No matter where you’re voting this November, chances are you’ve heard your fair share of talking points on health care.
Across the country, Democrats and Republicans have been trading blows about the Affordable Care Act and Republicans’ efforts to chip away at it.
The story is no different in North Carolina’s 2nd Congressional District, which includes parts of Franklin, Johnston, Wake, Nash and Harnett counties. In a debate Monday night, Republican Rep. George Holding sounded off on the ACA, also known as Obamacare, for raising premiums.
"Obamacare raised premiums by 100 percent, and after that 91 percent of the people were covered, but we’re all paying 100 percent more," Holding said.
Holding’s complaint was a popular refrain for Republicans last year, so PolitiFact has already checked similar claims from President Donald Trump, Vice President Mike Pence, House Speaker Paul Ryan, Sen. John Cornyn and Sen. James Lankford.
But the race between Holding and Democrat Linda Coleman, a former member of the state legislature, has morphed into one of the nation’s more competitive contests, so we decided to put Holding’s claim to the Truth-O-Meter.
In short, Holding’s claim that "we’re all paying 100 percent more" is highly misleading because it conflates the whole insured population with the 2 to 5 percent of people who buy their coverage on the individual market.
The Holding campaign declined to comment, but Republicans making similar claims last year often cited a 2017 report from the Department of Health and Human Services, which compared premiums from 2013 — a year before the ACA took full effect — to premiums in 2017.
That report looked at policies purchased on the individual market and found that premiums were 105 percent higher on average in 2017 than they were four years earlier.
A recent press release from the HHS’s Center for Medicare and Medicaid Services confirmed that premiums had more than doubled since Obamacare was put in place. "Average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on HealthCare.gov in 2017, an increase of $2,928 or 105 percent," the press release said.
Experts agree that premiums have gone up, but some have said the 2017 HHS report should be taken with a grain of salt.
David Anderson, a research associate at Duke University’s Margolis Center for Health Policy, said the 2013 and 2017 figures in the HHS report are not an apples-to-apples comparison.
"Their comparison is based on two totally different universes of individuals who are being covered," Anderson said. "The ACA market is significantly more morbid, which means more sick, which means higher claim levels than the pre-2014 market."
That’s because before ACA regulations took full effect, people who had pre-existing conditions or other risk factors could be denied coverage or charged higher rates, Anderson explained.
Additionally, the HHS report ignored subsidies provided under Obamacare, which lowered out-of-pocket expenses for many policyholders in 2017. These post-subsidy costs are more important anyway, since that’s what they actually have to pay.
The HHS study also listed several limitations to its findings, such as:
A note that Obamacare imposed many new regulations not fully in place until 2014. "In most states, these regulations increased insurance coverage requirements and would be expected, on average, to increase the price of ACA-compliant plans relative to pre-ACA plans," the report said.
A note acknowledging that "older and less healthy people are a larger share of the individual market risk pool (in 2017) than in 2013." The report said this change was likely "a significant cause of the large average premium increases in the individual market."
A note explaining that the report did not factor in premium changes in states that set up their own online exchanges, such as California. "To the extent that trends are different in state-based exchanges, the national average increase may differ," the report said.
With these limitations in mind, Anderson pointed instead to data from the Kaiser Family Foundation, a leading authority on health care, which he said shows how premiums have changed within the individual market as defined by the ACA.
That data compared monthly premiums from 2014 and 2018 and showed that they rose from $273 to $481 during that period for a slightly smaller increase of about 76 percent.
For the record, Anderson also said Holding was right that 91 percent of people are currently insured. But even still, the numbers were not the biggest problem with Holding’s statement.
Anderson said Holding’s claim that "we’re all paying 100 percent more" was "extremely problematic" because most people do not get insurance on the individual market, which typically provides coverage that is less comprehensive but more costly.
"This is, in my opinion, a very deceptive statement by Rep. Holding, as he is conflating the ACA created and regulated individual market with general experience in other, non-ACA regulated group and government market segments," he said.
More than 55 percent of Americans have employer-based health insurance plans, according to the U.S. Census Bureau. Approximately 19 and 17 percent are insured through Medicaid and Medicare, respectively, and a final 5 percent have military-provided coverage.
That means the Affordable Care Act’s individual market covers only about 5 percent of the population, and the percentage that does not receive help from subsidies is even smaller.
"The ACA premium increases that (Holding) references are relevant for 2 to 5 percent of the population in the individual market," Anderson said. "They are not reflective of what 86 to 88 percent of the population pays in premiums, where premiums have increased at a far slower rate."
Citing data from the Centers for Medicare and Medicaid Services and the State Health Access Data Assistance Center, Anderson said premiums for people covered by their employer or through Medicare or Medicaid have risen at a much slower rate. Employer-sponsored insurance premiums, for example, jumped about 14 to 17 percent between 2013 and 2017.
So Holding has cherry-picked the worst example that covers the smallest number of people and implied that everyone is paying 100 percent more for their coverage.
Holding said, "Obamacare raised premiums by 100 percent and after that 91 percent of the people were covered, but we’re all paying 100 percent more."
There are fragments of truth in that, but the way he’s constructed that statement makes it a significant distortion.
While a 100 percent increase is what was reported in 2017 by the Department of Health and Human Services, the comparison distorts the truth that the vast majority of Americans encountered.
Holding’s claim that "we’re all paying 100 percent more" was especially misleading because only 2 to 5 percent of people are affected by premium increases on the Affordable Care Act’s individual market. Holding cherry-picked the smallest market for insurance and suggested that everyone was suffering that way.
But for most people, the premium increases have not been nearly as steep as he said.
In particular, it’s simply not true that "we’re all paying 100 percent more." In fact, the vast majority of Americans get their coverage from employers, Medicare or Medicaid.
We rate this statement False.
This story was produced by the North Carolina Fact-Checking Project, a partnership of McClatchy Carolinas, the Duke University Reporters’ Lab and PolitiFact. The NC Local News Lab Fund and the International Center for Journalists provide support for the project, which shares fact-checks with newsrooms statewide.