AP FACT CHECK: Lindsey Graham revises history on Obamacare

Published 6:30 am Wednesday, October 14, 2020

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WASHINGTON — The senator leading Supreme Court confirmation hearings Tuesday launched into revisionist history on “Obamacare,” implying it was designed to help Democratic states like California, New York and Massachusetts while doling out less to states like his, South Carolina.

In doing so, Sen. Lindsey Graham skipped over the fact that health insurance is generally more expensive in places with a high cost of living. Also, South Carolina is among 12 conservative states that have not adopted the law’s Medicaid expansion, a big source of federal subsidies.

A look at the Senate Judiciary Committee chairman’s remark during questioning of nominee Amy Coney Barrett:

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GRAHAM: “Under the Affordable Care Act, three states get 35 percent of the money, folks. Can you name them? I’ll help you, California, New York and Massachusetts. They’re 22 percent of the population. Now, why did they get 35 percent of the money when they are only 22 percent of the population? That’s the way they designed the law; the more you spend, the more you get.”

THE FACTS: That’s misleading.

In a sense, it is true that states with higher premiums and more enrollment in the ACA’s health insurance marketplaces get more federal money. But that’s driven by differences in premiums between states and by the number of people who sign up for taxpayer-subsidized coverage.

It’s not that Democrats who wrote the law put their finger on the scale. The price of health insurance, like the real estate market, reflects underlying local costs such as hospital charges and doctors’ fees, which vary. For example, a 40-year-old nonsmoker in San Francisco would pay $574 a month for an Obamacare “silver” plan compared with $434 in Charleston, South Carolina, assuming no financial assistance.

And there’s another wrinkle: Larry Levitt of the nonpartisan Kaiser Family Foundation says the big reason that some states like South Carolina get much less federal money under Obamacare is that they have chosen not to expand Medicaid, where the federal government picks up 90 percent of the cost.

Contrary to Graham’s assertion, that wasn’t how the Obama administration and the then-Democratic Congress designed the law, Levitt points out. Obamacare originally required all states to expand Medicaid, with the federal government covering most of the cost, but the Supreme Court made Medicaid expansion optional in 2012.