CCF) and a research professor at Georgetown University. “There are more costs for low-income families and individuals…. That means they may miss the care that they need,” she said.