Fact-checking the Ted Cruz, Bernie Sanders health care debate

Call it the election that never was. Sens. Bernie Sanders, I-Vt., and Ted Cruz, R-Texas debated the future of the Affordable Care Act during a 90-minute primetime debate on CNN Tuesday.

President Donald Trump has promised to repeal and replace the health care law, often referred to as Obamacare, while Democrats have vowed to defend former President Barack Obama’s landmark legislation. (Read our explainer on the potential impact of a repeal.)

The two ideologues and runners-up in the 2016 presidential nominating contests went head-to-head in a preview of the one of the year’s most contentious political fights. Here are their claims, fact-checked and with context.

Sanders: "Women are considered a pre-existing condition by the insurance companies because they might have a baby."

We rated a similar claim True back in 2009. Pregnancy almost always counted as a pre-existing condition in 39 states, according to the National Association of Insurance Commissioners. In the other 11, insurers are not allowed to turn down applicants based on health risks, but they’re allowed exclusions — including maternity coverage.

Sanders: An "overwhelming majority of the American people say do not simply repeal the ACA.  Make improvements."

He is likely referring to a Kaiser Health poll released in early January 2017 in which 75 percent of Americans surveyed said the Affordable Care act should not be repealed or lawmaker should wait to vote on an appeal until a replacement has been announced.  

Sanders: "The United States is the only major country on Earth not to guarantee health care to all people as a right."

Sanders made this claim repeatedly on the campaign trail, and it rates Half True. Among the countries that belong to the Organization for Economic Cooperation and Development, the United States is the only one that lacks universal coverage. But that’s not the same thing as a guaranteed right to health care, which some developed countries lack.

Cruz: Obama’s "If you like your plan, you can keep your plan" promise was "not true."

Obama’s signature health care promise was rated PolitiFact’s 2013 Lie of the Year.

Cruz: Six million people had their insurance policies canceled because of Obamacare.

We rated a similar claim — that 4.7 million have lost their insurance due to Obamacare — Mostly False. Independent researchers estimate that 2.6 million received notices that their health care insurance policies were being canceled, but fewer than 1 million ended up with no coverage at all.

Cruz: Most of the people on Obamacare are covered by Medicaid.

Cruz’s Republican primary opponent, Sen. Rand Paul of Kentucky, made a similar claim in January 2017. About 14.5 million of the 20 million who gained coverage were under Medicaid or CHIP. But somewhere between a quarter to a half of that 14.5 million were eligible for Medicaid even before the Affordable Care Act took effect.

Sanders: "Tens of thousands of our fellow Americans die because they don’t go to the doctor when they should."

This is a variation of an old Democratic talking point. Several studies have estimated that up to 45,000 people die every year because of lack of health insurance, but experts have cautioned that correlation does not mean causation.

"So when you see that the uninsured have higher mortality, you don't know whether it is because they are uninsured or because they are lower income," Harvard University health economist professor Katherine Baicker told us in 2013.

Cruz: Obamacare premiums are "skyrocketing."

Premiums rose an average of 25 percent across the 39 states that use the federal exchange, with the highest increases in Arizona (116 percent) and Oklahoma (69 percent). But it's important to note that 81 percent of consumers qualified for subsidies that help blunt the cost of their care.

Cruz: "In 70 percent of the counties in America, on Obamacare exchanges, you have a choice of one or two health insurance plans, that's it."

During the debate, Cruz tweeted a map — sourced to the conservative Heritage Foundation — to support this point. The foundation found that about 2,200 counties, about 70 percent of the nation’s total counties, have just one or two insurance providers to choose from on the Affordable Care Act insurance marketplace. In a previous fact-check, we found that the number of insurance providers on the marketplaces exchanges shrunk in more than half of all states this year.

Sanders: The United States "spends twice as much on health care" as the next country.

Sanders has made several versions of this claim in the past few years with varying degrees of accuracy. It’s True that the United States spends almost three times on health care per capita than the United Kingdom, and about double what France pays. But European countries like Switzerland and Norway don’t spend that much less.

Cruz: Millions of people across this country have been forced into part-time work that used to have full-time employment because of Obamacare.

There are anecdotal examples of full-time jobs becoming part-time jobs to meet certain requirements under the Affordable Care Act. However, there is no evidence of this happening en masse, as we have found in prior fact-checks. Both a 2015 study by the right-leaning American Enterprise Institute and a 2016 study published in the journal Health Affairs found little evidence of changes in part-time work as a result of the health care law. Additionally, the number of part-time workers has actually decreased since the law went into effect, according to the Bureau of Labor Statistics.

Sanders: Medicare is a popular program, and it works well.

A Kaiser Foundation poll found that 77 percent of people said Medicare is a very important program. Contrast that with the latest Gallup poll, in which 40 percent of respondents surveyed in January 2016 said they were very or somewhat satisfied with Medicare, compared with 55 percent who were somewhat or very dissatisfied. Satisfaction with the program has wavered around 30 to 40 percent since 2001.

Cruz: "Nationally, the health outcomes under Medicaid are really poor."

We rated a similar claim from Cruz False in 2013. Medicaid patients tend to have worse medical outcomes than those with private insurance, but that’s because they tend to be sicker and wait until the last minute for care. We found several studies that show Medicaid actually improves access and quality of life for many patients — or at least doesn’t hurt them.

Sanders: Vermont has the second highest rate of insured, while Texas has the highest uninsured rate.

According to the Kaiser Family Foundation, Vermont is tied with several other states as having the second-lowest uninsured rate in the country, at just 5 percent uninsured. Texas has the highest uninsured rate, with 16 percent of residents uninsured.

Cruz: Over 6 million people are fined every year by the IRS because of Obamacare.

The Affordable Care Act requires citizens to have health insurance or pay a penalty. The IRS collected fines, averaging about $470, from 6.5 million people in 2016, according to the agency's internal data.

Sanders: Obamacare repeal would give billions of dollars in tax breaks to the top 2 percent.

Congress’ bipartisan Joint Tax Committee estimated that the Affordable Care Act’s taxes on people making more than $200,000 would generate $211 billion over 10 years — so repealing the law would result in billions in tax cuts to these wealthy Americans. A household income of $200,000 puts someone in the top 6 percent of earners.

Sanders: Cruz’s tax plan would give the top 1 percent billions in tax cuts.

Cruz advocated for a flat 10 percent tax during the Republican primary and again at the debate. As PolitiFact reported, the top 1 percent would see an average cut of around $408,000 or about 26 percent more in after-tax income under Cruz’s plan, according to the Tax Policy Center. That’s about $463 billion in tax breaks for the entire bracket.

Cruz: Sanders "helped write Obamacare."

During his primary campaign, Sanders himself said that he helped write the Affordable Care Act. We rated that claim Mostly False. He deserves credit for one provision of it — worth a not-insignificant $11 billion. But overall, he was hardly an inside crafter of the bill.