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A Project of The Annenberg Public Policy Center

South Carolina Smackdown

. . . And then there were four.


Facts were sometimes used as blunt instruments as the four remaining GOP presidential candidates hammered away at each other in the last debate before Saturday’s South Carolina primary.

  • Santorum and Romney tangled on the Massachusetts health care law. Santorum wrongly claimed it was a “government-run” program. Romney erred when he said everybody was covered by private insurance, ignoring Medicare and his own expansion of Medicaid.
  • Santorum also fouled up when he claimed the state has “the highest health insurance premiums of any state in the country.” Seven states and Washington, D.C., were higher in 2010, the most recent year for which figures are available.
  • Gingrich claimed Romney appointees “funded” an abortion clinic. The truth is that an autonomous state agency approved a tax-exempt loan — not direct taxpayer funding — and Romney said he wasn’t aware until after he left office.
  • Gingrich, slamming Jimmy Carter, said “unemployment went to 10.8 percent.” It did — nearly two years after Ronald Reagan took office. But it never exceeded 7.8 percent under Carter.
  • Gingrich claimed that “none” of the ideas on the website of his Center for Health Transformation resemble Obama’s program. Actually, we found a call there for an individual mandate, which Gingrich himself repeated as recently as last May.
  • Romney slammed Gingrich’s claim to have “helped” Reagan create jobs, saying Reagan mentioned Gingrich only once in his published diaries. That’s true. Reagan wrote that the young congressman’s 1983 suggestion to freeze spending “would cripple our defense program,” and he rejected it.
  • Ron Paul, a physician, claimed medicine “worked rather well” in the early 1960s. That was before Medicare, when in fact rising health care costs were forcing many of the elderly onto public assistance or charity care.


They met in Charleston, only hours after Texas Gov. Rick Perry announced he was suspending his campaign and endorsing former House Speaker Newt Gingrich.

Romney vs. Santorum: Massachusetts Health Care

Former Sen. Rick Santorum and former Massachusetts Gov. Mitt Romney both strayed from the facts at times as Santorum tried to bolster his claim that Romney’s health care law was a “disaster,” and Romney fought back saying Santorum’s claims were “wrong.” We’ll take that spirited exchange point by point:

Santorum wrong on “government-run” health care: Santorum called the law “a government-run health care system.” That’s not true. Like the federal law signed by Obama, the Massachusetts law doesn’t create a system in which the government is the insurer, or provider of health care. Instead, both laws mandated that all residents have insurance, expanding business for private carriers. They also offered subsidies to help lower-income residents buy private insurance, and they expanded Medicaid.

Romney wrong on “private” insurance: Romney was correct when he shot back that 92 percent of Massachusetts residents already had insurance in the state before the law went into effect. But he went too far when he said, “They still had the same private insurance. And the 8 percent of the uninsured, they bought private insurance, not government insurance.” Neither statement is entirely true.

Many of those insured previously were covered by Medicare (for those age 65 or older) or Medicaid (for low-income residents), which are both government programs, not “private insurance.”

Santorum right on added coverage (with a caveat): And as Santorum correctly noted, Romney’s program covered the uninsured in part by expanding Medicaid for some, and by providing state subsidies for the purchase of private insurance for some others.

Santorum: “[O]ver half the people that came on the rolls since you put Romneycare into effect are fully subsidized by the state of Massachusetts. And a lot of those are on the Medicaid program.

That’s correct: Of the 411,722 individuals who have gained insurance since the law was passed, 47 percent, or 193,393, have joined MassHealth, the state’s Medicaid and Children’s Health Insurance Program. The rest are on private insurance, with 77,330 buying their own insurance on the individual market and 158,973 getting plans with the help of state subsidies, as of Dec. 31, 2010.

In Romney’s defense, however, it should be noted that the ailing economy played a role in boosting the number of persons on Medicaid. In fact, the Massachusetts Medicaid Policy Institute estimates that 76 percent of the increase in Medicaid and CHIP beneficiaries would have happened without the law, and that only 61,000 of new MassHealth enrollees can be attributed to the legislation.

Another 75,000 are on fully subsidized plans, according to the Health Connector, the state exchange. All told, 65 percent of the newly insured are on fully subsidized insurance, whether through Medicaid or private insurance. So Santorum is correct, with the caveat that much of the Medicaid expansion would have occurred with or without Romney’s law.

As for Romney’s claim that “nothing changed” for the 92 percent of residents that already had insurance, that ignores the fact that they, too, are subject to the law requiring them to continue to have insurance — even if they leave their jobs, which is where most gained their coverage.

Santorum’s Dubious $8 Billion Claim: Santorum also said the state law was “$8 billion more expensive than under the current law.” (We assume he means the previous law.)

That questionable number comes from a conservative think tank that tallied not just the cost to the state government since the law was enacted in 2006, but also “new health care costs to the federal government and on state residents and businesses.” The June 2011 study came from the Beacon Hill Institute at Suffolk University.

A much lower estimate was issued by the nonpartisan Massachusetts Taxpayers Foundation, which estimated that the law cost $707 million in fiscal 2010, with the state paying half of that and the federal government paying the rest.

Santorum wrong on premium costs: Santorum claimed Massachusetts premiums are the highest in the country, 27 percent more than average. Neither claim is true.

Santorum: Massachusetts has the highest health insurance premiums of any state in the country. It is 27 percent more expensive than the average state in the country.

In fact, seven states and the District of Columbia, which got top honors, had higher premiums for family coverage, according to a report by the Commonwealth Fund. Massachusetts had held the No. 1 spot in 2008 and 2009, but family premiums fell slightly to $14,606 in 2010. That’s only 5.3 percent more than the state average, nowhere near Santorum’s figure of 27 percent.

Romney’s right on premium costs: Romney responded to Santorum by saying:

Romney: Massachusetts, by the way, had the highest insurance costs before the plan was put in place and after. But fortunately, the rate of growth has slowed down a little less than the overall nation.

That’s right. The state’s slide in premium costs for 2010 does indeed mean the “rate of growth has slowed down,” as Romney said. We’d also note that premium costs in the state accounted for a lower percentage of the median household income than many other states.

Santorum misleads on waiting times: Santorum also gave a misleading view of the law’s impact on waiting times to see doctors:

Santorum: Over 50 percent of the doctors now are not seeing new patients — primary care doctors are not seeing new patients. Those who do get to see a patient are waiting 44 days on average for the care.

Those numbers come from reports by the Massachusetts Medical Society, which said in 2009 that the average wait time in the state for both family medicine and internal medicine was 44 days. But the group has been lamenting long wait times and doctor shortages for many years, since before the law was enacted, a point it noted in a 2011 report titled “Access to Health Care in Massachusetts: The Implications of Health Care Reform.” The medical society said that “primary care shortages continue in Massachusetts, but they predate health reform by many years, and mirror shortages in many other areas of the country.”

Also, the average wait time for family medicine physicians was down to 36 days on average in 2011, but the wait time for internal medicine physicians was up to 48 days. It’s hard to draw firm conclusions on the law’s impact. The wait time for internal medicine was 47 days in 2005, a year before the law was enacted. Santorum is correct that more than half of primary care physicians are no longer accepting new patients.

The medical society said the issues of doctor shortages and primary care physicians not seeing new patients weren’t solely due to the health care law, but it had contributed to the problem. “Although these challenges are not all a direct result of health care reform, in some cases health care reform has exacerbated the situation,” the society said.

Romney’s rosy view of premiums: Romney also used the most favorable estimates in describing a decrease in premiums for plans on the individual market:

Romney: Individuals who wanted to buy their own insurance saw their rates — when they were not part of a big group — saw their rates drop by some 40 percent with our plan.

It’s true that MIT economist Jonathan Gruber, who advised the Romney administration on the health care law, told us that individual market premiums dropped by as much as 40 percent. But some of that was due to young, healthy persons buying cheaper plans in that market after the law. That brought the average price down. He told us the decrease would be smaller if an adjustment was made for the less generous benefits in many of the newly purchased policies.

We found an 18 percent decrease in premiums when we looked at the individual market premium in 2006, per person per month, and compared that with the premium in 2008.

Santorum’s “failure” claim: Finally, Santorum said the Massachusetts law was “an abject failure.” In fact, the law succeeded in achieving its main goal: reducing the number of uninsured. As of the end of 2010, 98.1 percent of state residents, and 99.8 percent of children, had insurance.

Gingrich vs. Romney: Funding Abortion

Gingrich revisited an issue that came up in 2007, saying that when Romney was governor — and after he had become an abortion opponent — “a branch of the government which included his appointees did agree to fund an abortion clinic for Planned Parenthood.” That’s true as far as it goes — but there’s more to the story.

Two months before Romney left office, Massachusetts’ economic development agency granted initial approval to a $5 million tax-exempt bond — not direct taxpayer funding — for a Planned Parenthood clinic in Worcester that would provide abortions, according to the Boston Globe.

And though Gingrich is correct that the agency, MassDevelopment, was controlled by Romney appointees, it was an autonomous authority and not under the governor’s direct control.

Romney campaign spokesman Eric Fehrnstrom said in 2007 that Romney was simply unaware the project was under consideration, and that Romney would have attempted to block it if he had known about it.

In a statement to the Globe, Ranch Kimball, the chairman of the authority and a Romney appointee, said he did not brief the governor’s office on the initial approval of the loans in late 2006. Final approval of the project came in February 2007, a month after Romney left office, and was ultimately approved by Democratic Gov. Deval Patrick, an abortion rights supporter.

Gingrich Flunks History

Gingrich claimed that unemployment hit 10.8 percent under Democratic President Jimmy Carter:

Gingrich: Under Jimmy Carter, we had the wrong laws, the law regulations, the wrong leadership, and we killed jobs, we had inflation, we went to 10.8 percent unemployment. Under Ronald Reagan, we had the right jobs, the right laws, the right regulators, the right leadership. We created 16 million new jobs.

That’s wrong. The jobless rate never was higher than 7.8 percent during Carter’s presidency, and was as low as 5.6 percent.

The rate did later rise to 10.8 percent in November and December of 1982 — but that was nearly two years into Reagan’s first term. The rate declined slowly from there, and was still 7.3 percent when Reagan was sworn in for his second term. It did not get below 6 percent until late 1987, and was 5.4 percent when Reagan left office in January, 1989.

Romney vs. Gingrich: Reagan’s Diaries

With Gingrich claiming credit for helping create jobs during Reagan’s presidency, Romney cracked that Gingrich rated just one mention in the Reagan diaries, and not a particularly flattering mention at that.

Romney: I mean, Mr. Speaker, it was — you talk about all the things you did with Ronald Reagan and the Reagan revolution and the jobs created during the Reagan years and so forth. I mean, I looked at the Reagan diary. You’re mentioned once in Ronald Reagan’s diary.

And in the diary, he says you had an idea in a meeting of young congressmen, and it wasn’t a very good idea and he dismissed it. That’s the entire mention.

Just to check, we did a quick word search on the The Reagan Diaries – a daily diary President Reagan kept by hand — and as Romney said, there was but one mention of  Gingrich by name. It came in an entry for Monday, Jan. 3, 1983 — when Gingrich had been in the House barely four years.

The Reagan Diaries: A tough budget meeting & how to announce the deficits we’ll have — they are horrendous & yet the Dems. in Cong. are saying there is no room for budget cuts. Met with a group of young Repub. Congressmen. Newt Gingrich has a proposal for freezing the budget at the 1983 level. It’s a tempting idea except that it would cripple our defense program. And if we make an exception on that every special interest group will be asking for the same.

Given his tough budget-cutting stance in the 2012 campaign, Gingrich might be quite proud his budget-freezing proposal then as a young congressman from Georgia’s 6th district. But at the time, the Gipper didn’t think the idea was too practical.

Gingrich vs. Obama: Health Care

Gingrich — under attack from Santorum for once supporting a government mandate requiring individuals to obtain health insurance — denied that anything like Obama’s health care program could be found on the website of Gingrich’s Center for Health Transformation.

Gingrich: And the fact is, I helped found the Center for Health Transformation. I wrote a book called “Saving Lives and Saving Money” in 2002. You can go to healthtransformation.net and you’ll see hundreds of ideas, none of which resemble Barack Obama’s programs.

That’s not quite true. Wayne Oliver, a former lobbyist for the Georgia Pharmacy Association and a vice president at the center, wrote an op-ed that appeared in the Atlanta Journal Constitution April 23, 2009 on the so-called public option. Oliver wrote in opposition to a public-option plan, which was one of the options being considered by the Democrats at the beginning of the debate on a federal health care law. In the op-ed, Oliver says: “Everyone should be required to have health insurance coverage; or, if they are opposed to insurance, they should post a bond.”

That same position was also voiced by Gingrich — most recently during a May 15, 2011 interview on “Meet the Press.” He said, “I’ve said consistently we ought to have some requirement that you either have health insurance or you post a bond … or in some way you indicate you’re going to be held accountable.” And he acknowledged that would be “a variation” of the individual mandate idea.

In addition, the center published a book called, “Paper Kills 2.0: How Healthcare IT Can Save Your Life and Your Money.” The book, which is promoted on the center’s website,  advocates for improving patient outcomes by upgrading and expanding the use of electronic patient records. Gingrich and former Democratic Senate Leader Tom Daschle wrote the book’s foreword. Daschle was Obama’s first choice to become the health and human services secretary and oversee his administration’s effort to change the health care laws to make insurance more affordable and accessible. The Affordable Care Act contains numerous health information technology provisions, as did the American Recovery and Reinvestment Act, which is known as the stimulus bill.

Paul: Medicine ‘Worked Rather Well’ Before Medicare

Texas Rep. Ron Paul, a physician, claimed medicine “worked rather well” in the early 1960s:

Paul: I had the privilege of practicing medicine in the early ’60s before we had any government. It worked rather well and there was nobody out in the street suffering with no medical care.

That was before Medicare was signed into law in 1965. But as early as 1959, during the Republican administration of President Dwight D. Eisenhower, the Department of Health, Education and Welfare issued a report to Congress stating that the rising cost of health care was forcing some people onto public assistance or charity from hospitals, and more so for the elderly than for younger persons:

HEW, 1959: The rising cost of medical care, and particularly of hospital care, over the past decade has been felt by persons of all ages. Older persons have larger than average medical care needs. As a group they use about two-and-a-half times as much general hospital care as the average for persons under age 65, and they have special need for long-term institutional care. Their incomes are generally considerably lower than those of the rest of the population, and in many cases are either fixed or declining in amount. They have less opportunity than employed persons to spread the cost burden through health insurance. A larger proportion of the aged than of other persons must turn to public assistance for payment of their medical bills or rely on ‘free’ care from hospitals and physicians.

Santorum vs. Obama: Cutting Veterans’ Benefits

Santorum criticized Obama for proposing cuts in military veterans’ benefits.

Santorum: We have the president of the United States who said he is going to cut veterans benefits, cut our military, at a time when these folks are four, five, six, seven tours, coming back, in and out of jobs, sacrificing everything for this country.

Much has been written about the president’s plans to reduce the size and cost of the U.S. military, but what about veterans’ benefits? The president’s deficit reduction plan does indeed propose some changes in military health and retirement programs.  The plan would:

  • Impose a $200 annual fee on TRICARE for Life recipients. TRICARE for Life is a supplemental health insurance program for veterans 65 and over. It covers certain out-of-pocket expenses not covered by Medicare. Currently, TRICARE for Life does not charge fees or premiums. The administration estimates the proposal would save about $6.7 billion over 10 years.
  • Increase prescription drug benefit co-pays. The administration estimates this proposal would save $20.6 billion over 10 years.
  • Create a commission to study military retirement benefits. The deficit-reduction plan says the current benefits are “generous” and “out of line with most other Government or private retirement plans.”

The proposal was submitted in September, and has not become law.

– by Lori Robertson, Robert Farley, Eugene Kiely, Brooks Jackson and D’Angelo Gore.


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