Fact Check: AFP's 'It's about people'

A review of a second ad from Americans for Prosperity finds no outright falsehoods but some missing context in its arguments against President Barack Obama, the Affordable Care Act and Democratic U.S. Sen. Kay Hagan.

Posted 8:45 p.m. Nov 22, 2013 — Updated 10:07 p.m. Nov 22, 2013

Mark Binker

RALEIGH, N.C. — American's for Prosperity has launched its second television ad targeting U.S. Sen. Kay Hagan for her support of the Affordable Care Act.

"Obamacare doesn't work. It just doesn't work," concludes a woman who looks straight into the camera for the majority of the 30-second spot.

Hagan, a first-term Democrat, faces re-election in 2014. She holds a big fundraising lead over the field of Republican hopefuls but has seen her approval ratings suffer in recent polling due to the rocky roll-out of President Barack Obama's signature health care law. However, money spent by non-candidate groups could go a long way toward helping candidates on either side, potentially evening the playing field for the eventual GOP nominee.

A spokesman for American's for Prosperity says it will spend $1.5 million airing this ad on both cable and broadcast television in North Carolina. That's in addition to the $1.65 million spent on the group's first ad targeting Hagan's support for the Affordable Care Act.

AFP's spending, combined with $400,000 spent by a Democratic political action committee to bolster Hagan's image, means television ad spending alone has topped $3.55 million without the candidates themselves going on the air – that also doesn't count robocalls, billboards and the like.

Americans for Prosperity is national conservative-leaning group that has been one of the most vocal critics of Obama and the health care law. The group has been active in prior elections.

The claims

This newest ad is primarily meant to target women, ages 36 to 64, according to paperwork filed with the FCC. The overall message is that "Obamacare doesn't work," and viewers are urged to call Hagan, presumably to tell her to vote against further implementation of the law. As noted in a prior fact check, it is certainly accurate to say Hagan has voted in favor of the law, even though she has recently taken pains to ensure that she's seen as troubled by its problematic debut.

More specifically, the ad makes three factual claims:

"millions of people have lost their health insurance"
"millions of people can't see their own doctors"
"millions are paying more and getting less"

Upon request, Americans for Prosperity provided citations for those claims. The Hagan campaign has offered its own document refuting the claims.

The following is WRAL News' analysis. For those who want to skip to the bottom line, none of these claims are absolutely false, but the commercial doesn't tell the whole story, and viewers who don't seek more information could be misled.

'Millions of people have lost their health insurance'

As backup for the ad, AFP points to a Fox News story and a piece Forbes.com published by Avik Roy, a fellow at the conservative Manhattan Institute.

Those stories certainly do point to well-documented problems with the Affordable Care Act roll-out, including the fact that, despite assurance by the president, there are those who shop in the individual market who have not been able to keep their current policies. Obama has since proposed an administrative change that would allow individuals to keep their plans for at least the next year, and there are other proposals in Congress that would extend the life of those existing plans.

"The president himself has acknowledged that millions of Americans are losing their insurance plans," said Donald Bryson, a spokesman for AFP in North Carolina. "He has since created a 'fix' for this problem by allowing insurance companies to reinstate plans for people who were on the canceled plans. Many proponents of the Affordable Care Act will say, 'This means people are not losing their coverage.' However, our position is that, in one year, this situation will repeat itself, and these same people will again lose their insurance plans."

More context would be useful in understanding this claim.

For example, that "millions" number applies to people encountering insurance issues nationwide. In North Carolina, Insurance Commissioner Wayne Goodwin has said about 473,000 of roughly 9 million state residents would have had to change insurance plans under the original Affordable Care Act rules. Nationwide, the number of those shopping in the individual market is closer to 14 million, according to California Healthline.

The people who have "lost" their health insurance have been told that their existing plans don't meet the rules for minimum coverage laid down by the Affordable Care Act. Those people are being offered alternate insurance products, albeit sometimes those replacement plans cost more than their old insurance plan.

In fact, this is one of the biggest reasons that the website failures referenced in the ad are such a big deal. Ideally, those who could not keep their previous plans would have logged on and found new insurance, in many cases subsidized. Instead, there is a great deal of uncertainty about their ability to find replacement insurance. It's fair to note, as the Hagan campaign does, that it was the decision of the Republican-led General Assembly that stopped development of a state-based exchange and forced North Carolinians to shop on the troubled federal exchange.

The Fox News piece also cites a conservative think tank report that says 50 million to 100 million people insured through their small businesses will see their policies changed by the the Affordable Care Act. This is not just a notion tossed around by conservatives. Former Democratic presidential contender Howard Dean told CNN, "Small businesses are going to dump their employees into the exchange. I think that's a good thing."

But the 100 million number exceeds other estimates. For example, a report by the nonpartisan Congressional Budget Office fixed the number of people who could lose employer-based coverage at 20 million, describing that as a worst-case scenario. As with those in the individual market, the Affordable Care Act anticipates they'll be able to find new coverage through the exchanges.

Is this claim true? Yes, but there is a lot of context missing. "Millions" is a nationwide number, not a figure for North Carolina, and the vast majority, if not all, of those people will be able to find replacement insurance.

The Hagan campaign points out the senator has signed onto a bill that would make Obama's one-year extension of some plans permanent. In this way, Hagan's position jibes with the point AFP is making.

'Millions of people can't see their own doctors'

Over the past several years, the promise that people can keep their doctors has been up there with the pledge that people could keep their existing insurance plans. Just as it turns out not to be true everyone can keep their plans, it turns out that the blanket promise that everyone would be able to keep going to the same doctor is problematic.

Among the backup provided by AFP for this claim is a New York Times story that says, "From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans."

While there is some substance to this claim, viewers would do well to take a step back for a moment. To say that "millions of people can't see their own doctors" implies that the health law somehow legally prohibits people from visiting doctors they know and like. This is clearly not the case.

So what's really going on?

The conflict between the promises and the reality of the Affordable Care Act has been explored by Time, CNN, FactCheck.org and PolitiFact.

The gist of all those stories is that absolute statements one way or the other about whether people would be able to keep their doctors are misleading. For example, PolitiFact criticized U.S. Sen. Marco Rubio, a Florida Republican, for saying with a high degree of certainty that people would lose access to their doctors of 15 to 20 years. But FactCheck called it "misleading" to say with certainty that people would be able to keep seeing their existing doctors.

As the New York Times story points out, health insurance companies are trying to save money by narrowing their networks, the doctors, hospitals and other providers who have a direct relationship with the company. Generally, it is cheaper for people on a health plan to see an "in-network" doctor as opposed to an "out-of-network" doctor, and it would be fair to say some patients might find that cost prohibitive.

So, some people will certainly find that it is more difficult, or at least more expensive, to stay with their existing health care provider if that person or institution is no longer included in their network.

Is the claim true? It is overstated. There will be some group of people who will find it more complicated, or at least more expensive, to stick with their existing health care providers. But to imply that people would be prohibited from seeing their existing doctors goes a step beyond reality.

'Millions are paying more and getting less'

Among the backup materials that AFP relies upon for this claim are articles that show health care premiums spiking for some, particularly those who had low-cost catastrophic coverage plans. Many of those stories were based on a Manhattan Institute Report that showed how rates were expected to climb.

Again, some more context would be useful.

The first thing to know is that insurance rates are going up largely because insurers are being required to provide a higher level of service. According to Healthcare.gov, there are 10 "essential" services that health plans must cover: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care.

The idea that single men would need to have coverage for "maternity and newborn care" recently got a great deal of focus during a congressional hearing.

Not cited by AFP, but helpful to their case, is a loophole noted by Kaiser Health News and The Wall Street Journal, some "large employers" could get around penalties in the law by offering "skinny" plans. These plans would cover just what the ACA requires and nothing beyond that. However, a key paragraph from that Wall Street Journal story reads, "It is unclear how many employers will adopt the strategy, but a handful of companies have signed on, and an industry is sprouting around the tactic. More than a dozen brokers and benefit administrators in 10 states said they were discussing the strategy with their clients." So, it's less than clear whether "millions" will actually be impacted by this.

As for the "paying more" side of the claim, both PolitiFact and FactCheck.org have looked at claims that rely on the Manhattan Institute study. It's important to know that study does not fully take into account subsidies available to many people on the exchanges. So, not everyone is going to experience the full force of whatever the cost increases turn out to be.

As FactCheck.org notes, the study looks at the cheapest rates available before the ACA passed and compares them with the cheapest rates on the exchange.

"The institute didn’t adjust the level of benefits or coverage of these plans," the fact-checking site wrote. "As we’ve said before, the law requires certain minimum benefits, which many individual market plans don’t meet. Not everyone will take advantage of, or welcome, those expanded benefits, of course, and the study was looking only at the cheapest plans available on the market before and after these regulations kicked in and the exchanges opened."

Still, the fact-checking sites concur that the Manhattan Institute doesn't compare "apples-to-apples" and doesn't allow people to see the true impact of the cost, since it can't account for subsidies.

Is the claim true? Certainly, some people will pay more for health insurance, but for the large percentage of those people, if they see a rate increase, it will be because their new plans cover more services.

Overall: is the ad accurate?

It seems a little bit early to conclude "Obamacare doesn't work. It just doesn't work." The Affordable Care Act certainly has had a rough roll-out, but it doesn't fully go into effect until early next year.

However, unlike AFP's first ad of the campaign, this one has firmer footing rooted in reports that have examined the law. The factual problems with this ad are issues of context and emphasis. It should come as no surprise that AFP, which has been a vocal and persistent opponent of the Affordable Care Act and its backers, paints the worst possible picture of the measure.

As with Obama's pledge that those who liked their health care would be able to keep it or Rubio's certainty that people would lose access to their doctors, sweeping one-line phrases about a massive piece of legislation are rarely going to turn out to be completely accurate, whether those statements are promoting the bill or seeking to cast it in a negative light.

In this case, none of the statements in this ad are absolutely false, but it by no means tells the whole story, and viewers could be misled if they seek no further information.

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