Clinton vs. Obama

The debate took place Nov. 15 in Las Vegas and was hosted by CNN. We found sharp exchanges between the front-runners.

15 Million Left Out?

Sens. Hillary Clinton and Barack Obama traded words about their health care plans, and we found both dabbled in exaggerations:

Clinton: His plan would leave 15 million Americans out. That’s about the population of Nevada, Iowa, South Carolina and New Hampshire. I have a universal health care plan that covers everyone.

Obama: Well, let’s talk about health care right now because the fact of the matter is that I do provide universal health care. … [W]e’ve put forward a plan that makes sure that it is affordable to get health care that is as good as the health care that I have as a member of Congress.

Clinton uses a dubious statistic when she claims Obama’s plan would leave out 15 million of the uninsured. But Obama’s statement that his proposal provides “universal” health care is also suspect.

Clinton based her claim on a column by The New Republic’s Jonathan Cohn, who loosely estimated Obama’s plan would leave 15 million uninsured:

Cohn (The New Republic, June 3): The best studies out there — by Urban Institute researchers, the RAND Corporation, and MIT economist Jonathan Gruber — suggest that, without a mandate, improving affordability will cover roughly one-third of the people who don’t have coverage. Mandating that kids (but not adults) have coverage bumps that up to about a half. Obama’s advisers think that, by really loading up on the subsidies … they can goose that up to two-thirds. But that’s getting optimistic — and, even then, you still have around 15 million people who are uninsured.

Cohn makes it clear here that he is offering an estimate based on the best information available, not a hard and fast calculation. And the best available information doesn’t always agree. One of the people Cohn cites, economist and influential health care expert Jonathan Gruber, has gone on record saying that without a mandate, Obama’s plan would still leave 6 percent of the nation – about 18 million people – uninsured. But it’s not clear whether he meant “without an individual mandate” or “without any kind of mandate.” The Obama plan does include limited mandates, including a requirement for employers to either provide health insurance or pay into a public fund. A Gruber study from 2006 estimates that a plan with generous subsidies and an employer mandate would lead to 82 percent of the uninsured gaining coverage, based on 2001 data. Applied to today’s figures, that would leave about 8.5 million without insurance. Gruber found that a proposal that included an individual mandate would lead to 100 percent coverage of the uninsured.

Other studies also find only a small discrepancy between the types of plans that Obama and Clinton are proposing. For instance, a 2003 Commonwealth Fund study found that a plan with mixed private-public options (as the leading Democratic candidates have put forth) that also included an individual mandate would reach near universal coverage, leaving just 1 percent of people uninsured. Not including a mandate would still reach most of the uninsured, leaving about 3 percent without coverage.

Update: Three months after this article was published, we looked into the 15 million claim again in light of a new report on the topic by M.I.T. economics professor and health care expert Jonathan Gruber. Gruber did estimate that 15 million of the uninsured would not gain coverage under Obama’s plan, and another health care expert told us the figure would be about 26 million. Both experts said a plan without an individual mandate, like Obama’s plan, would insure substantially fewer of the currently uninsured than a plan with an individual mandate, like Clinton’s. We found that Obama was being misleading by saying his plan would “cover everyone” and that Clinton’s plan would leave out a million people or more, depending on how she enforced her mandate. Our more recent article can be found here.

Similar Plans

It’s true that Clinton’s plan would likely lead to somewhat higher levels of coverage than Obama’s, according to the research we’ve seen. But the difference in outcomes may not amount to much. The main distinction: Clinton calls for a mandate that would require all individuals to have health insurance; Obama requires only that children have coverage and that dependents be covered under their parents’ insurance up to age 25. Of the estimated 46.5 million uninsured in the U.S., 9.4 million are children and 37 million are adults, according to an analysis of Census data by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute. But neither candidate has provided enough detail for analysts to predict confidently how many might be left uninsured under either plan.

• Sara Collins, an assistant vice president at The Commonwealth Fund, a private foundation that calls for higher quality and accessibility in health care, says that the Obama and Clinton plans (as well as Edwards’) are “very, very similar in structure.” Studies show that mandates make a difference, but Collins says the “15 million” seems like too big a number based on past analyses.
• Kenneth E. Thorpe, a professor of health policy at Emory University who worked in President Clinton’s administration and who has evaluated several presidential candidates’ health plans, also says that “it’s hard to come up with precise numbers” without knowing the details on the federal subsidies these plans would include. “Whether it’s 15, 20 or 10,” he says, that estimate makes “an assumption on the subsidies that the campaign hasn’t put out.”
• Robert Blendon, director of the Harvard Program on Public Opinion and Health and Social Policy, estimates Obama’s plan would end up covering 5 percent to 10 percent fewer individuals than Clinton’s. But that’s assuming that it’s possible for Clinton to require everyone to purchase insurance. Blendon suspects that it isn’t. “At the end of the day,” he tells FactCheck.org, “it’s not going to be everybody. We have no idea what the actual falloff would be.”

Among the unknown factors is what sort of insurance would turn out to be available under either plan. Preliminary data from Massachusetts, which implemented a sweeping health insurance plan last year, is showing that many people would rather remain uninsured than purchase a stripped-down plan. “People always say having some insurance is better than no insurance,” Blendon says. “It turns out, in some of the focus groups in Massachusetts, people don’t believe that.”

One Obama claim that we wondered about turned out to be true, or at least close enough.

Obama: An employer has more of a chance of getting hit by lightning than be prosecuted for hiring an undocumented worker. That has to change.

We have no idea how many of those lightning casualties are employers, let alone how many might have hired illegal aliens. What we do know is that the Immigration and Customs Enforcement service reports that in the most recent 12-month period on record, the total number of arrests of persons in the “employer supervisory chain” was 91.

-by Lori Robertson, Jessica Henig, Brooks Jackson and Justin Bank.

Correction, Nov. 19: Our original story included a typo in quoting the Citizens for Tax Justice’s estimate for removing the earnings cap on Social Security taxes.  The figure is $124 billion per year. The story has been corrected above.