FactCheck: Fact and Fiction in Obama's Speech

President Obama's prime-time address to Congress and the nation on health care prompted a Republican congressman to shout "you lie!" Did he? Here's what we've found:

The president addressed a joint session of Congress Sept. 9, and the event was televised nationally.

Illegal Immigrants
Obama said that his proposal would not cover illegal immigrants, a remark that prompted Republican Rep. Joe Wilson of South Carolina to shout "You lie!"

The president is correct: The House bill contains a section (Sec. 246) titled "NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS," which states: "Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."

However, conservative critics object to a lack of specific enforcement measures in the bill. They argue that the lack of a specific verification mechanism constitutes a loophole that would allow illegal immigrants to get benefits despite the legal prohibition. Republican Rep. Dean Heller of Nevada proposed an amendment to the bill that would have required the use of the Systematic Alien Verification for Entitlements program to check the citizenship of anyone applying for federal coverage or affordability credits. SAVE is the program used by Medicaid and similar entitlement programs. That amendment was voted down along party lines by the House Ways and Means Committee.

Republicans have a point here: More could be done to enforce the ban. But it's worth remembering that, as a spokesperson for the American Immigration Lawyers Association told us, attempting to get a health care credit would have legal repercussions. "Making a fraudulent claim to an entitlement program when you're not actually entitled to it would have serious consequences for any person," the spokesperson told us, "but especially if it's considered a false claim to citizenship, that would have serious immigration consequences that could ultimately lead to deportation." And Rep. Wilson certainly was out of bounds to call the president's statement a "lie." He later issued a statement apologizing for his "inappropriate and regrettable" comments.

The president insisted that no federal money would pay for abortions:

The truth of that depends on what is meant by "federal dollars." Actually, as we've written before, under Democratic legislation now before Congress, the "public option" would cover abortions in cases of rape, incest or threat to the life of the mother and could cover all abortions if the administration chooses, and as Obama once promised. Private insurance plans purchased with the help of federal subsidies to low- and moderate-income workers also could cover all abortions, as many, if not most, private plans do today.

Under an amendment adopted by a House committee, abortions would be paid for by the "public option" only with money collected from policyholders in the form of premiums, not with money collected from taxpayers. But is money collected by the government and paid out to abortion providers by the government "federal dollars"? The anti-abortion side says yes. And the same goes for federal subsidies given to low- and moderate-income persons to help them buy insurance. If they use those dollars to buy private policies that cover all abortions, does that mean "federal dollars" go to fund abortions? Again, abortion foes say yes.

The advocates of abortion rights argue otherwise. They say the House bill would be an extension of longstanding policy under the Hyde amendment, which forbids use of federal taxpayer dollars to fund Medicaid abortions except in cases of rape, incest or threat to the mother's life, but also allows states to use their own Medicaid money to fund other abortions (and 17 of them do). In any case, the matter is not so simple or clear as the president would like it to seem.

The president repeated his promise to fully pay for the plan.

Up until now, that's been a promise in search of fulfillment. As we reported earlier, the nonpartisan Congressional Budget Office has found that Democratic plans in the House and Senate both would add hundreds of billions of dollars to the federal deficit over the coming decade.

In his speech, the president reduced the price tag, saying "the plan I'm proposing will cost around $900 billion over 10 years." That's about $100 billion less than what the CBO said the House bill would cost. And the president embraced a tax on expensive employer-paid health plans, something he's resisted in the past. He also said there will be a provision in this plan that "requires us to come forward with more spending cuts if the savings we promised don't materialize."

But it remains to be seen whether the CBO's budget experts will agree that the plan would be fully paid for. For that, they'll need to see more specific details.

Insurance Competiton
Obama overstated somewhat the degree of concentration in the insurance industry:

We asked the White House for the source of those figures, but received no reply. The president probably was referring to a report from the Government Accountability Office, which found that "[t]he five largest carriers in the small group market, when combined, represented three quarters or more of the market in 34 of the 39 states supplying this information"

We agree that having three-quarters or more of any market can fairly be characterized as having "control." However, the GAO report dealt only with insurance bought by small groups, not the entire "insurance market," as the president said.

Furthermore, while the GAO reported that BlueCross BlueShield of Alabama, the largest private insurer in the state, has a 96 percent share of the small group market, it does not actually control 90 percent of the state's total market. A spokeswoman for the company told us that the president is "unfortunately using an incorrect figure." She said that the company's share of the Alabama insurance market is closer to 75 percent. She said it covers 2.4 million persons in the state, and Census Bureau figures show private insurance covers a total of 3.2 million Alabama residents.

"Public Option"
The president misstated a few details on the proposed "public option":

In fact, under the House bill, the new federal plan would be open to anybody who buys insurance on his or her own, whether or not the person currently has coverage. It also would be open to employees of small businesses, defined in the House bill as those with no more than 20 employees, whether or not those employees are currently covered by another plan. It's true that the "public option" is aimed at the uninsured, but they wouldn't be the "only" ones who could buy it.

It is true, as Obama said, that "no one would be forced to choose it." But experts say that it might well have an "impact" on some of those who currently have insurance. Obama noted that "based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up" for the federal plan. The CBO did say that only 11 million to 12 million Americans would join the public plan under the original House bill. But estimates from the Lewin Group, a subsidiary of UnitedHealth Group that says it operates with editorial independence, were higher, at 33.6 million. Lewin's estimate triples when it looks at what might happen if the federal plan were available to everyone, a possibility the House bill leaves open. The House bill as amended by the Energy and Commerce Committee, however, sets up a "public option" that won't affect nearly as many people. The CBO estimates that an insignificant number would switch under that plan, and Lewin's estimate drops to 20.6 million, if the plan were open to all.

Choosing Words Carefully
Some of the president's factual claims, while accurate, were notable for his careful wording.

"Citizens" is the operative word here. And even so, the 30 million figure is an understatement. The official Census figure for 2007 was actually 45.7 million persons in the U.S., but that figure includes an estimated 10 million who are not U.S. citizens, including 5.6 million who are here illegally, according to the National Institute for Health Care Management Foundation. That still leaves about 35.7 million U.S. citizens without health coverage in 2007, well above the president's figure. And hours after the president spoke, Census released new figures for 2008, showing the total number of uninsured went up slightly, to 46.3 million.

It's true that no Democratic legislation would "require" workers or employers to change coverage, though some existing plans may have to be upgraded to meet new federal minimum standards if, for example, they fail to cover preventative screenings.

Obama has become more cautious in his wording since an Aug. 15 appearance when he said "if you like your health care plan, you keep your health care plan." That won't always be true. In fact, as we noted at the time, some firms are likely to buy different coverage for their workers than they have now, or simply drop coverage and pay a penalty instead, leaving workers to buy their own private coverage or go on a new federal insurance plan. The CBO estimated that 3 million who now have employer-provided coverage would lose it under the House bill, as their employers find that paying the penalty is cheaper than providing coverage. The CBO also said these employers would likely have lower-wage employees eligible for federal subsidies to help them purchase insurance.

We slammed the Democratic National Committee for running an ad that said Republicans voted to "abolish Medicare." The president was talking about the same vote, and characterized it much more accurately. The budget resolution supported by most House Republicans would have preserved the current system for everybody age 55 or over, but when younger workers reached retirement age they would have been given a choice of government-approved private insurance plans and a government subsidy to pay most of the premiums.

However, Obama continued to make one factual claim we have repeatedly found to be wrong:

That figure comes from a study by Families USA estimating the effect on premiums of uncompensated care, which is care that is provided to the uninsured but not paid for. But that group advocates vigorously for wider government health coverage.The figure is not supported by the Kaiser Family Foundation or the Congressional Budget Office. Both have reported that uncompensated care actually leads to lower hospital profits, not higher premiums. KFF's estimate of the amount of uncompensated care shifted to premium-payers works out to about $200 per family per year, not $1,000.

Overall, Obama got good marks for clarity and accuracy from at least one expert who's sometimes been critical. John Sheils, senior vice president of the Lewin Group, which has analyzed the House bill and health care proposals, told us that there was "a lot of stuff you could quibble with" in the president's speech, but overall he was "impressed" with the way Obama explained a "hugely complicated issue." "I think in the main of it, I think he did pretty well."

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