FactCheck.org http://www.factcheck.org A Project of the Annenberg Public Policy Center Mon, 27 Jul 2015 17:05:06 +0000 en-US hourly 1 http://wordpress.org/?v=4.2.1 Mailbag: Bernie Sanders on the Rich http://www.factcheck.org/2015/07/mailbag-bernie-sanders-on-the-rich/ http://www.factcheck.org/2015/07/mailbag-bernie-sanders-on-the-rich/#comments Mon, 27 Jul 2015 17:03:55 +0000 http://www.factcheck.org/?p=97573 This week, readers sent us letters about a claim made by Sen. Bernie Sanders, who is running for the Democratic nomination for president, about income inequality in the United States.

In the FactCheck Mailbag, we feature some of the email we receive. Readers can send comments to editor@factcheck.org. Letters may be edited for length.


The Wealth of  ‘the Few’

In your article [“Sanders Stretches State of the Rich,” July 23], you arbitrarily define “the few” as 0.1 percent, or one out of 1,000 people. Then you generously say that Mr. Sanders may consider it 1 percent, or one out of 100. Myself, I would consider the few, in this context, as maybe 5 percent, or five out of 100. If I had a large group of people, and I selected 5 percent, yes, that would be a few. And yes, if just 5 percent of the population holds over 50 percent of the wealth, that is a great cause of concern. I believe it is the highest concentration since the late [19]20s. In my book anyway.

Randy Stemen  
Cincinnati, Ohio


It took an incredible degree of verbal jiu jitsu, but you turned the (undefined) “few” into the 0.1 percent, then turned that into “the rich.” I think that most of us would consider the top 1 percent, or even the top 10 percent, to be “few” (at least relatively). While on the other hand, most of us in the bottom four quintiles would consider the top 20 percentile to be rich.

To focus your criticism of Senator Sanders’ statement almost entirely on an assumption that he means the top 0.1 percent, and only briefly considering that he might mean a larger share of the population than that (and even then only the top 1 percent), is an incredibly elitist reading of his statement. You do not even consider that the substantial share of national wealth held by the wealthiest 0.1 percent in this country is an indicator of the share of the wealth held by the top 5 percent or 10 percent. Your headline writer then takes the opposite tack and turns your critique, which focuses on an extremely narrow interpretation of “the few,” and generalizes it into “the rich.”

Your team does some great work, but you’ve let us all down on this one.

Ray Wells
Ellensburg, Washington


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Obama-Rouhani Photo Is Not Real http://www.factcheck.org/2015/07/obama-rouhani-photo-is-not-real/ http://www.factcheck.org/2015/07/obama-rouhani-photo-is-not-real/#comments Fri, 24 Jul 2015 19:03:30 +0000 http://www.factcheck.org/?p=97525 A word of caution to ad makers: Don’t believe everything you see online, even images “in circulation widely on the internet.”

Restoration PAC learned that lesson the hard way when it used an image of President Barack Obama shaking hands with Iranian President Hassan Rouhani for a TV ad airing in Wisconsin. The ad, which promotes incumbent Republican Sen. Ron Johnson for his opposition to the Iran nuclear agreement, pans across an image of a smiling Obama and Rouhani as the narrator accuses Obama of signing a “toothless agreement that makes us less safe.” The problem: Obama has never met Rouhani.

BuzzFeed News called out Restoration PAC in a July 23 post under the headline, “Anti-Iran Deal TV Ad Uses Fake Image Of Obama Meeting Iranian President.” The article said the original, authentic image was of Obama meeting with former Indian Prime Minister Manmohan Singh in 2011. In the image used in the ad, BuzzFeed said, Rouhani was Photoshopped in.

Here’s the image used in the Restoration PAC ad:


And here’s the original photo it came from, according to BuzzFeed:


When we reached out to Restoration PAC by email, spokesman Dan Curry asked whether BuzzFeed “had any proof the photo was fake.”

We sent Curry links to several articles noting that a potentially historic handshake photo-op between the two leaders at the United Nations in 2013 never materialized. And the White House later confirmed to us that Obama and Rouhani have never met.

Curry responded with an official “Statement to FactCheck regarding liberal Buzzfeed post.” Here’s the part that addresses the photo:

Curry, July 23: BuzzFeed was not able to provide any proof that the photo was fake and it indeed is in circulation widely on the internet. There also are no articles claiming the image is fake. However, out of an abundance of caution, we are replacing the image with side-by-side Obama and Rouhani photos that make exactly the same point. The composition of the original image was not central to the ad’s point. The revised ad will be in circulation Friday morning.

Katherine Miller, the political editor for BuzzFeed News, told us via email that her only comment was, “The image is fake.”

As promised, Restoration PAC updated the ad with a new image, of Obama and Rouhani side-by-side but clearly not together.


The defense for the manipulated image — that “it indeed is in circulation widely on the internet” — is, in fact, no defense at all. We’ve got a whole section of our website devoted to bogus information circulating widely on the Internet.

We’ll leave it up to readers to determine whether or not the image is “central to the ad’s point.” But we note that images, in general, can be powerful and persuasive in political ads. And if Obama had shaken hands with Rouhani, it would have been news.

As Time’s Michael Crowley wrote in the days leading up to Rouhani’s visit to the United Nations in 2013: “An encounter between Obama and Iran’s new president at the United Nations on Tuesday would be the most important—or at least the most analyzed—handshake since the historic grip between Rabin and Arafat (or, if you prefer, Nixon and Elvis). It would only be a symbolic act, to be sure. But when it comes to international diplomacy, symbolism can go a long way.”

The ad — which praises Sen. Johnson for “understand[ing] that preventing Iran from getting the bomb is essential to our safety” — is running in Madison, Milwaukee and Green Bay. A press release for the ad notes that it was produced by Rick Reed, a Republican strategist involved in the controversial Swift Boat Veterans for Truth ad campaign in 2004 that attacked Democratic presidential candidate John Kerry’s military service. Restoration PAC is a conservative group that seeks to elect conservative Republicans to the Senate. According to its website, the PAC advocates for and against candidates based on their adherence to the “Blueprint for the Restoration of America,” an agenda that includes conservative principles such as reducing the size of government and the debt, cutting taxes, and repealing the Affordable Care Act.

Johnson is set to square off for a second time against former Democratic Sen. Russ Feingold in what Roll Call called “one of the country’s most closely watched races.”

— Robert Farley

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Sanders Stretches State of the Rich http://www.factcheck.org/2015/07/sanders-stretches-state-of-the-rich/ http://www.factcheck.org/2015/07/sanders-stretches-state-of-the-rich/#comments Thu, 23 Jul 2015 17:10:28 +0000 http://www.factcheck.org/?p=97490 Sen. Bernie Sanders claims that in the United States, “almost all of the wealth rests in the hands of the few.” He exaggerates. At most, the top 0.1 percent of U.S. families own 22 percent of the nation’s wealth, and Federal Reserve Board economists put the figure at 14 percent.

Either way, that’s a high concentration, and it has been growing in recent years. But neither 22 percent nor 14 percent is anywhere close to “almost all.”

Even if Sanders’ idea of “the few” includes the top 1 percent (about 1.6 million families), one study he has referenced puts their wealth at 42 percent of the total, and the Fed puts it at 36 percent. That’s not even most of the wealth, let alone “almost all” of it.

22 Percent?

Sanders, a presidential candidate, made the comment during his keynote address at the Iowa state Democratic Party Hall of Fame dinner on July 17 (at about the 5-minute mark).

Sanders, July 17: Today, in our great country, we are the wealthiest country in the history of the world, today, in the history of the world. But most Americans don’t know that because almost all of the wealth rests in the hands of the few.

America now has more wealth and income inequality than any major country on earth, and it is worse today than at any time since 1928.

Some of Sanders’ claims on income and wealth come from a widely quoted October 2014 study by economists Emmanuel Saez of the University of California, Berkeley, and Gabriel Zucman of the London School of Economics and Political Science. It garnered lots of headlines with its finding that wealth was more concentrated now than it has been at any time since the Great Depression.

But the Saez-Zucman study estimated that the top 0.1 percent (about 160,000 families) held 22 percent of the nation’s wealth, not “almost all.” And while it estimated that the top 10 percent owned 77.2 percent of the wealth, that would be well over 31 million people, which hardly qualifies as “the few.”

Furthermore, the Saez-Zucman study is an estimate that other economists say is inflated. The authors couldn’t actually measure anyone’s wealth directly, of course, because an individual’s net worth is generally confidential information not usually shared with the public or even with the Internal Revenue Service, which requires reporting of taxable income but not of the value of a house or of stocks or bonds or bank accounts.

Instead, the authors infer wealth from 2012 income as reported to the IRS, the most recent year for which they had income tax data.

(As for Sanders’ claim about wealth and income inequality, we covered that previously. Nations including Russia, Turkey and Brazil have greater inequality than the U.S.)

Or 14 Percent?

Saez and Zucman’s work has been criticized by economists at the Federal Reserve Board, which has conducted its own studies of the wealth held by U.S. households since the 1960s. The Fed’s Survey of Consumer Finances is based on extensive surveys conducted every three years. The most recent covered 2013 (one year more recent than the Saez-Zucman paper’s coverage) and was based on a sample of about 6,500 families who agreed to share detailed information about their net worth.

The Fed’s survey data put the share of wealth held by the top 0.1 percent at 14 percent.

What accounts for the difference? Saez and Zucman argue that the Fed’s survey misses some of the richest families — those featured in the Forbes magazine list of the 400 wealthiest Americans. But that alone can’t account for the gap. The combined net worth of the entire Forbes 400 for 2013 was $2.021 trillion, accounting for just about 3 percent of total wealth, according to a paper published in June by Fed economist Jesse Bricker and three colleagues, Alice M. Henriques, Jake A. Krimmel and John E. Sabelhaus.

The Fed economists offer a detailed critique of the Saez-Zucman methodology, arguing that it has an “upward bias.” For example, the tax return data used by Saez and Zucman measure only taxable income, and can’t account for a lot of untaxed benefits, such as employer-paid health care and employer contributions to Social Security and Medicare, which benefit those in the middle more than those at the top.

They also defend their own methodology, noting that the Fed survey deliberately over-samples wealthy families and makes other adjustments to compensate for the fact that the very rich are relatively scarce and thus often missed by random surveys.

We won’t attempt to resolve this academic dispute. It may be that the correct figure for the top 0.1 percent lies somewhere between 14 percent and 22 percent of all wealth. We’ll just note that neither set of figures supports the overheated claim made by Sanders.

— Brooks Jackson

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Trump’s McCain Attack http://www.factcheck.org/2015/07/trumps-mccain-attack/ http://www.factcheck.org/2015/07/trumps-mccain-attack/#comments Wed, 22 Jul 2015 20:33:46 +0000 http://www.factcheck.org/?p=97461 Donald Trump distorts the facts in a recent op-ed in which he says Sen. John McCain has “abandoned our veterans” and “failed the state of Arizona and the country.”

  • Trump says McCain authored legislation “to cover up the VA scandal,” claiming the bill “made sure no one has been punished” at the Department of Veterans Affairs for falsifying data to mask long delays for care at VA hospitals. But VA officials have been punished, and the bill expanded the VA secretary’s power to discipline employees for misconduct.
  • Trump claims “1,000+ veterans died waiting for medical care” in the “VA scandal.” But an independent government report said it was “unable to conclusively assert” that delays caused veterans’ deaths. The 1,000 figure comes from a news report on the number of wrongful death payments involving veterans who received inadequate VA care.
  • He says McCain has made the U.S. “less safe,” citing as evidence the fact that McCain “even voted for the Iran Nuclear Review Act of 2015,” which gave Congress the right to vote on the Iran nuclear deal. Trump doesn’t mention that the bill passed the Senate 98-1.

The New York real estate mogul, who is running for the Republican presidential nomination, has been rising in the polls. The latest Washington Post-ABC News Poll shows that 24 percent of registered Republicans and Republican-leaning independents support him for president. That gives him a double-digit lead over his nearest competition, Wisconsin Gov. Scott Walker (13 percent) and former Florida Gov. Jeb Bush (12 percent).

Trump came under heavy criticism for saying at a July 18 event in Iowa that McCain is “not a war hero.” McCain, who was the party’s 2008 presidential nominee, served in Vietnam and was held captive for more than five years.

In response to the criticism of his comments on McCain, Trump wrote a July 19 op-ed for USA Today that carried the headline “Trump: I don’t need to be lectured.” The op-ed lists the ways that Trump believes McCain has “failed the state of Arizona and the country.”

Trump has every right to express that opinion, but he twists the facts when providing his supporting evidence.

The ‘VA Scandal’

In his op-ed, Trump writes about the wait-list controversy that cost VA Secretary Eric Shinseki his job.

The controversy originated at the Phoenix VA Health Care System in McCain’s home state of Arizona. The House Committee on Veterans’ Affairs revealed on April 9, 2014, that the Phoenix VA was keeping two sets of records to hide long waits for health care appointments and that “as many as 40 veterans” may have died because of the delayed care, the Arizona Republic reported.

An internal audit conducted by the VA in May and June 2014 found the problem of fraudulent scheduling was widespread, as USA Today reported at the time.

Congress responded with legislation — sponsored in the Senate by Bernie Sanders, who’s running for the Democratic nomination for president, and cosponsored by McCain — called the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014.

Trump, July 19: Thanks to McCain and his Senate colleague Bernie Sanders, their legislation to cover up the VA scandal, in which 1,000+ veterans died waiting for medical care, made sure no one has been punished, charged, jailed, fined or held responsible. McCain has abandoned our veterans. I will fight for them.

There are multiple issues with this excerpt, but let’s first consider the claim that the legislation was “to cover up the VA scandal” and that it “made sure no one has been punished.”

The fact is that eight VA employees have been punished, although that’s not as many as some in Congress — including McCain — would like.

New York Times, April 22: The documents given this month to the House Committee on Veterans Affairs, which provided them to The New York Times, show that the department punished a total of eight of its 280,000 employees for involvement in the scandal. One was fired, one retired in lieu of termination, one’s termination is pending, and five were reprimanded or suspended for up to two months.

In addition, the legislation that Trump criticizes provided the VA secretary with greater authority to discipline senior employees. A summary of the conference report drafted by the House Veterans’ Affairs Committee listed the ways that the bill provided “real accountability” for misconduct:

House Veterans’ Affairs Committee, 2014: To provide real accountability for incompetent or corrupt senior managers, the bill would:
— Authorize VA to fire or demote Senior Executive Service (SES) employees and Title 38 SES equivalent employees for poor performance or misconduct.
— Provide an expedited and limited appeal process for employees disciplined under this authority. Appeals would go to a Merit Systems Protection Board administrative judge, who would have 21 days to decide on the appeal. If a decision is not reached within that 21-day period, then VA’s decision to remove or demote the executive is final.
— Prohibit SES employees from receiving pay, bonuses and benefits during the appeal process.

As for his claim that “1,000+ veterans died waiting for medical care,” Trump is conflating two issues: the wait-list controversy and the number of wrongful death settlements at VA hospitals.

Trump’s op-ed links to a news article about a June 2014 report released by Sen. Tom Coburn’s office that said: “Over the past decade, more than 1,000 veterans may have died as a result of VA malfeasance.” A footnote in Coburn’s report explains that the 1,000 figure comes from a Center for Investigative Reporting project on wrongful death settlements at VA hospitals.

Coburn’s report links to a CIR story that ran in the Philadelphia Inquirer that says “nearly 1,000″ payments were made over a 10-year period for a variety of reasons to the families of veterans who received inadequate care at the VA.

Center for Investigative Reporting, April 3, 2014: In that time, CIR found the agency made wrongful death payments to nearly 1,000 grieving families, including 36 in Pennsylvania, ranging from decorated Iraq War veterans who shot or hanged themselves after being turned away from mental health treatment, to Vietnam veterans whose cancerous tumors were identified but allowed to grow, to missed diagnoses, botched surgeries and fatal neglect of elderly veterans.

The full CIR report, which can be found on the group’s website, and the Inquirer article both quote VA spokeswoman Victoria Dillon as saying “any adverse incident for a veteran within our care is one too many,” but the wrongful deaths over that 10-year period represented a small percentage of VA patients. The article said there are “more than 6 million veterans who seek care from the agency every year.”

As for the number of deaths caused by the wait-time scandal, the Office of Inspector General within the Department of Veterans Affairs issued a final report in August 2014 on patient deaths at the Phoenix VA. The report said: “While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.”

On Sept. 17, 2014, Acting Inspector General Richard Griffin testified before a House committee that his office could not prove causality.

“As I cautioned in my May 15, 2014, testimony before the U.S. Senate Committee on Veterans’ Affairs, it is one thing to be on a waiting list and it is another thing to conclude that being on a waiting list caused death,” Griffin said in his testimony.

Iran Nuclear Deal

Trump also criticizes McCain for voting for the Iran Nuclear Review Act of 2015, citing it as evidence that McCain “has made America less safe.”

Trump, July 19: He even voted for the Iran Nuclear Review Act of 2015, which allows Obama, who McCain lost to in a record defeat, to push his dangerous Iran nuclear agreement through the Senate without a supermajority of votes.

Again, Trump is entitled to his opinion. But he leaves out some important context — beginning with the fact that the bill passed the Senate 98-1 and the House 400-25. Trump fails to mention that when singling out McCain for capitulating to President Obama.

The bill — which is actually called the Iran Nuclear Agreement Review Act of 2015 — was a compromise between Congress and the White House that allowed Congress to review and possibly vote to reject the deal. It also imposed some requirements on the administration.

As the New York Times reported, it would “require that the administration send the text of a final accord, along with classified material, to Congress as soon as it was completed. It also would halt any lifting of sanctions pending a 30-day congressional review and culminate in a possible vote to allow or forbid the lifting of congressionally imposed sanctions in exchange for the dismantling of much of Iran’s nuclear infrastructure.”

Senate Majority Leader Mitch McConnell on the Senate floor during the vote on May 7 called the bill “the best chance for our constituents, through the Congress they elect, to weigh in on the White House’s negotiations with Iran.” The president signed it on May 22.

Congress could block the nuclear agreement, if it musters the two-thirds majority that would be needed to override a veto that the president has promised if Congress voted to reject the deal.

Trump is free to criticize the legislation and McCain for voting for it, just as he is free to criticize McCain for cosponsoring the VA legislation. But in both cases he goes too far when he distorts and obscures the facts to fit his narrative.

— Eugene Kiely

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Unspinning the Planned Parenthood Video http://www.factcheck.org/2015/07/unspinning-the-planned-parenthood-video/ http://www.factcheck.org/2015/07/unspinning-the-planned-parenthood-video/#comments Tue, 21 Jul 2015 16:46:18 +0000 http://www.factcheck.org/?p=97353 Several Republican presidential candidates have claimed that Planned Parenthood is “profiting” from abortions. But the full, unedited video they cite as evidence shows a Planned Parenthood executive repeatedly saying its clinics want to cover their costs, not make money, when donating fetal tissue from abortions for scientific research.

Four experts in the field of human tissue procurement told us the price range discussed in the video — $30 to $100 per patient — represents a reasonable fee. “There’s no way there’s a profit at that price,” said Sherilyn J. Sawyer, the director of Harvard University and Brigham and Women’s Hospital’s “biorepository.”

Republicans made their claims following the release of a secretly recorded video showing Deborah Nucatola, the senior director of medical services at Planned Parenthood, discussing the procurement of fetal tissues when conducting abortions. The edited video, released July 14 by an anti-abortion group called the Center for Medical Progress, leaves the impression that Nucatola is talking about Planned Parenthood affiliates making money from fetal tissue. But the edited video ignores other things Nucatola said that contradict that idea.

The Videos, Edited and Unedited

At one point in the unedited video (which was also released by the group), Nucatola says: “Affiliates are not looking to make money by doing this. They’re looking to serve their patients and just make it not impact their bottom line.”

Nucatola also says, “No one’s going to see this as a money making thing.” And at another point, she says, “Our goal, like I said, is to give patients the option without impacting our bottom line. The messaging is this should not be seen as a new revenue stream, because that’s not what it is.”

The footage was recorded secretly during a lunch meeting on July 25, 2014, between Nucatola and two people posing as employees of a company looking to procure fetal tissue for research purposes.

While eating a salad and drinking red wine, she casually discusses which tissues are valued by researchers and how to preserve those tissues while conducting abortions. Planned Parenthood President Cecile Richards has apologized for Nucatola’s “tone” and manner of speaking, which House Speaker John Boehner condemned as “cavalier” in calling for a congressional investigation.

In the edited video, Nucatola says the cost for fetal tissue specimens was between $30 and $100, “depending on the facility and what’s involved.” She defined “specimen” as, “one case. One patient.”

Republicans have focused on those comments, characterizing the practice as a way to profit off abortion:

Rick Perry, July 14: The video showing a Planned Parenthood employee selling the body parts of aborted children is a disturbing reminder of the organization’s penchant for profiting off the tragedy of a destroyed human life.

Rand Paul, July 14: … a video showing [Planned Parenthood]’s top doctor describing how she performs late-term abortions to sell body parts for profit!

Carly Fiorina, July 14: This latest news is tragic and outrageous. This isn’t about “choice.” It’s about profiting on the death of the unborn while telling women it’s about empowerment.

Nucatola’s comment, though, isn’t evidence that Planned Parenthood or its affiliates are selling “body parts” or fetal tissue for profit. The full video shows that after Nucatola mentions the $30 to $100, she describes how those amounts would be reimbursement for expenses related to handling and transportation of the tissues. Nucatola talks about “space issues” and whether shipping would be involved.

We asked all three candidates listed above whether they believed the $30 to $100 per specimen amount constitutes making a “profit” from fetal tissue, and we did not receive specific answers to that question. The chief political strategist for Rand Paul’s campaign, Doug Stafford, sent us the following statement in an email:

Stafford, July 15: Planned Parenthood and their supporters in the media are willing to say anything to defend their taxpayer funded abortions and profiteering from selling aborted fetuses. They want to argue about what week they kill a child or how much they do or do not profit? What’s blatantly obvious is that Planned Parenthood is trying to distract from their extremist positions and immoral “business.”

We also asked experts in the use of human tissue for research about the potential for profit. Sherilyn J. Sawyer, the director of Harvard University and Brigham and Women’s Hospital’s “biorepository,” told us that “there’s no way there’s a profit at that price.” She continued in an email:

Sawyer, July 20: In reality, $30-100 probably constitutes a loss for [Planned Parenthood]. The costs associated with collection, processing, storage, and inventory and records management for specimens are very high. Most hospitals will provide tissue blocks from surgical procedures (ones no longer needed for clinical purposes, and without identity) for research, and cost recover for their time and effort in the range of $100-500 per case/block. In the realm of tissues for research $30-100 is completely reasonable and normal fee.

Jim Vaught, president of the International Society for Biological and Environmental Repositories and formerly the deputy director of the National Cancer Institute’s Office of Biorepositories and Biospecimen Research, told us in an email that “$30 to $100 per sample is a reasonable charge for clinical operations to recover their costs for providing tissue.” In fact, he said, the costs to a clinic are often much higher, but most operations that provide this kind of tissue have “no intention of fully recovering [their] costs, much less making a profit.”

Carolyn Compton, the chief medical and science officer of Arizona State University’s National Biomarkers Development Alliance and a former director of biorepositories and biospecimen research at the National Cancer Institute, agreed that this was “a modest price tag for cost recovery.” Compton told us in an email: ” ‘Profit’ is out of the question, in my mind. I would say that whoever opined about ‘profit’ knows very little about the effort and expense involved in providing human biospecimens for research purposes.”

Nucatola does make one statement in the unedited video that suggests to critics that some clinics would be comfortable with a payment that was slightly more than their expenses for providing the tissue. “I think for affiliates, at the end of the day, they’re a nonprofit, they just don’t want to — they want to break even. And if they can do a little better than break even, and do so in a way that seems reasonable, they’re happy to do that,” Nucatola says.

But immediately after this statement, Nucatola goes on to say: “Really their bottom line is, they want to break even. Every penny they save is just pennies they give to another patient. To provide a service the patient wouldn’t get.” Planned Parenthood told us that she may have been referring to more general operations of the clinics.

SciCHECKinsertNucatola repeatedly talks about affiliates only wanting to provide a service to their patients, who elect to donate the tissue for medical research, and not having that service impact their bottom lines. She says that it’s “not a new revenue stream the affiliates are looking at” and that “nobody should be ‘selling’ tissue. That’s just not the goal here.” She says some affiliates might donate the tissue for free.

Nucatola also discusses Planned Parenthood clinics’ interactions with a tissue procurement company called StemExpress. The company’s website says that partnering with StemExpress can be “financially profitable” for a clinic — a point that some conservative websites have singled out. But this also does not constitute evidence that Planned Parenthood is profiting in such a way.

StemExpress, which provides other types of tissue aside from fetal tissue, did not respond to our request for clarification on profitability. It did release a statement on its website expressing pride in its work to advance research and saying it complies “with all laws.”

According to another tissue procurement company called Advanced Bioscience Resources, which has provided fetal tissues to researchers in a number of federally funded studies, the costs mentioned in the video are reasonable. Linda Tracy, ABR’s president, told us in an email that “[i]t is difficult to pinpoint the exact cost of tissue acquisition due to the many variables involved,” such as the location of the facility, the specific requests from researchers and any special handling that is required. She said, however, that “$30 to $100 is within a comparable range of what ABR pays for reimbursement of costs.”

At one point in the video, Nucatola tells the “buyers” (the actors purporting to represent a fetal tissue procurement company are described as “buyers” in a transcript provided by the Center for Medical Progress) that affiliates wouldn’t make decisions about whether to work with a tissue research organization based on money. “You could call them up and say, ‘I’ll pay you double the money,’ and they’re almost more inclined to say no, because it’s going to look bad. … To them, this is not a service they should be making money from, it’s something they should be able to offer this to their patients, in a way that doesn’t impact them.”

She then suggests that these “buyers” might be able to compete with other companies by offering extra services, such as taking tissue the clinics would otherwise have to dispose of themselves.

In a statement on its website, Planned Parenthood defended its affiliates’ practice of fetal tissue donation as “standard across the medical field”:

Planned Parenthood, July 14: At several of our health centers, we help patients who want to donate tissue for scientific research, and we do this just like every other high-quality health care provider does — with full, appropriate consent from patients and under the highest ethical and legal standards. There is no financial benefit for tissue donation for either the patient or for Planned Parenthood. In some instances, actual costs, such as the cost to transport tissue to leading research centers, are reimbursed, which is standard across the medical field.

Richards, the Planned Parenthood president, said in a video response to the controversy: “The allegation that Planned Parenthood profits in any way from tissue donation is not true.”

On July 21, the Center for Medical Progress released a second, similar video, again featuring a discussion with a Planned Parenthood official in a restaurant. The numbers mentioned in the edited video are similar to what Nucatola said. The official, Mary Gatter, quotes a rate of $75 per specimen, and says she was thinking of saying $50. The discussion only reaches $100 because the “buyers” in the video mention higher prices. At one point, Gatter says that “we’re not in this for the money,” and later she reiterates that “money is not the important thing.”

Though few studies of costs associated with fetal tissue acquisition are available, existing evidence does suggest the prices named in the video are in line with general practices. The National Institutes of Health conducts research with fetal tissue, and in the late 1990s, the Government Accountability Office (then known as the General Accounting Office) looked into the acquisition of such tissue, finding that the direct cost to researchers was “low.” GAO said payments primarily went to “central tissue suppliers,” as opposed to health clinics. In most cases, GAO found that clinics did not charge researchers, but when they did, the cost ranged from $2 to $75. The report did not address how much clinics might have received from central tissue suppliers, which is more analogous to the situation presented in the video.

What Does the Law Say?

In a statement made to CNN, another presidential candidate, retired neurosurgeon Ben Carson, called the practice discussed in the video a “clear violation of federal law.” The “sale” of organs, both adult and fetal, for transplantation is indeed illegal, but donation of tissue — both from aborted fetuses and from adults — is not. And payment for “reasonable” costs is also allowed under the law.

The video itself highlights a portion of title 42 of the U.S. code, which reads: “It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.” The law does include fetal tissue in its definitions. It says that the term “valuable consideration” doesn’t include “reasonable payments” for removal, transportation, preservation and other associated costs.

In 1993, a law pertaining to federally funded NIH research was enacted that allows donation of fetal tissue from induced abortions if certain criteria are met. These include that the woman donating is not aware of the recipients of the tissue, and that the abortion timing, procedures or method itself would not be altered for the sole purpose of obtaining the tissue.

The 1993 law also says that it is unlawful “for any person to knowingly acquire, receive, or otherwise transfer any human fetal tissue for valuable consideration if the transfer affects interstate commerce.” The law again excludes the types of costs Nucatola discussed in the video: “The term ‘valuable consideration’ does not include reasonable payments associated with the transportation, implantation, processing, preservation, quality control, or storage of human fetal tissue.”

The American Medical Association echoes this in its ethical guidelines on the issue: “Fetal tissue is not provided in exchange for financial remuneration above that which is necessary to cover reasonable expenses.”

Why Is Fetal Tissue Scientifically Useful?

Historically, the use of fetal tissue has produced some groundbreaking scientific discoveries. According to the American Society for Cell Biology, a nonprofit representing a large and varied group of scientists, “Fetal cells hold unique promise for biomedical research due to their ability to rapidly divide, grow, and adapt to new environments. This makes fetal tissue research relevant to a wide variety of diseases and medical conditions.”

According to the Guttmacher Institute, a nonprofit focused on sexual and reproductive health, tissue from fetuses has been used since the 1930s for a variety of purposes. Perhaps most famously, the 1954 Nobel Prize in medicine was awarded to researchers who managed to grow polio vaccine in fetal kidney cell cultures.

In another example, Leonard Hayflick created a cell line from an aborted fetus in the early 1960s that has been used to create vaccines against measles, rubella, shingles and other diseases. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, told the journal Nature in 2013 that “[t]hese cells from one fetus have no doubt saved the lives of millions of people.”

In more recent years, however, the use of stem cells for therapeutic and research purposes has taken a more central role than fetal tissue. As Arthur Caplan, a bioethicist at New York University, told Buzzfeed News, “fetal cells are not a big deal in science anymore.”

In spite of the waning interest, it remains legal to donate tissue from a legally aborted fetus, and for that tissue to be used for research purposes.

Editor’s Note: SciCheck is made possible by a grant from the Stanton Foundation.

– Dave Levitan and Lori Robertson

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Clinton Twists Bush’s Words http://www.factcheck.org/2015/07/clinton-twists-bushs-words/ http://www.factcheck.org/2015/07/clinton-twists-bushs-words/#comments Thu, 16 Jul 2015 17:48:07 +0000 http://www.factcheck.org/?p=97329 Hillary Clinton has continued to twist Jeb Bush’s words, suggesting that he thinks “the nurse who stands on her feet all day or the trucker who drives all night” needs to “work longer hours.” Bush did say “people need to work longer hours,” but he has since said he was talking about part-time workers who want full-time hours.

We don’t know what Bush had in mind when he first spoke, but his explanation is consistent with his previous statements about the underemployed.

Bush’s “longer hours” comment exploded on social media, and in traditional media, as Democrats pounced on a carelessly worded response to a question about tax reform that the Republican presidential candidate fielded in New Hampshire from The Union Leader:

Bush, July 8: My aspiration for the country and I believe we can achieve it, is 4 percent growth as far as the eye can see. Which means we have to be a lot more productive, workforce participation has to rise from its all-time modern lows. It means that people need to work longer hours and, through their productivity, gain more income for their families. That’s the only way we’re going to get out of this rut that we’re in.

His campaign quickly clarified that the “longer hours” quote was a reference to the underemployed and part-time workers. According to the Bureau of Labor Statistics, there were 6.5 million people in June who said they were working part-time because they couldn’t find full-time work or because business was slow. By comparison, that figure was 4.6 million when the Great Recession started in December 2007.

Nonetheless, a number of Democrats criticized Bush for being out-of-touch, accusing him of saying Americans ought to work more than the standard 40 hours a week.

“Americans already work the longest hours of any people in the western industrialized world,” said Democratic presidential candidate Bernie Sanders. “In fact, 80 percent of working men work longer than 40 hours a week.”

(Actually, Sanders was wrong. According to the Organisation for Economic Co-operation and Development, Americans worked more hours than the average for OECD-member countries, but ranked 15th out of the 34 countries surveyed. And, OECD reported, 83 percent of men and 65 percent of women in the U.S. worked 40 hours or more — but that’s not the same as working more than 40 hours.)

The jabs continued on Twitter, where Rep. Steve Israel wrote: “Bush: ‘People should work longer hours’; next up: Bush: ‘GDP could double without those lazy weekends.’ ”

The Clinton campaign tweeted out, “Anyone who believes Americans aren’t working hard enough hasn’t met enough American workers.”

Bush addressed the budding controversy himself the same day, telling reporters, “If we’re going to grow the economy, people need to stop being part-time workers, they need to be having access to greater opportunities to work.”

Bush, July 8: You can take it out of context all you want, but high-sustained growth means that people work 40 hours rather than 30 hours and that by our success, they have money, disposable income for their families to decide how they want to spend it rather than getting in line and being dependent on government.

Health-care costs are rising. In many places, the cost of doing business is extraordinarily high and the net result of that is that business start-up rates are at an all-time low. Workforce participation rates are low. If anyone is celebrating this anemic recovery then they’re totally out of touch. The simple fact is that people are really struggling. So giving people a chance to work longer hours has got to be part of the answer. If not, you’re going to see people lose hope.

That explanation is not only a plausible clarification of his original comment, it is consistent with previous statements Bush has made about the problem of underemployment.

For example, when laying out his economic plan on Feb. 4 at the Detroit Economic Club, Bush said the Obama economy had led to workers’ hours being cut (at the 14:51 mark of the video).

Bush, Feb. 4: For several years now, they have been recklessly degrading the value of work, the incentive to work, and the rewards of work. We have seen them cut the definition of a full-time job from 40 hours to 30 hours, slashing the ability of paycheck earners to make ends meet. We have seen them create welfare programs and tax rules that punish people with lost benefits and higher taxes for moving up those first rungs of the economic ladder.

Bush was referring to the Affordable Care Act’s requirement for employers with at least 50 workers to provide health insurance to full-time employees, defined as those who work 30 hours or more per week. Bush and other critics of the ACA say that encourages employers to cut workers’ hours to avoid the insurance requirement.

The Bush campaign also addressed the issue of underemployment in a July 5 Medium blog post, stating: “More than 6 million people are working part-time jobs when they’d prefer full-time.” That same post blamed the Obama-backed Affordable Care Act for “holding down worker hours and reducing the payoff from working.”

And in an interview with Neil Cavuto on Fox News on June 2, Bush lamented that the “work force participation rate is lower than it was 30 years ago.”

(As an aside, we have noted that the ratio of part-time workers to all workers is about the same as when Obama took office. We also addressed the reasons for the declining workforce participation rate.)

Some Democrats have softened their tone on the “longer hours” quote in light of Bush’s clarification. For example, Sanders said this July 10 after CNN anchor Chris Cuomo accused Sanders of twisting Bush’s words: “Well, if [Bush] is talking about the need for more full-time jobs rather than part-time jobs, he’s absolutely correct. That’s — that’s what we have to. But I want to reiterate. We work — our people work today the longest hours of any people in any major industrialized country.”

Clinton has continued to take digs at Bush’s “longer hours” comment, suggesting that Bush thinks that already hard-working Americans need to work harder still. One example came during a speech on July 13 at the National Council of La Raza’s annual conference. (starting at the 11:36 mark)

Clinton, July 13: Now you probably heard Governor Bush say last week that Americans just need to work longer hours. Well, he should tell that to the farm workers breaking their backs picking fruit in Southern California. Or he should tell that to the dishwashers working their hands raw in the kitchens of Las Vegas. Or he should tell that to the nurse who stands on her feet all day or the trucker who drives all night or the fast-food workers marching in the streets for better pay. They don’t need a lecture; they need a raise.

Clinton made nearly identical remarks when outlining her economic policy plan the same day in New York City (starting at the 21:30 mark).

Clinton, July 13: Now, you may have heard Governor Bush say last week that Americans just need to work longer hours. Well, he must not have met very many American workers. Let him tell that to the nurse who stands on her feet all day or the teacher who is in that classroom or the trucker who drives all night. Let him tell that to the fast food workers marching in the streets for better pay. They don’t need a lecture; they need a raise.

The Clinton campaign says she was simply making the point that the central economic problem for American workers is not that they need to work longer hours, but rather that they are not paid enough for the hours they do work.

“During this speech, Hillary Clinton laid out what she views as the defining economic challenge of our time: Raising incomes for hardworking Americans so they can afford a middle class life,” Clinton spokesman Josh Schwerin told us via email. “The contrast she was making with Bush is that he’s not offering any ideas to address this central economic challenge.”

That’s an argument worthy of political debate. But by highlighting Bush’s comment about people needing to work longer hours and following that with the suggestion that Bush needs to “tell that to the nurse who stands on her feet all day or the teacher who is in that classroom or the trucker who drives all night,” Clinton implies that Bush thinks those workers need to work more hours. Those are full-time workers, but Bush says he wasn’t referring to them at all.

Misrepresenting your opponent’s words is a campaign staple, of course. It reminds us at FactCheck.org of Republicans twisting Obama’s quote, “If you’ve got a business — you didn’t build that,” and of Obama spinning Mitt Romney’s quote that “we shouldn’t move heaven and earth to get one man,” referring to Osama bin Laden.

Bush’s “longer hours” comment makes for hard-to-resist material during a heated campaign, appealing to full-time workers who might be offended by someone saying he or she needs to work longer hours. We’d be surprised if this doesn’t continue to be a frequent attack point. But Bush has since clarified that his words were being misinterpreted, and that he was making an argument in favor of part-time workers who want more hours to be given those opportunities.

— Robert Farley, with Joe Nahra

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Graham Wrong on 9/11 Visas, Again http://www.factcheck.org/2015/07/graham-wrong-on-911-visas-again/ http://www.factcheck.org/2015/07/graham-wrong-on-911-visas-again/#comments Wed, 15 Jul 2015 21:59:20 +0000 http://www.factcheck.org/?p=97352 Sen. Lindsey Graham incorrectly claimed that “all the hijackers who attacked — attacked us on 9/11 were visa overstays.” Two of the 19 hijackers were in the U.S. on expired visas as of Sept. 11, 2001, according to the 9/11 Commission.

Graham, a South Carolina Republican who is running for president, made his remarks on CNN’s “State of the Union,” while discussing immigration. He said the U.S. needs not only to secure the border with Mexico, but also to revamp the visa program that allows foreigners to stay for extended visits.

Graham, July 12: All the hijackers who attacked — attacked us on 9/11 were visa overstays. So it’s more than just the border. You have got to control your visa program.

It’s true that the 9/11 hijackers took advantage of a flawed U.S. visa program. A 241-page report produced by the staff of the 9/11 Commission, “9/11 and Terrorist Travel,” detailed numerous flaws in the visa program that allowed the hijackers to gain entry to and remain in the U.S. to carry out the attacks.

That report — a self-described “story of how 19 hijackers easily penetrated U.S. border security” — explained how many of the hijackers gamed the visa system by supplying fraudulent information to gain entry and/or by violating the terms of the visa while in the U.S.

But that report said that only two hijackers — Satam al Suqami and Nawaf al Hazmi, both non-pilots on the day of the attacks — overstayed their visas.

9/11 Commission staff report, Aug. 21, 2004: That Suqami was limited to a business instead of a tourist stay meant that he and Nawaf al Hazmi (who overstayed his tourist visa despite filing for an extension of his stay in July 2000) were the only operatives who had overstayed their authorized lengths of stay as of September 11.

Two other hijackers – pilots Mohamed Atta and Marwan al Shehhi – overstayed their visas during preparations for the attack, but they had approved visas as of Sept. 11, 2001, according to a staff statement presented at a 9/11 Commission public hearing on Jan. 26, 2004.

Their case is an example not of visa overstays but of bureaucratic bungling. Atta and al Shehhi were given tourist visas, even though the law required them to have student visas, and even though there were discrepancies in their stories that initially caught the attention of federal inspectors.

9/11 Commission staff statement, Jan. 26, 2004: Marwan al Shehhi came in through Newark in late May 2000, followed a week later by Mohamed Atta. Both were admitted as tourists and soon entered flight school in Florida. In September they did file applications to change their status. Before 9/11, regulations allowed tourists to change their status at any time, so they were in compliance. But both overstayed their periods of admission and completed flight school to obtain commercial pilot licenses. Atta and al Shehhi then left within a few days of one another and returned within a few days of one another in January 2001, while their change in visa status from tourist to student was still pending.

Atta and al Shehhi did get some attention when both said they were coming back to finish flight school. Primary inspectors noticed with each that their story clashed with their attempt to reenter on tourist visas. The rules required them to get proper student visas while they had been overseas, since their earlier pending applications for a change of status were considered abandoned once they left the United States. Atta and al Shehhi were each referred by the primary inspectors to secondary inspection. … The secondary inspectors admitted Atta and al Shehhi as tourists.

In all, “at least six of the 9/11 hijackers violated immigration laws,” according to the staff statement. In addition to the four hijackers we already mentioned, Ziad Jarrah entered on a tourist visa but then enrolled in flight school for six months without changing his immigration status from tourist to student as required by law, and Hani Hanjour came on a student visa but never attended school, the 9/11 staff statement said.

Graham is a repeat offender on this issue. He said something similar two years ago, when he claimed that all 19 hijackers overstayed their student visas. As we wrote, only one had a student visa and he did not overstay his visa.

— Eugene Kiely

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FactChecking Scott Walker http://www.factcheck.org/2015/07/factchecking-scott-walker/ http://www.factcheck.org/2015/07/factchecking-scott-walker/#comments Mon, 13 Jul 2015 17:04:03 +0000 http://www.factcheck.org/?p=97297 Wisconsin Gov. Scott Walker became the 15th Republican to officially declare he is running for president of the United States. “I’m in,” he tweeted to his followers this morning. He is scheduled to deliver an announcement speech in his home state at the Waukesha County Exposition Center.

Walker, who won reelection as governor in 2014, will join the race as a top contender for his party’s nomination, according to Real Clear Politics’ polling average. We fact-checked the governor during last year’s campaign and after his victory once it became clear he would run for president. Here are some of our findings.


In January, Walker boasted that his education policies were working, citing as evidence that “ACT scores are up and Wisconsin now ranks second in the country.” But the state’s ACT college admission scores are not up, and it ranks second out of 30 states — not the entire country.

The state’s average composite score on the 2013-14 ACT college admission exam was 22.2 — exactly what it was in the 2010-11 school year, when Walker first took office.

As for Wisconsin’s ranking, ACT does not rank states. The Wisconsin Department of Public Instruction determined the state’s ranking by comparing its composite score with 29 other states that had 50 percent or more of their students take the ACT test. While Walker said Wisconsin ranks second “in the country,” it is really only among 30 states.

Job Creation

In late October 2014, during his campaign for reelection as governor, Walker claimed in a TV ad that his “reforms” were helping Wisconsin create jobs, boasting that “just last month our reforms helped create 8,400 new jobs.”

But Walker was only referring to private-sector jobs. The state’s gain in total employment for September was just 300 jobs because of steep declines in local government jobs. The preliminary jobs data for September 2014 showed a gain of 8,400 private-sector jobs, but a loss of 8,100 government jobs — for a net gain of 300 jobs. (See Table 5.)

(Postscript: After Walker was elected, the BLS conducted its annual benchmarking correction that turned the state’s preliminary net gain of 300 total jobs in September to a net loss of 4,200. There was a downward revision in Wisconsin’s 2014 employment statistics, first reflected with the release of the January figures, to 2,851,000 in August and 2,846,800 in September – a loss of 4,200 jobs. See Table D-1. Those remain the current job figures for those months.)

In that same ad, Walker said his state “now ranks in the top four states in the Midwest for private-sector job growth.” But the state’s job gains at the time lagged behind the national average.

The Bureau of Labor Statistics’ total jobs data from January 2011 to September 2014 showed that Wisconsin had a job growth rate of 4.3 percent compared with a national average of 6.6 percent, ranking it ninth at the time among the 12 states that make up the “Midwest” under the U.S. Census Bureau’s definition.

We will be following Walker and all 20 of the declared candidates and any others who may join in. (Ohio Gov. John Kasich plans to make it official on July 21.) You can keep track of the candidates by going to our “Presidential Election 2016” page.

— Eugene Kiely

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July 10: EPA, Path to Citizenship, World Opinion http://www.factcheck.org/2015/07/july-10-epa-path-to-citizenship-world-opinion/ http://www.factcheck.org/2015/07/july-10-epa-path-to-citizenship-world-opinion/#comments Fri, 10 Jul 2015 18:34:34 +0000 http://www.factcheck.org/?p=97402
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Is Medicaid Bad for Your Health? http://www.factcheck.org/2015/07/is-medicaid-bad-for-your-health/ http://www.factcheck.org/2015/07/is-medicaid-bad-for-your-health/#comments Fri, 10 Jul 2015 17:15:16 +0000 http://www.factcheck.org/?p=97054 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

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