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A Project of The Annenberg Public Policy Center

Misleading Pennsylvania Voters

Clinton and Obama trade bogus charges about health care.


Clinton and Obama twisted facts unmercifully as they strained to make Pennsylvania voters believe the other is offering a flawed health care plan.

  • An anti-Obama ad by a pro-Clinton group says her plan would "help every American" and implies his would not. In fact, Obama proposes to offer subsidized coverage, just as Clinton does.
  • An Obama TV ad claimed his plan would save families more money than Clinton’s, but one independent expert sees "zero credible evidence" that either plan would produce the kind of savings the campaigns claim.
  • A Clinton ad claims her plan would cost $1,700 less to cover each uninsured person. But that’s based on a study that compares a Clinton-like plan with one that is different from Obama’s.
  • Clinton unleashed attack phone calls accusing Obama of "impos[ing]" a "hidden tax" on families that isn’t a tax at all but a cost that actually would be reduced.

In fact, the Clinton and Obama health care plans would both offer large government subsidies to aid the estimated 47 million Americans who don’t have health insurance. Both are predicted to do far more to reduce the number of uninsured than anything offered by Republicans, and to cost far more as well. The biggest difference is that Clinton would impose a requirement on everybody to obtain coverage, a potentially unpopular mandate. Obama’s plan would make coverage available to all but require it only for children, not adults. These attacks and counterattacks, however, present a warped picture to Pennsylvanians.


With a pivotal primary election looming on April 22 in Pennsylvania, both Sens. Hillary Clinton and Barack Obama attacked each other with ads about their health care plans.

[TET ]

American Leadership Project Ad: "Every"

Announcer: The difference? Hillary Clinton’s health care plan would help every American get affordable, quality health care. Barack Obama’s plan would leave as many as 15 million Americans uncovered, so you would either be one of the millions without coverage, or you would keep paying more to provide emergency health care for the millions of uninsured. Call Barack Obama and tell him to support health care for all Americans. Paid for by the American Leadership Project which is responsible for its contents. Not authorized by any candidate or candidate’s committee. [/TET] 

The Attack: Phony "Difference" 

The misleading exchange of attacks regarding health care began last week with an ad by a pro-Clinton group, the American Leadership Project. The ad said "the difference" between the candidates’ proposals is that Clinton’s plan would "help every American" while Obama’s would "leave as many as 15 million Americans uncovered."

That’s misleading. "The difference" between the two plans is actually that Clinton’s plan would require all individuals to obtain coverage. In fact, Obama’s plan would "help every American" too, making federally subsidized coverage available. But unlike Clinton’s plan, adults would not be required to obtain coverage, and a number of experts say millions of them, perhaps 15 million or more, would not take advantage of the offered subsidies. Both plans would require that families obtain insurance for their children.

We’ve been over all of this any number of times before, but anyone unfamiliar with the Clinton and Obama plans might think from the way this ad is phrased that Obama’s plan simply offers no federal subsidy for 15 million uninsured Americans, and that’s false. 

Obama’s Response: Phantom Savings

Obama responded with an ad saying the Clinton plan "forces everyone to buy insurance even if you can’t afford it. And you pay a penalty if you don’t." 

[TET ]

Obama’08 Ad: "Afford"Obama

Announcer: Hillary Clinton is attacking. But what’s she not telling you about her health care plan? It forces everyone to buy insurance, even if you can’t afford it. And you pay a penalty if you don’t. Barack Obama believes it’s not that people don’t want health care. It’s that they can’t afford it. That’s why the Obama plan reduces costs more than Hillary’s, saving $2,500 for the typical family. For health care we can afford, vote for change we can believe in.
Obama: I’m Barack Obama and I approve this message. [/TET]

It is true, as we just noted, that Clinton’s plan would force everyone to buy insurance. Nevertheless, the Clinton camp objects, saying the claim is false. The objection is to the phrase, "even if you can’t afford it." Clinton says everybody will be able to afford coverage under her plan.

We agree that the ad could mislead anyone who isn’t aware that the Clinton plan would provide subsidies to help people buy health insurance, but Obama’s basic point here is sound. Clinton’s personal mandate would require some sort of enforcement mechanism, such as garnisheeing the wages of those who refuse to comply or automatically deducting the premiums from workers’ pay whether they agree to it or not. Clinton herself said on Feb. 3, when pressed repeatedly on this point by ABC’s George Stephanopoulos, that "I think there are a number of mechanisms, going after people’s wages, automatic enrollment, when you are at the place of employment. …"

Obama’s ad also makes a dubious claim when it says his plan "reduces costs more than Hillary’s" and would save $2,500 for the typical family. It’s true that Clinton claims her plan will save $2,000. But as we’ve noted before, both candidates are promising savings that a number of experts say they can’t deliver. Back in February we quoted Jonathan Gruber of the Massachusetts Institute of Technology as saying, "I know zero credible evidence" supporting the campaigns’ claims of big cost savings.

Clinton’s Counterattack: "False Charges"

Clinton counterattacked with an ad accusing Obama of making "false charges" and saying his plan would cost taxpayers $1,700 more than hers to cover each new person.

[TET ]

Hillary for President Ad: "Answer"

Clinton: I’m Hillary Clinton and I approve this message.
Announcer: He couldn’t answer tough questions in the debate. So Barack Obama is making false charges against Hillary’s health care plan. She has a plan everyone can afford. Obama’s will cost taxpayers $1,700 more to cover each new person. Hillary’s plan covers everyone. Obama’s leaves 15 million people out.
Obama’s attacks have been called "destructive and poisoning." There are more and more questions about Barack Obama. Instead of attacking, maybe he should answer them. [/TET]

It may be correct that Clinton’s plan will cost taxpayers less to insure each previously uninsured individual, but the $1,700 figure is a misinterpretation of a study done by one economist. The Clinton campaign cited as its source a Feb. 2 blog entry by New York Times columnist and Princeton economist Paul Krugman, who in turn cited a paper by MIT’s Gruber. However, Gruber’s paper ("Covering the Uninsured in the U.S.," published by the National Bureau of
Economic Research) does not actually compare Clinton’s plan with Obama’s. It compares a Clinton-like plan with mandates and a plan that (unlike Obama’s) does not include any mandates at all. As we mentioned, Obama’s plan would require coverage for children.

When we interviewed Gruber about this some weeks ago, he confirmed that his study didn’t include Obama’s plan and said Krugman’s use of his paper was somewhat off. A plan with an individual mandate in his study was "sort of a guess of what a Clinton-like plan would look like," Gruber told us. "The other is not an Obama plan." He said of Obama, "He’s got an excellent plan which I strongly believe will cover the majority of the uninsured in America. … It just wouldn’t cover them all."

A $900 "Hidden Tax"?
In addition to its TV ad, the Clinton campaign used automated telephone calls to Pennsylvania voters accusing Obama of imposing "a $900 hidden tax on families" in his health care plan. We judge that to be so misleading as to be close to an outright falsehood. No tax would be imposed on families. What the Clinton campaign is describing is not a "hidden tax" but costs that actually would be reduced by what Obama proposes.

Hillary for President Robocall

Female Voice: Pennsylvania families cannot afford Barack Obama. Barack Obama’s health care plan fails to deliver health care for every American, just what the HMOs and pharmaceutical companies want. What’s more, Sen. Obama’s health care plan imposes a $900 hidden tax on families. That’s $900 more than anyone should have to pay to stay healthy. Pennsylvania families need a leader they can count on and a fighter who will deliver.

Source: MSNBC

The Clinton calls refer to the increased cost borne by persons who have health insurance (and their employers) when hospitals, doctors and other providers charge higher rates to make up for the cost of providing care to those who lack coverage and can’t pay on their own. A number of experts believe insurance providers are able to pass on the cost of this uncompensated care to those with insurance in the form of higher premiums. The American Leadership Project ad described the issue more accurately, saying that under Obama’s plan, "you would keep paying more to provide emergency health care for the millions of uninsured." That may be true.

The Clinton calls go too far by stating the $900 figure as a fact, when it is actually a highly uncertain estimate produced by the campaign, based on a heap of assumptions that may or may not turn out to be accurate. The campaign’s starting point is a study published by the advocacy group Families USA and based on data supplied by former Clinton administration health expert Kenneth E. Thorpe, who now is a professor at Emory University. That study concluded that two-thirds of the cost of uncompensated care is borne by insured families in the form of higher premiums, and one-third is paid by government. The Thorpe study estimated that the cost to insured families in higher premiums would be $1,502 in 2010. Clinton aide Judd Legum told us he arrived at the $900 figure by taking the $1,502 estimate, adding an additional 50 percent to account for the projected cost borne by government and paid by taxes, and figuring that Obama’s plan would save only 60 percent of the total.

"Obviously, the $900 figure is an estimate," Legum said. It’s an estimate all right, but that isn’t so obvious from the attack phone calls being made by the Clinton campaign.

Thorpe told FactCheck.org that the $900 figure the campaign uses may be a little high. But there would be more of a cost shift to pay for care for the uninsured under the Obama plan than under the Clinton plan, since her plan would cover more people, he says. In neither case, however, would costs go up: Both plans propose a reduction in the uninsured, which translates into a reduction in spending for uncompensated care.

"What would happen if we do nothing?" Thorpe asks. "It’s not that there’ll be $900 more than what we’re already paying." Just in premiums, Thorpe estimates, the average family is going to pay $1,500 more in 2010. That’s what families would pay with no Obama plan, no Clinton plan. "So with the Obama plan, you may pay $600, $700. … It’s a big reduction." Under Clinton’s plan, he says, the cost would be even lower.

Furthermore, there’s disagreement as to the accuracy of the original Families USA figure. John Sheils, senior vice president of The Lewin Group, which has analyzed health care plans for both Democrats and Republicans, says he thinks the numbers in the Thorpe study are too high. But "even if you accept them, you can’t use them the way they’re being used."

Whatever figure one accepts, it is simply false to say that Obama’s plan would "impose" it as a tax, when he actually would cut costs by better than half even by the Clinton reckoning. To be honest, her campaign would need to say something like, "We predict Clinton’s plan will cut the amount families pay for care of the uninsured by $900 more than Obama’s."

– by Brooks Jackson and Lori Robertson


"Paying a Premium: The Added Cost of Care for the Uninsured." Families USA, June 2005.

Gruber, Jonathan. "Covering the Uninsured in the U.S." National Bureau of Economic Research, Jan. 2008.

Obama, Barack. "Plan for a Healthy America," 2007.

Clinton, Hillary. "American Health Choices Plan," 2007.

ABC News Transcript. "Sen. Hillary Clinton talks about the election." "This Week with George Stephanopoulos. ABC News, 3 Feb. 2008.