Right-wing media are pre-emptively attacking a “public option" health care proposal supported by Democratic presidential nominee Hillary Clinton and President Barack Obama by linking it to supposedly “socialist” single-payer systems that have been routinely demonized through the history of health care reform. Conservative media used this tactic to disparage the public option in 2009 during the legislative debates that created the Affordable Care Act (ACA) and to tap into powerful historical tropes that promote misinformation and misperceptions of the American health care system, stymieing much-needed reform and perverting the public opinion.

The Affordable Care Act has become a major topic of conversation leading up to the election. Right-wing media have manufactured scandals by taking former President Bill Clinton’s comments at an October rally out of context and falsely claiming the newly announced health care marketplace premium increases are evidence of the so-called “death spiral” conservative media have been predicting for years -- despite no evidence the law is in danger of collapsing in on itself. The newest target of right-wing media ire is the public option, a proposal supported by Hillary Clinton and President Obama, which would introduce a low-cost, government-administered health insurance option into the federally run health insurance marketplaces.

The strategy right-wing media are using to scandalize the public option revolves around linking it to the single-payer systems used in countries with socialized medical options, either implicitly or explicitly invoking the specter of “Big Government.” Some media argue that the public option is a “Trojan Horse” to destroy the current private insurer-based market or claim that the public option is just “single-payer on the installment plan.” Others argue that Clinton “ultimately wanted a single-payer ultimate government control system for health care” and thus will eventually “go towards the single payer option” when she “replace[s] Obamacare with Hillarycare.”

If these attacks sound familiar, it’s because they are. The original draft versions of the ACA included a robust public option that Democrats ultimately dropped, partially because it became politically toxic as a result of concerted right-wing media assaults. Prominent right-wing media figures called the proposed public option a “stalking horse” or a “buy in,” arguing that “such a plan will lead to a single-payer system.” Others argued that the key to defeating the public option is “expos[ing] the positive-sounding ‘public option’ for what it truly is: a government grab.” They used the same fearmongering “Trojan Horse” rhetoric that right-wing media use now to play upon distrust of the government. They also actively demonized the public option as a socialist takeover of the health care system -- framing that has significantly impacted public opinion on the ACA and health care policy generally.

But none of this is true. Numerous fact-checkers have debunked the claim that the public option is just single-payer in sheep's clothing or that Clinton secretly wants a single-payer system. The public option is a government-administered health insurance plan that would compete in the insurance markets against private insurance plans, while in a single-payer system, “everyone in the country would have health coverage provided by the government,” according to FactCheck.org. Jonathan Oberlander, a professor of social medicine and health policy at UNC Chapel Hill, noted that “‘single payer’ is often used loosely to refer to everything” and argued that “depicting the Affordable Care Act (ACA) as a ‘slippery slope’ to single payer is bizarre.” Thus, efforts to conflate the two actively spread misinformation and make health care policy even more confusing than it already is for the American public.

This practice of scandalizing the public option in an effort to torpedo reform efforts is particularly problematic since the ACA does need reforms. Clinton and Obama both acknowledge the necessity of reforming the ACA to address fundamental issues about affordability and competition in the marketplaces. Recognizing that there are issues with the ACA does not mean the law is failing. However, purposefully stigmatizing a substantive proposal for reforming the current health care system is particularly troubling since Republicans have yet to produce a viable alternative to replace Obamacare. Americans remain seriously uninformed about health care policy, and the media shouldn’t allow conservative media myths to demonize a potentially productive reform before the public even has the chance to properly learn about it. 

During a phone interview with Fox News, Republican presidential nominee Donald Trump claimed that his companies “don’t use much Obamacare” just minutes after publicly stating that “all of [his] employees are having a tremendous problem with Obamacare.” The contradiction went unnoticed at Fox, which allowed the GOP nominee to peddle misinformation about the law’s supposed impending demise.

The Affordable Care Act, also known as Obamacare, was thrust into national headlines on Monday after the Obama administration confirmed double-digit premium increases on average for insurance plans sold on Obamacare’s online marketplace at Healthcare.gov for 2017. This will raise the average cost for a “Silver” plan, which is the benchmark that Obamacare subsidies are calculated for, to $3,552 annually, before subsidies are applied (the vast majority of enrollees receive substantial subsidies). As MSNBC’s Ali Velshi explained today, this premium level is consistent with the Congressional Budget Office’s 2009 analysis of future rates.

Trump made a series of false claims about the ACA during the interview that went unchecked by Fox anchor Bill Hemmer, including touting the benefits of repealing and replacing Obamacare (there is no replacement plan), calling the average figure for premium increases of 25 percent a “phony number,” praising the benefits of health savings accounts (they’re widely criticized by health experts as an insufficient replacement for insurance), and denouncing Obamacare for killing jobs (it doesn’t).

Perhaps most perplexing was Trump’s claim that he doesn’t “use much Obamacare” when numerous reporters confirmed that Trump claimed “all of my employees are having a tremendous problem with Obamacare” during a rally in Doral, Florida, just before the Fox interview.

While right-wing media and Trump tend to focus on exaggerating the troubles of the health insurance exchanges, those marketplaces represent one part of the ACA, which includes vital consumer protections and mechanisms to improve care quality while lowering costs. Trump’s flip-flop on whether or not he “uses” Obamacare is particularly baffling, since the Employer Shared Responsibility Provision of the ACA (also known as the employer mandate) “penalizes employers who either do not offer coverage or do not offer coverage which meets minimum value and affordability standards.” So either his employees do have “a tremendous problem with Obamacare,” which means he doesn’t provide health benefits for his employees since his businesses would qualify as “large employers,” or he doesn’t “use much Obamacare,” which still means his businesses do provide insurance and thus are complying with the law. Either way, Trump’s inconsistent claims about Obamacare and Fox’s decision to not push back on his plethora of misinformed claims about the ACA reveals their fundamental misunderstanding of the Affordable Care Act as a whole.

Watch the full interview from the October 25 edition of Fox News’ America’s Newsroom:

The Washington Post editorial board used the latest Census data showing that the rate of U.S. residents without health insurance continues to drop as proof that the Affordable Care Act (ACA) -- commonly referred to as Obamacare -- is working. The paper also argued that Obamacare would help millions more Americans if Republican-led states accepted federal subsidies to expand Medicaid. Right-wing media outlets have spent years encouraging the ongoing obstruction of this key provision of health care reform.

In a September 17 editorial, the Post highlighted the U.S. Census Bureau’s annual report on health insurance coverage, which showed that the percentage of people with health insurance had risen to 90.9 percent nationwide in 2015. The editorial board noted that the same report showed room for even more improvement in expanded health insurance coverage if the law were fully implemented at the state level. According to the Census data, the uninsured rate in states that did not accept Medicaid expansion under the ACA is still 12.3 percent, far above the national average and even further still from the 7.2 percent uninsured rate in states that have accepted the law’s allocation of funds for low-income Americans. In the Post’s view, the 19 states that continue to refuse Medicaid expansion are “irrationally holding out,” not only because their refusal of “huge amounts of federal money” has denied 4 to 5 million more Americans access to health care, but also because studies have shown that each state would receive vastly more money from the government than it would spend on expansion. From The Washington Post:

But the overall number could be cut much lower, and quickly, if Obamacare were working as it was meant to. We are not referring to the recent, much-discussed exit of some major health insurers from the marketplaces the law created. We are talking about Obamacare’s expansion of Medicaid, the state-federal health plan for the poor and near-poor. The Supreme Court in 2012 made the expansion optional for states, and a large chunk, including Virginia, have refused. The Census Bureau found that the uninsured rate was 7.2 percent in expansion states last year and 12.3 percent in non-expansion states. Five states have expanded since, but that still leaves 19, representing 4 million to 5 million people who would otherwise get coverage, irrationally holding out.

Why irrationally? In their effort to hobble Obamacare, state Republican leaders have left huge amounts of federal money on the table. The federal government has offered to pay nearly the whole cost of the expansion, forever. Though states must pitch in a bit, they get a much lower uninsured rate, lower uncompensated care costs and other savings in return. The Urban Institute found last month that the 19 holdout states would get an average of $7.48 from the federal government for every dollar they spent on Medicaid expansion. Even those costs, meanwhile, would likely be further offset by savings elsewhere. States that have already expanded, in fact, have generally seen net revenue gains.

The Post dinged “state Republican leaders” for “their effort to hobble Obamacare,” but continued obstruction to the law remains a feature of right-wing media coverage as well. For years, Fox News fueled obstructionist politicians by promoting myths that expanding Medicaid was costly for states; in reality, states that expanded Medicaid saw slower health care cost increases than non-expansion states, and August 2016 research from the Urban Institute shows that the remaining holdouts stand to benefit enormously from Medicaid expansion. After discouraging states from taking part in the law, Fox absolved itself (and Republicans) of responsibility for the resulting coverage gap, which it framed as as “another problem growing out of Obamacare.”

Right-wing media have smeared Obamacare for years with baseless catastrophic predictions and falsehoods, and while their fearmongering has been stunningly wrong, it has continued unabated. Positive news about Obamacare -- like its role in reducing medical debt and increasing public health, or the record low uninsured rates driven by the law -- goes unmentioned by conservative outlets while they hype isolated program stumbles as the onset of a looming “death spiral” that will destroy the health care system.

Republican presidential nominee Donald Trump announced that his campaign was expanding its so-called “economic advisory council” to include New York Post columnist Betsy McCaughey, a serial misinformer with no economic expertise and a long track record of promoting outrageous lies through conservative media.

According to an August 11 press release from the Trump campaign, McCaughey and eight others will join Trump’s team of economic advisers, adding to a group that had been pilloried by journalists and policy experts for initially including no women and only two individuals with more than an undergraduate background in economics. McCaughey, a former one-term lieutenant governor of New York, has no background or experience in economic policy but gained considerable acclaim in conservative media in 2009 when she alleged that the Affordable Care Act (ACA) or “Obamacare” would create “death panels” to ration care for sick and elderly patients. PolitiFact awarded the “death panel” charge the inglorious honor of Lie of the Year.

Since sparking the death panel myth in conservative media, McCaughey has been a frequent and outspoken critic of the Obama administration.

McCaughey recently suggested that the United States was “heading into a recession” despite being unable to cite any evidence to back up her claim. She has claimed for years that Obamacare was doomed to fail and could ruin the American economy, only to be proved wrong time and again. In 2014, McCaughey became a go-to expert for right-wing outlets hoping to stoke fear about the spread of Ebola in the United States. She has even attempted to deny the scientific consensus on human-induced climate change. She has also never quite given up on her bogus lie that Obamacare would create “death panels” that enforce end-of-life decisions for American citizens. When confronted with her lies on the September 11, 2014, edition of The Daily Show, McCaughey walked off set rather than face further questioning:

The New York Times highlighted a new study showing states that expanded Medicaid under the Affordable Care Act (ACA) saw noticeable improvements in public health outcomes relative to states that did not enact the expansion -- adding to mounting evidence debunking right-wing media paranoia about the inevitable demise of Obamacare.

On August 9, the Times reported that a new article in JAMA Internal Medicine -- a subsidiary of The Journal of the American Medical Association (JAMA) -- points to the ACA as a component in improving American public health through Medicaid expansion and increasing access to health care. The newspaper noted that this report comes after multiple studies have shown the ACA has been reducing Americans’ medical debt and encouraging more Americans to see a doctor for regular preventative services -- showing that the law is effective at accomplishing its goal of assisting Americans’ access to quality health care. From The New York Times:

A few recent studies suggest that people have become less likely to have medical debt or to postpone care because of cost. They are also more likely to have a regular doctor and to be getting preventive health services like vaccines and cancer screenings. A new study, published Monday in JAMA Internal Medicine, offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand.

[...]

Their survey found people in Arkansas and Kentucky were nearly 5 percent more likely than their peers in Texas to say they were in excellent health in 2015. And that difference was bigger than it had been the year before.

No two states are exactly the same, of course. There are many differences between Texas, Arkansas and Kentucky, besides their decisions on this part of the Affordable Care Act. The authors cautioned that their results can’t prove that Medicaid expansion caused people to be healthier.

These findings come one month after JAMA published an article President Obama wrote about the accomplishments of his signature legislation since it became law in 2010. The president’s article, the first scholarly work ever authored by a sitting president, noted that the uninsured rate has dropped 43 percent (from 16.0 percent in 2010 to 9.1 percent in 2015), that the law has contributed to greater financial security for Americans, and that it has actually led to better public health.

These latest reports directly contradict past right-wing media fearmongering that the law would not help Americans and would ultimately fail to provide stable, affordable, and expanded access to health care. For years, conservative media promoted the lie that Obamacare created so-called “death panels” that would ration health care for the sick and elderly. They falsely claimed that the law would weaken the economy, fail to attract participants, have no effect on uninsured rates, significantly increase health care costs, and irrevocably undermine the fabric of society. All of the catastrophic predictions failed to materialize.