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A Project of The Annenberg Public Policy Center

Rahall Twists Jenkins’ Words

Rep. Nick Rahall of West Virginia takes a quote from his Republican opponent, Evan Jenkins, out of context to falsely imply that Jenkins is “comfortable” with raising “seniors’ out-of-pocket costs” for Medicare by $6,000. Actually, Jenkins was talking about nominal copays for Medicaid — not Medicare.

The TV ad, titled “Listens,” is the latest example of what we call “Mediscare” — a distortion of an opponent’s position on Medicare to scare seniors.

Rahall’s ad warns that Jenkins listens to “his billionaire financial backers [who] want to turn Medicare into a voucher plan that could raise seniors’ out-of-pocket costs — something Evan Jenkins is comfortable with.” The words “$6,000 in higher out-of-pocket costs for seniors” appear on the screen.

The “voucher plan” and the $6,000 price tag are badly outdated references to a House Republican budget plan introduced by Rep. Paul Ryan of Wisconsin in 2011. As we have written a few times, Ryan significantly revised that plan and it may or may not increase seniors’ out-of-pocket expenses. The “billionaire financial backers” — the Rahall campaign tells us — refers to David Koch, Koch Industries Inc. PAC, and Americans for Prosperity, a political organization founded by David Koch.

Immediately after the ad’s narrator says Jenkins is “comfortable” with raising seniors’ out-of-pocket costs, the ad makes this false claim: “He said seniors should have some ‘financial skin in the game’ and ‘think harder about going to the doctor.’ ” On the screen, viewers see a partial quote attributed to Jenkins from a Charleston Daily Mail article from May 13, 2013: “With a little financial skin in the game, they will think about . . . whether or not ‘I really need to go to the doctor.’ ”

Who’s “they”? Not seniors. Jenkins wasn’t talking about Ryan’s plan, seniors or Medicare. He was talking about Medicaid expansion under the Affordable Care Act and charging Medicaid recipients a nominal copay to prevent the overuse of services, particularly emergency department services. Medicaid is a joint federal-state health insurance program for low-income people; Medicare provides health insurance for those age 65 and over.

The Charleston Daily Mail article said Medicaid recipients in West Virginia have “little reason to avoid unnecessary visits to doctors’ offices and hospitals” because they do not have to make copays. “That soon will change, though, as West Virginia moves forward with its expansion of Medicaid under President Obama’s Patient Protection and Affordable Care Act,” the paper wrote. The Obama administration, in 2013, allowed states to charge slightly higher Medicaid copays, and West Virginia, at the time of the article, was moving forward with plans to implement nominal copays.

Jenkins — a state senator and executive director of the West Virginia State Medical Association — was “comfortable with” (to borrow the ad’s language) nominal Medicaid copays.

Charleston Daily Mail, May 13, 2013: Under current Centers for Medicare and Medicaid rules, states cannot charge Medicaid recipients more than $8 for non-emergency trips to a hospital emergency room.

For inpatient care, states can charge patients as much as half the cost for their first day of treatment, or set a nominal fee. For outpatient care, states only can charge a $4 co-pay if patients’ income is below the federal poverty line.

That doesn’t seem like much, but state Sen. Evan Jenkins, D-Cabell, said studies have proven even small co-payments encourage health care consumers to reconsider unnecessary medical services.

Jenkins also serves as executive director of the West Virginia State Medical Association.

“With a little financial skin in the game, they will think about that co-pay when deciding whether or not ‘I really need to go to the doctor,’ ” he said. “When something is free, we don’t place a very high value on it. We may take it for granted and we may over-utilize.”

Indeed, the state enacted new and increased copays for Medicaid services, effective Jan. 1. The amount varies depending on income and the medical service provided. There are three income levels based on the federal poverty level: up to 50 percent of poverty, up to 100 percent, and more than 100 percent. The range of copays include: zero to $4 for doctor visits and outpatient surgical services, $8 f0r non-emergency emergency department visits, and zero to $75 for inpatient acute-care hospital services.

The out-of-pocket maximum ranges from $8 to $143 — far less than the $6,000 figure that the ad displays on the screen.

One last thing: It’s true that, nationwide, about 6 million low-income seniors 65 and older are both Medicare and Medicaid recipients — the so-called dual eligible beneficiaries. Nearly two-thirds of Medicaid spending on dual eligible beneficiaries was spent on long-term care, such as nursing home care. But West Virginia’s revised copay rules specifically exempts individuals in nursing homes and those receiving hospice care from Medicaid copays, so those seniors are not affected by the new rules.

In response to our questions, the Rahall campaign said Jenkins’ support for copays and his financial backers’ support for Ryan’s Medicare plan prove that Jenkins wants seniors to pay more for health care. But it’s clear to us that the ad takes Jenkins’ quote out of context and misleads voters, particularly seniors, in West Virginia’s 3rd Congressional District.

— Eugene Kiely