Tagged KHN & PolitiFact HealthCheck

Hickenlooper Expanded Medicaid, Created State-Run Marketplace To Insure Nearly All Coloradans

Former two-term Colorado Gov. John Hickenlooper is a rare breed in the 2020 presidential race — he’s running as a moderate.

On health care, he supports universal coverage and boasts about Colorado’s record-low uninsured rate. But unlike many of his competitors for the Democratic nomination, he opposes “Medicare-for-all,” the single-payer federal system that would guarantee health care coverage to every American.

Hickenlooper has been making the rounds on cable talk shows and is trying to distinguish himself as a compromiser. In an interview on MSNBC’s “Meet the Press,” Hickenlooper said, “We got to almost universal coverage in health care in Colorado. We expanded Medicaid. We created one of the most innovative exchanges in the country.” His campaign website claims that “nearly 95 percent” of Coloradans currently have health care coverage.

We wondered how Colorado’s uninsured rate changed during Hickenlooper’s time in the governor’s mansion and how it compares with the rest of the country.

How Did Hickenlooper Do It?

The Affordable Care Act, or ACA, authorizes states to expand Medicaid to include health care coverage for all adults earning up to 138% of the federal poverty level. Colorado is one of 37 states that have opted to do so.

In 2013, then-governor Hickenlooper announced his proposal to expand Medicaid at no cost to the state general fund. Under the ACA, the federal government would pay for the program until 2016, after which states had to pay a portion. Hickenlooper planned to cover future expenses with cost-cutting efforts and existing revenues, including a hospital provider fee rolled out in 2009.

After Hickenlooper launched the Medicaid expansion, Colorado’s uninsured rate dropped from 14.3% in 2013 to 6.5% in 2017, according to the Colorado Health Institute.

However, about 350,000 Coloradans still don’t have health insurance — one-quarter of whom are undocumented, making them ineligible for public insurance. Also, the price of coverage continues to rise in Colorado, where people pay some of the highest premiums in the United States.

Hickenlooper saw Medicaid expansion as a step toward his goal of making Colorado the “healthiest state in America.” But he hasn’t always supported policies that could give more people health care coverage. In 2016, he opposed a ballot measure that would have created a single-payer state health care system called ColoradoCare. Then, he said he’d be open to a Trump administration-backed policy to implement a work requirement for Medicaid recipients.

How Does Colorado Compare?

Hickenlooper’s Medicaid expansion more than halved Colorado’s uninsured rate. But if a 6.5% uninsured rate counts as “almost universal coverage,” then how many other states can tout that accomplishment?

According to the Kaiser Family Foundation, Colorado’s uninsured rate positions it squarely in the upper half of the pack, with a national average uninsured rate of 9%. (It’s important to note that the Kaiser Family Foundation measured Colorado’s uninsured rate differently, pegging it at 8%. The Colorado Health Institute said its rate is slightly lower because it includes more data on children. Kaiser Health News is an editorially independent program of the foundation.)

The foundation lists 20 states with even lower uninsured rates than Colorado, including Massachusetts at 3% and Iowa at 4%.

In an email to PolitiFact, Michele Lueck, the president of the Colorado Health Institute, called Hickenlooper’s claim that “nearly 95 percent” of Coloradans currently have health care coverage a “friendly rounding error.”

Enrollment Numbers In Decline Nationwide, But Not In Colorado

About 300,000 fewer Americans bought insurance through healthcare.gov during the enrollment period in 2018 than in the previous year. Meanwhile, Colorado’s enrollment numbers were up.

The Affordable Care Act allowed states to create their own marketplaces to sell insurance plans to people who aren’t covered by their employer, Medicaid or Medicare — which includes about 8% of the total market in Colorado. Twelve states, including Colorado, run their own marketplaces.

Some credit lower enrollment across the country to the Trump administration’s policies to stymie the Affordable Care Act. It cut funding for healthcare.gov’s budget for marketing and eliminated the penalty for not having insurance.

But in Colorado, nearly 6% more people purchased a plan on Connect for Health Colorado, the state-run marketplace that operates independently of the federal government. While healthcare.gov released fewer ads and shut down weekly for maintenance, Connect for Health Colorado continued to reach out to eligible customers.

Our Ruling

Hickenlooper said, “We got to almost universal coverage in health care in Colorado.” Though Colorado is much closer to universal health care coverage than before the Affordable Care Act, hundreds of thousands of Coloradans remain uninsured and other states have even lower uninsured rates. Nevertheless, the state has an uninsured rate of 6.5%, which is close to universal coverage, as Hickenlooper said. The state achieved this by expanding Medicaid and running its own health care marketplace.

We rate the claim Mostly True.

Mulvaney: Trump Brought Down Drug Prices For The First Time In 50 Years

President Donald Trump announced last month that the GOP will become “the party of health care,” and news reports suggest he intends to make it a top issue in his reelection campaign.

So when Mick Mulvaney, the acting White House chief of staff, touted the administration’s work on prescription drug prices — a hot-button issue that has drawn scrutiny from across the political spectrum, and one that voters say should be a top priority — we were intrigued.

On “Fox News Sunday” April 7, Mulvaney said: “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”

This statement is particularly hard to prove affirmatively. Drug prices are measured through a host of metrics and affected by all sorts of political and economic forces.

We reached out to the White House for more explanation. Its staff directed us to a report published last October by its Council of Economic Advisers, as well as to data suggesting the consumer price index for prescription drugs declined in January 2019 compared with January 2018.

But experts who reviewed that data said it doesn’t necessarily support Mulvaney’s claim — and certainly not by the magnitude he suggests.

A Broad Brush, And Some Missing Data

We interviewed five experts who all agreed that, no matter which metric was used, evidence is lacking to unequivocally say drug prices decreased last year. The most generous reading came from Matthew Fiedler, a health economist at the Brookings Institution: It’s “within spitting distance of something that’s true.”

But with more examination, the claim’s veracity became murkier.

“Drug prices” can refer to many things: a list price, a net price (what is paid after rebates, or the discounts negotiated by insurers or other payers), the pharmacy’s price or total national spending on prescription drugs.

Let’s start with the latter. Data from the Kaiser Family Foundation shows total spending on prescription drug prices has climbed during the past several years. (KHN is an editorially independent program of the foundation.) In 2018, total spending continued to grow, just at a slower pace. That’s a positive trend, experts noted, but it isn’t the same thing as spending going down.

“It doesn’t mean we’re spending less money on drugs than before,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University.

We also examined the CPI data the White House provided. It could suggest that in the past year prescription drugs’ list prices have indeed dropped, and even by a meaningful amount.

But the CPI data doesn’t account for whether manufacturers lowering their list prices have also changed the size of the rebates they provide. That’s essential information in understanding if the real price of a drug — what insurance pays and, ultimately, what consumers pay — has actually changed.

These trend lines also vary depending on the 12-month period they cover, argued Walid Gellad, an associate health policy professor at the University of Pittsburgh. January to January could show a list price decrease, but July to July could show an increase.

Plus, the CPI data includes only drugs sold through retail, or about three-fourths of all prescriptions. That excludes many high-priced specialty meds sold only via mail order, argued Michael Rea, who heads Rx Savings Solutions, a consulting firm.

It also paints with a broad brush — obscuring, many said, just how many list prices are continuing to climb.

This year, the list price of more than 3,000 drugs went up, while the price of only 117 went down, according to data compiled by Rx Savings Solutions. Last year, an analysis by the Associated Press revealed that, from January to July, 4,412 branded drug prices went up, while 46 were cut.

So, Mulvaney’s downward price claim didn’t come out of thin air. But interpreting the data to mean that drug prices are down ignores crucial parts of the prescription drug marketplace.

The White House’s Work

Mulvaney also said Trump has played a key role in bringing down drug prices. When we asked the administration what he meant, a spokesman pointed to their efforts to bring more generic drugs to market — a boost the White House said has fueled competition and helped make lower-price alternatives available to consumers.

But there’s no evidence yet to suggest that the boost in generic drug approvals has that effect. Experts said it takes time for these products to reach the marketplace, create competition and demonstrate a measurable impact on prices.

Indeed, many of those generics, while approved, never went to market. This White House assertion also doesn’t account for high-priced, branded drugs that lack a generic counterpart.

Yes, Trump’s tough talk — accusing pharma companies of “getting away with murder” — may have persuaded some drug manufacturers to hold off on increasing their prices — at least temporarily, or until after the government releases key stats on how many prices have gone up, Dusetzina said. But it’s hard to separate that phenomenon from the pressure also levied by Congress and state legislatures.

For what it’s worth, the administration has proposed many new policies meant to curb drug prices, many noted, such as eliminating some kinds of rebates, or changing how Medicare Part B pays for drugs. But none of those have taken effect — so they haven’t brought prices down.

Our Ruling

Mulvaney said, “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”

At first glance, CPI data could conceivably support the argument that the list prices for some prescription drugs dipped. But that data doesn’t include many high-priced specialty drugs that drive costs up, and the pattern it illustrates can change based on the time frame selected.

The CPI data set obscures the individual drugs for which the list prices have increased — with far more going up than down. It also does not account for a drug’s true “net price.”

Mulvaney’s statement also does not reflect trends showing that, nationally, spending on drugs has continued to climb, even if that growth has slowed. There is also no evidence to support the argument that Trump himself is responsible for changes in drug pricing.

This claim has an element of truth, but it ignores key facts and context that would give a very different impression. We rate this claim Mostly False.