Tracing the path of the GOP’s Trumpcare spin, from TV to print

The Congressional Budget Office (CBO) report that landed Monday has damaged Republican efforts to repeal and replace Obamacare. The report, by the government’s impartial legislative arbiter, delivered the bad news many Republicans were not anxious to hear: their proposal, the American Health Care Act, would raise the number of uninsured Americans by 24 million people during the next decade, to a total of 52 million uninsured. An insurance loss of that size would erase the gains in coverage that the Affordable Care Act achieved.

Perhaps the GOP expected the loss. That would explain last week’s rush to secure quick approval of its bill by two Congressional committees before waiting for the CBO score, as is customary.

It would also explain the sudden inrush of spin from Republican politicians as they prepared for the worst. After Sunday morning interview shows gave GOP guests a megaphone to amplify their messages and shape coverage after the CBO report, subsequent news stories passed plenty of spin along to the public.

The GOP’s spin machine sprang into action a week ago during the American Health Care Act’s mark-up at the House Energy and Commerce Committee. Texas Republican Michael Burgess announced that the CBO was off in its projection that 21 million people would be covered under the ACA by 2016.

“That number in fact was 10 million,” Burgess claimed, and then said that the CBO score “is hardly the final word on the issue.” (In March 2016, about 11 million people had Obamacare marketplace policies, and about 13 million others had gained Medicaid coverage.) Fellow committee member Richard Hudson added that the “CBO number is a false argument the Democrats have created”—as though the CBO number was not relevant to the debate. The same day, at a White House press briefing, press secretary Sean Spicer told reporters, “if you’re looking at the CBO for accuracy, you’re looking in the wrong place.”

But it was during last weekend’s Sunday shows that the spin really gained traction.

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On ABC’s This Week, budget director Mick Mulvaney told George Stephanopoulos that the CBO had been wrong about Obamacare:

“I love the folks at the CBO. They work really hard. They do, but sometimes we ask them to do stuff they’re not capable of doing, and estimating the impact of a bill of this size probably isn’t the best use of their time.”

When Stephanopoulos raised the subject of the bill’s rushed process, Mulvaney responded, “We already had two committee hearings, which I believe is two more than Obamacare had in the House.” That claim prompted Washington Post fact checker Glenn Kessler to ask Mulvaney’s staff for evidence. Kessler reported that the paper received nothing specific in response, and detailed the long history of Obamacare’s path through the House. “We’re not sure what Mulvaney has been smoking, except his own propaganda,” Kessler wrote.

On NBC’s Meet the Press, Health and Human Services Secretary Tom Price got ample time to make his case and trash the CBO, to boot. When Chuck Todd asked whether people would be worse off financially with the GOP plan, Price asserted, “I firmly believe that nobody will be worse off financially in the process that we’re going through,” a belief he grounded in the plan’s “choices” rather than “[what] the government forces them to buy.”

In response to Todd’s question about the possibility of 15 million fewer people covered, Secretary Price responded that the American Health Care Act “will not leave that number of individuals uncovered. In fact, I believe, again, that we’ll have more individuals covered.” As for the CBO report, Price said the office “has been very adept in not providing appropriate coverage statistics.”

When Face the Nation’s John Dickerson asked House Speaker Paul Ryan why the House started work on the bill without the CBO score, Ryan didn’t answer the question. Instead, he flipped to his talking points:

“The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage.’ You know why? Because this isn’t a government mandate. This is not ‘the government makes you buy what we say you should buy, and therefore the government thinks you’re going to buy it.’ So there’s no way we can—you can compete with on paper a government mandate with coverage.”

When Dickerson asked how many people would lose coverage under the GOP plan, Ryan replied, “I can’t answer that question. It’s up to people.” Although Dickerson tried to pin down the number of people who would lose coverage, Ryan wouldn’t budge, and the conversation turned to the transition period.

Most of the points the GOP’s trio made showed up in news coverage, with variations here and there. Monday’s New York Times picked up Mulvaney’s comments about the CBO. Mulvaney’s message also showed up on Politico, which reported on the budget director’s appearance on MSNBC’s Morning Joe. “I don’t believe the facts are correct,” said Mulvaney during his appearance. “I’m not just saying that because it looks bad for my political position. I say that based upon a track record of the CBO being wrong before and we believe the CBO is wrong now.”

The AP also passed along GOP messages reporting that Ryan told Fox News that the CBO report “actually exceeded my expectations.” Ryan explained the CBO’s loss-of-coverage estimate this way: “If we’re not going to force someone to buy something they don’t want to buy, they’re not going to buy it, and that’s kind of obvious.” The AP didn’t probe what might happen to those people, and to the health system, as a consequence. Meanwhile, Ryan’s positive take on what were arguably the worst of the CBO findings was picked up by outlets from The Daily Beast to Breitbart.

Almost all the stories I read published the same essential points from the CBO report: The Republican plan would cover far fewer Americans by ending the Obamacare mandate to carry insurance and throwing millions of Americans off the Medicaid rolls, and would reduce federal budget deficits by $337 billion over 10 years (in large part because it wouldn’t be paying for poor people’s health coverage under Medicaid).

A few stories, however, distinguished themselves by providing fuller, contextualized explanations of the GOP talking points.

Margot Sanger-Katz produced a fine piece at The New York Times that explained clearly and forcefully how Republicans plan to lower premiums. The CBO found that, during the first few years the Republican plan is in effect, premiums would rise and then fall. Sanger-Katz explained how: Older people who will pay more under Trumpcare will be discouraged from buying insurance. “The plan will lower the average sticker price of care,” she wrote. “But that doesn’t mean prices will get lower for everyone.”

Sanger-Katz also pointed out that a shift to a different kind of tax credit will hurt older workers. Insurers will be allowed to charge older workers more than they do now, but the tax credits they’ll receive won’t make up for the increase, and so older workers will have to dig deeper into their pockets to pay the difference.

Not many outlets dwelled on Medicaid changes, which is hardly surprising: Medicaid is not a favorite topic among editors. But the Detroit Free Press deserves kudos for localizing the CBO’s findings. A piece by Todd Spangler got right to the point: More than 600,000 Michiganders who qualified for expanded Medicaid coverage under the Affordable Care Act “would be expected to ultimately lose or fail to qualify for coverage” under the Republican plan.

Spangler’s story included a standard “blah-blah” comment from one of the state’s Congressional representatives, Mike Bishop, who said he was “confident Congress will build on the progress outlined in [the CBO] report to make healthcare work for everyone.” However, Spangler told readers, Bishop did not “did not mention the analysis’ finding that millions could become uninsured or what specifically those Medicaid reforms might mean to people slightly above the poverty line” who currently receive care in the state.

Other stories anticipated Republican efforts to kill the messenger, and looked into the CBO’s performance record. CNN’s Tami Luhby provided a clear look at what the CBO’s Obamacare predictions got right and wrong. More employers continued to offer coverage to their workers than was first predicted, Luhby found, and more Americans were eligible for Medicaid and did not need to shop in the Obamacare marketplaces.

There’s one GOP talking point most stories barely mentioned. A story in The Hill included this quote from Paul Ryan: “We set out a clear goal—to give every American access to quality affordable care—and a clear plan to achieve it. Now we must keep our promise and deliver.”

That slogan is close to the one used by Democrats to promote the Affordable Care Act. And that irony should prompt reporters to push for specific, and localized, answers to this question: Can the Republicans deliver “quality affordable healthcare” to everyone any more than the Democrats could with Obamacare?

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.