If Kellyanne Conway thinks there are no cuts to Medicaid, she should ask the people who stand to lose coverage.

We are delighted to welcome to our Alternative Fact of the Week feature its godmother, President Donald Trump's senior adviser Kellyanne Conway, who coined the term in the very first week of his administration. What's so special about her appearance is that this week she injected into the public discourse something that might actually qualify as an alternative "fact" rather than what we usually discuss, which is a lie some politician insists to be true.

Kellyanne Conway, senior White House Adviser and coiner of the term "alternative fact."
Kellyanne Conway, senior White House Adviser and coiner of the term "alternative fact." (Alex Brandon / AP)

In a sense, Ms. Conway was accurate when she told ABC News' George Stephanopoulos that the Senate health care bill does not cut Medicaid.


As the fine folks at Politifact note, under the Senate bill, Medicaid spending would increase from $403 billion in 2018 to $460 billion in 2026. Medicaid spending would go up by $57 billion, ergo, not a cut — at least in the simplest sense.

But sometimes a fact misses so much context as to be just as false as a lie, and this is just such a time. Under current law, Medicaid spending would go from $415 billion to $624 billion during those years. Cumulatively, over a 10-year period, the federal government would spend $772 billion less on Medicaid under the Senate bill than it would under current law. It does so by tapering off federal funding for the Obamacare Medicaid expansion, limiting eligibility and eventually changing the nature of the program altogether from an open-ended federal-state partnership to one in which the federal contribution would be capped. Bottom line, people who have health insurance through Medicaid now won't if this bill becomes law.

A conservative pundit offered a bogus statistic about Medicaid on "Face the Nation," and no one challenged him.

What Ms. Conway has stumbled on is a persistent problem in how we talk about spending cuts in government, one that we've witnessed time and again in Annapolis. Some, like Ms. Conway in this instance, argue that reducing projected increases in future spending doesn't count as a cut. But it is, and that's not just some kind of government fuzzy math.

Imagine you work for a company that promises never to cut its payroll. Over time, it hires more people but doesn't increase the amount it spends on salary and benefits. Consequently, your paycheck gets smaller and smaller. Is that a cut?

Suppose McDonald's decides to increase the amount of beef it sends to its franchisees by 1 percent a year even if sales increase by 10 percent a year. Eventually, your Quarter Pounder becomes an Eighth Pounder. Is that a cut?

Maybe the rates for electricity and natural gas go up, but you decide to adjust your thermostat to keep your utility bill the same this winter as last. Is your house still just as warm?

The CBO predicts that the Senate healthcare bill will cut premiums -- but not the cost of insurance.

The reason Medicaid spending is projected to go from $415 billion in 2018 to $624 billion in 2026 is because the population is expected to increase and medical costs to go up — both rock-solid assumptions, based on past results. It is not because eligibility requirements are going to change or because the services offered are going to expand. The reason the Senate health care bill calls for lower spending is because eligibility requirements would change and benefits would contract. If that's not a cut, we don't know what is.

In fact, by its own terms, the Senate bill has to be considered a cut to Medicaid. In order to avoid a filibuster and pass the measure with as few as 50 votes (though at this point, even that may be a stretch), Senate Majority Leader Mitch McConnell needs to use a procedure known as reconciliation. Among the rules for that process is that the Senate version must reduce the deficit by as much or more than the House bill. The way to determine that is to compare its effects to projected spending and deficits under current law. Considering that the Senate bill makes the deficit worse to the tune of $751 million over a decade from tax cuts for the wealthy and the elimination of penalties for non-compliance with Obamacare, it needs some hefty spending cuts to come out on the side of deficit reduction. Without construing the $772 million in reductions to projected Medicaid spending as cuts, the math doesn't work.

On the other hand, if Ms. Conway would like to make her "there are no cuts to Medicaid" argument to the Senate parliamentarian and force this bill to meet the 60-vote threshold to end a filibuster, she can be our guest.

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