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PolitiFact: When are health-care ‘cuts’ really cuts?

Politics and math don’t always get along, and counselor to the president Kellyanne Conway raised a common complaint about how people talk about the future of Medicaid spending under the Senate Republican health care bill.

In an interview Sunday, ABC news host George Stephanopoulos brought up the bill’s projected $800 billion in Medicaid savings and asked Conway if that undermined the president’s campaign promise to spare Medicaid from cuts.

“These are not cuts to Medicaid, George,” Conway said on This Week. “This slows the rate for the future.”

Conway was weighing in on a long-running debate over what qualifies as a cut. On one level, she has a point, we at PolitiFact found. Future savings are not always “cuts.” But in the case of the GOP health care bill, there are indeed cuts that go beyond dollars spent.

To first vet Conway’s statement that there are no cuts to Medicaid, we need to begin with a few basic numbers.

The Congressional Budget Office estimated that under current law, from 2018 through 2026, the federal government would spend about $4.62 trillion on Medicaid.

For the Senate bill, the CBO estimated that total Medicaid spending would be about $770 billion less.

But you can also compare how much Washington spends in 2018 — the first year a health care bill would take effect — and what it would spend in 2026.

If things stay as they are, spending goes from $415 billion to $624 billion.

Under the Senate Republican bill, spending goes from about $403 billion to about $460 billion.

Point being, spending increases under either scenario; it just increases at a far slower rate under the Senate bill.

But it’s the specific nature of those program’s changes that are more important than the total dollars spent.

When Democrats passed the Affordable Care Act in 2010, it included less money for Medicare over the years. In a mirror image of today’s debate, Republicans, notably House Speaker Paul Ryan, accused Democrats of cutting a vital health care program for the elderly. Democrats argued back that spending increased.

We did a series of fact-checks about the back-and-forth and generally rated the Republican attacks Half True.

Then, Democrats reduced payment levels to health care providers. Now, Republicans propose reducing payments to states. But at least in terms of the money trends, both situations follow the same general outlines — with one key difference:

The Democrats didn’t change the eligible population, and the Republicans do.

That’s a cut. Fewer people will have access to Medicaid no matter how much money is spent.

Conway, in fact, highlighted the Republican goal.

“Medicaid’s imperative, its founding was meant to help the poor, the sick, the needy, the disabled children, some elderly women, particularly pregnant women,” she said on ABC. “We are trying to get Medicaid back to its original moorings.”

Our ruling:

Conway said that Republicans are not cutting the Medicaid program. The Republican health care proposals would slow the rate at which Medicaid spending increases, but spending would still increase.

However, the proposals include policy changes that will leave fewer people eligible for Medicaid. That’s a cut.

Conway’s claim has an element of truth but leaves out critical facts that would give a different impression. We rate the claim Mostly False.

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