On Wednesday, Republicans continued their effort to sell their miserable death-inducing wealthcare plan. In an effort to make it look less like an anti-Robin Hood money grab that steals from the poor to give to the very rich (which it is), they resorted to that most Ross Perot-like way of explaining numbers—badly made charts. Both Donald Trump and HHS Secretary Tom Price deployed charts to “prove” that the Republican healthcare plan was not cutting Medicaid. Both of them are wrong.
Trump’s chart was, of course, attached to a tweet, and was laid out with such lack of skill that it was easy to picture Trump himself spending hours with Excel for Dummies Donald, puzzling it out. However, the plain ugliness of the graph disguises some genuine skill in distorting information that argues Trump wasn’t actually at the helm.
Price clearly has access to aides with a little more experience in both graphic tools and a different scheme for how to make bad news look good.
Both charts accomplish the same thing—passing off a cut as an increase—through purposeful distortions that would make visual information guru Edward Tufte roll over in his grave. If Edward Tufte was dead. Which he isn’t. Let’s look at how they did it.
Both charts not only distort the basic data by leaving out inflation and the increasing population, they take the most direct approach to giving bad information by setting the wrong baseline. By failing to reflect the Medicaid spending called for under current law, they hide the fact that the numbers proposed under the Republican plan are massive cuts—cuts that reach $160 billion within a decade.
But both charts also distort the information through a simpler, but less obvious technique—scaling. In different ways, both Trump and Price create a mountain out of what’s not even a molehill of increase.
Trump accomplishes this by spreading out the X-axis of his chart, starting not at the present, or even a few years in the past, but 50 years ago. This allows the chart to pass off two lies in one. First, since the first Medicaid bill was only passed in 1965 and states are allowed to opt in as they want, the chart gives the impression that the Medicaid used to be incredibly cheap. By starting too soon, the chart actually represents coverage in only a handful of states. It also ignores that what we call Medicaid did not include several other programs that were lumped under the same heading in the budget reconciliation act of 1990. Before that date, what the Trump chart shows is only a small fragment of what we now call Medicaid.
And, of course, a major factor of the Affordable Care Act is Medicaid expansion—giving states the option to offer the program to Americans with higher income than was previously allowed. States opting into this program account for most of the increases in the last decade of Trump’s chart. The Affordable Care Act was passed in 2009, but many aspects of the law didn’t kick in until a couple of years later.
So, what does Trump’s chart look like if we take out the distorting influence of decades that have almost no relationship to the current Medicaid program?
The mountain of increasing spending indicated by the Trump version vanishes, revealed as an artifact of using decades of excess data to compress the chart’s horizontal axis and mixing different programs to make it seem that spending has experienced explosive growth. Instead it’s clear that the Republican plan falls far short of the current projected spending, leaving millions of Americans out in the cold.
Price’s chart uses a different means to the same end. Take a look at the scale on the left side of Price’s version. 450, 425, 375 … 0? By zooming in massively along the vertical axis, Price forces the same sort of distortion as Trump.
With proper scales restored, it’s easy to see that in pure numbers, Medicaid spending is all but flat. In fact, adding another set of numbers to Price’s chart shows that spending under the BCRA falls far behind a simple estimate for changes due to inflation. Even if not one more person was added to the plan, the money the Republicans are offering would mean that care diminished by tens of billions per year.
Add in changes to the population and the Republican plan falls very far short of even maintaining the status quo. When you have less funds available providing a lesser quality of care, that’s a cut. And in this case, it’s a cut that can be measured in lives.
The truth is that the cost of Medicaid is not rising out of control, as implied by the Trump chart, and the money offered by the Republican plan isn’t an “increase” under any view … but the most Republican.
