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On Veterans Day, the statewide advocacy organization Progress Iowa released an attack ad against U.S. Sen. Joni Ernst on social media, criticizing her record on veterans' health care. The Republican faces reelection in 2020. The 40-second ad states that 'Ernst has voted to repeal the Affordable Care Act four times” and 'those votes would cost 8,295 Iowan veterans their health coverage.”
In source material for the ad provided to the Fact Checker team, Progress Iowa cited Ernst's voting record on three bills and one amendment as its explanation for the statement that she 'has voted to repeal the Affordable Care Act four times.”
Following President Donald Trump's election, the Republican-controlled House and Senate made a concerted effort to repeal and replace the Affordable Care Act, also dubbed Obamacare, but were unsuccessful.
Progress Iowa provided a New York Times article dated July 2017 that tracked votes on three such proposals developed in the Senate: the Better Care Reconciliation Act, the Obamacare Repeal Reconciliation Act and the Health Care Freedom Act.
Ernst did vote in favor of all three proposals, which would have repealed the Affordable Care Act in various capacities, according to the New York Times article. Voting records from the Senate's website also confirms Ernst's support for the acts.
Progress Iowa also cited a vote Ernst cast in 2015 on McConnell Amendment No. 2328, an amendment proposed by Senate Majority Leader Mitch McConnell to repeal the Affordable Care Act entirely. This was an amendment to legislation that authorized funding for transportation projects nationwide.
However, the vote Progress Iowa is referring to is a motion to invoke cloture on the amendment. Establishing cloture sets a time limit to debate a bill or motion before the Senate and is meant to eliminate a filibuster in opposition.
An official voting record on the Senate's website confirms Ernst and 48 other senators voted to pass the motion. It wasn't enough to pass, and failure to achieve cloture effectively killed the amendment.
Progress Iowa said it considered the cloture vote part of an effort to repeal the Affordable Care Act as Ernst had 'characterized it as a vote on policy.”
Ernst's statement on the vote from her official website, dated July 26, 2015, supports that characterization.
'Today's measure to repeal and replace Obamacare would have been an important step towards achieving a sustainable health care system that puts the focus back on Iowa families and individuals,” according to Ernst's statement.
For its second statement in the ad, Progress Iowa pointed to an analysis released earlier this year on veterans' health care access and the Affordable Care Act as its source.
Called Families USA, the consumer health advocacy organization released the report in opposition of 'Texas vs. United States,” the lawsuit brought by Texas and other states challenging the constitutionality of the individual mandate within the Affordable Care Act. The case is awaiting a ruling from the 5th Circuit Court of Appeals.
Families USA supported enactment of the Affordable Care Act before it was signed into law in 2010.
The analysis relied on estimates from a 2017 study conducted by the RAND Corporation, a centrist public policy research firm. According to its website, RAND is funded for its research by government agencies, international organizations and academic agencies, among others.
RAND's analysis states if provisions of a certain Affordable Care Act repeal law were in effect for 2026, 8,295 veterans living in Iowa would lose all health insurance coverage.
Though there's no way to predict what Congress will do in the future, it should be noted that action affecting the study's forecast could have been taken before 2026.
The RAND study estimated the potential impact of VA utilization among nonelderly veterans if the American Health Care Act of 2017 - the House version of the Better Care Reconciliation Act, which Ernst supported - had gone into effect.
The analysis, which was sponsored by the Robert Wood Johnson Foundation and the New York State Health Foundation, based its state-specific estimates on 2016 population data. RAND researchers also determined the rate of insured veterans between 2013 and 2015 as a result of the Affordable Care Act by using data from a survey conducted by the U.S. Census Bureau.
The RAND study was the only research the Fact Checker team could find with the 8,295 total Iowa veterans referenced in the Progress Iowa ad.
However, there is consensus among other studies that the United States saw gains in veterans' health care coverage under the Affordable Care Act. One 2017 study from the left-leaning Urban Institute found the uninsured rate among veterans under the age of 65 fell nearly 40 percent between 2013 and 2015, meaning that about 429,000 individuals gained coverage.
Ernst has voted to repeal and replace the Affordable Care Act on at least three pieces of major legislation. The fourth vote counted in the Progress Iowa ad is fair to include in its claim based on Ernst's own characterization of the vote's significance.
The ad stated 8,295 Iowans veterans would lose health care coverage under a repeal, which matches an analysis conducted by the RAND Corporation. Although no other study backs up that specific estimate, there is consensus in other studies that veterans saw gains in coverage under the Affordable Care Act.
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This Fact Checker was researched and written by Michaela Ramm of The Gazette.