In the race to repeal and replace the Affordable Care Act, lawmakers on both sides of the political aisle have been guilty of spreading erroneous statements, exaggerating the truth, and skimping on context.
That's the takeaway from a review by ProPublica and its partners at Kaiser Health News, Stat, and Vox of more than 200 letters that members of Congress sent out to their constituents in response to the public's questions and concerns about the Affordable Care Act, and its proposed replacement, the GOP's American Health Care Act.
We reviewed the emails and letters sent by 51 senators and 134 members of the House within the past few months. More Republicans fudged than Democrats, though both had their moments. The legislators cited wrong statistics, conflated health care terms, and made statements that don't stand up to verification.
More from Vox:
The FBI probe into Trump and Russia is huge news. Our political system isn't ready for it.
A veteran GOP strategist explains why conservative elites put up with Trump's lies and corruption Bill Gates takes his campaign against "America First" directly to Donald Trump today
It's not clear if the inaccuracies were intentional, or if the lawmakers and their staff don't understand the current law or the proposals to alter it. But either way, the issue has become increasingly heated as the House gets ready for a vote on the GOP's replacement bill this Thursday.
Here are some whoppers from members of both parties, and the truth and context behind what they told voters.
The lies Republican members made to their constituents
Republicans criticize the law for not living up to its promises. They say former President Barack Obama pledged that people could keep their health plans and doctors and premiums would go down. Neither has happened. They also say that insurers are dropping out of the market and that monthly premiums and deductibles (the amount people must pay before their coverage kicks in) have gone up. That's all true.
But they also told a few whoppers.
1) They lied about the number of Obamacare exchanges in a state's counties
Rep. Pat Tiberi, R-OH: "In Ohio, almost one third of counties will have only one insurer participating in the exchange."
What's misleading: Only 23 percent (less than one quarter) had one option, according to an analysis by the Kaiser Family Foundation.
His response: A Tiberi spokesperson defended the statement. "The letter says 'almost' because only 9 more counties in Ohio need to start offering only 1 plan on the exchanges to be one third."
Why his response is misleading: Ohio has 88 counties. A 10 percent difference is not "almost."
2) They blamed the ACA for the number of uninsured Americans
Rep. Chuck Fleischmann, R-TN: "According to the U.S. Census Bureau, approximately thirty-three million Americans are still living without health care coverage and many more have coverage that does not adequately meet their health care needs."
Why it's misleading: The actual number of uninsured in 2015 was about 29 million, a drop of 4 million from the prior year, the Census Bureau reported in September. Fleischmann's number was from the previous year.
Beyond that, reducing the number of uninsured by more than 12 million people from 2013 to 2015 has been seen as a success of Obamacare. And the Republican repeal-and-replace bill is projected to increase the number of uninsured.
His response: None.
3) They overstated the impact the ACA had on part-time employment
Rep. Dana Rohrabacher, R-CA: "It has also, through the requirement that employees that work thirty hours or more be considered full time and thus be offered health insurance by their employer, distorted the labor market."
What's misleading: A number of studies have found little to back up that assertion. A 2016 study published by the journal Health Affairs examined data on hours worked, reason for working part-time, age, education, and health insurance status. "We found only limited evidence to support this speculation" that the law led to an increase in part-time employment, the authors wrote. Another study found much the same.
In addition, PolitiFact labeled Donald Trump's assertion that, "Because of Obamacare, you have so many part-time jobs" as a false statement last June.
His response: Rohrabacher spokesperson Ken Grubbs said the Congress member's statement was based on an article that said, "Are Republicans right that employers are capping workers' hours to avoid offering health insurance? The evidence suggests the answer is 'yes,' although the number of workers affected is fairly small."
Why it's misleading: We pointed out that "fairly small" was hardly akin to distorting the labor market. To which Grubbs replied, "The congressman's letter is well within the range of respected interpretations. That employers would react to Obamacare's impact in such way is so obvious, so nearly axiomatic, that it is pointless to get lost in the weeds," Grubbs said.
4) They blamed the ACA for eroding the quality of health care in the country
Rep. Kevin Yoder, R-KS: "Quality of care has decreased as doctors have been burdened with increased regulations on their profession."
Why it's misleading: Some data shows that health care has improved after the passage of the ACA. Patients are less likely to be readmitted to a hospital within 30 days after they have been discharged, for instance. Also, payments have been increasingly linked to patients' outcomes rather than just the quantity of services delivered. A 2016 report by the Commonwealth Fund, a health care nonprofit think tank, found that the quality care has improved in many communities following the ACA.
His response: None.
5) They said a majority of health insurance marketplaces run by states have failed
Rep. Blaine Luetkemeyer, R-MO: "Nearly 75 percent of state-run exchanges have already collapsed, forcing more than 800,000 Americans to find new coverage."
What's misleading: When the ACA first launched, 16 states and the District of Columbia opted to set up their own exchanges for residents to purchase insurance, instead of using the federal marketplace, known as Healthcare.gov.
Of the 16, four state exchanges, in Oregon, Hawaii, New Mexico, and Nevada, failed, and Kentucky plans to close its exchange this year, according to a report by the House Energy and Commerce Committee. While the report casts doubt on the viability of other state exchanges, it is clear that three-quarters have not failed.
His response: None.
The lies Democratic members told voters
Democrats emphasize that millions of previously uninsured people now have medical coverage thanks to the law. They say insurance companies can no longer discriminate against millions of patients with pre-existing conditions. And they credit the law with allowing adults up to age 26 to stay on their parents' health plans. All true.
But they also told some lies of their own.
1) They exaggerated the number of young adults who stayed on their parents' health plan after the ACA
Rep. Joseph P. Kennedy III, D-Mass.: The ACA "allowed 6.1 million young adults to remain covered by their parents' insurance plans."
What's misleading: A 2016 report by the U.S. Department of Health and Human Services, released during the Obama administration, however, pegged the number at 2.3 million.
Kennedy may have gotten to 6.1 million by including 3.8 million young adults who gained health insurance coverage through insurance marketplaces from October 2013 through early 2016.
His response: A spokeswoman for Kennedy said the office had indeed added those two numbers together and would fix future letters.
2) They wrongly stated family premiums are declining under Obamacare
Sen. Dick Durbin, D-Ill.: "Families are seeing lower premiums on their insurance, seniors are saving money on prescription drug costs, and hospital readmission rates are dropping.
What's misleading: Durbin's second and third points are true. The first, however, is misleading. Family insurance premiums have increased in recent years, although with government subsidies, some low- and middle-income families may be paying less for their health coverage than they once did.
His response: Durbin's office said it based its statement on an analysis published in the journal Health Affairs that said that individual health insurance premiums dropped between 2013 and 2014, the year that Obamacare insurance marketplaces began. It also pointed to a Washington Post opinion piece that said that premiums under the law are lower than they would have been without the law.
Why his response is misleading: The Post piece his office cites states clearly, "Yes, insurance premiums are going up, both in the health-care exchanges and in the employer-based insurance market."
3) They incorrectly said that the Republican bill to repeal Obamacare would cut funding for seniors in nursing homes
Sen. Ron Wyden, D-Ore.: "It's terrible for seniors. Trumpcare forces older Americans to pay 5 times the amount younger Americans will—an age tax—and slashes Medicaid benefits for nursing home care that two out of three Americans in nursing homes rely on."
What's misleading: Wyden is correct that the GOP bill, known as the American Health Care Act, would allow insurance companies to charge older adults five times higher premiums than younger ones, compared to three times higher premiums under the existing law. However, it does not directly slash Medicaid benefits for nursing home residents. It proposes cutting Medicaid funding and giving states a greater say in setting their own priorities. States may, as a result, end up cutting services, jeopardizing nursing home care for poor seniors, advocates say, because it is one of the most-expensive parts of the program.
His response: Taylor Harvey, a spokesman for Wyden, defended the statement, noting that the GOP health bill cuts Medicaid funding by $880 billion over 10 years and places a cap on spending. "Cuts to Medicaid would force states to nickel and dime nursing homes, restricting access to care for older Americans and making it a benefit in name only," he wrote.
Why his response is misleading: The GOP bill does not spell out how states make such cuts.
4) They exaggerated the percentage of Medicaid spending that covers the cost of long-term care
Rep. Anna Eshoo, D-Calif.: "It's important to note that 60 percent of Medicaid goes to long-term care and with the evisceration of it in the bill, this critical coverage is severely compromised."
What's misleading: Medicaid does not spend 60 percent of its budget on long-term care. The figure is closer to a quarter, according to the Center on Budget and Policy Priorities, a liberal think tank. Medicaid does, however, cover more than 60 percent of all nursing home residents.
Her response: Eshoo's office said the statistic was based on a subset of enrollees who are dually enrolled in Medicaid and Medicare. For this smaller group, 62 percent of Medicaid expenditures were for long-term support services, according to the Kaiser Family Foundation.
What's misleading about the response: Eshoo's letter makes no reference to this population, but instead refers to the 75 million Americans on Medicaid.