As Republicans and Democrats argue over Obamacare repeal, facts are stretched

President Obama and Vice President-elect Mike Pence were both on Capitol Hill Wednesday, making competing cases for and against Obama's signature health care law. Republicans have promised to make repeal of the Affordable Care Act their first order of business, once they control both Congress and the White House.

Obama is urging his fellow Democrats to do what they can to preserve the law. If that fails, Democrats plan to hold Republicans accountable for any disruption the repeal may trigger. Both sides are trying to position themselves as the protectors of Americans' health care, while branding the other party as a dangerous threat.

As usual, the truth may be somewhere in between. Here we take a closer look at some of the claims being floated by both parties:

President-elect Trump got the ball rolling with a pre-dawn tweet, cautioning that "Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases......"

Republican House Speaker Paul Ryan echoed Trump. "This law has failed," Ryan told reporters. "We know that things are only getting worse under Obamacare. This is about people paying higher premiums every year and feeling powerless to stop it. It's about families paying deductibles that are so high it doesn't even feel like you have health insurance in the first place. And in so many parts of the country, as you've always heard, even if you want to look for better coverage, you're stuck with one option. One choice is not a choice. It is a monopoly. The health care system has been ruined, dismantled under Obamacare."

CLAIM: Obamacare suffers from "massive premium increases" FACT CHECK: True in some cases, but it's also relative. Obamacare is also actually cheaper on average than the typical employer-provided plan.

Many people shopping for health insurance on the government-run exchanges set up by Obamacare have seen double-digit premium increases this year.

The average cost of a benchmark plan rose 25 percent nationwide, but there was considerable variation from state to state. Premiums in Arizona jumped an average of 116 percent, while premiums in Indiana and Massachusetts actually went down. Most people buying insurance on the exchanges receive a government subsidy, which helps defray the cost. A study by the Urban Institute last year found that even without the subsidy, insurance policies sold on the exchanges cost about 10 percent less than the typical employer-provided plan. Exchange policies might seem more expensive, because part of the cost of workplace plans is typically paid by employers, and thus largely invisible to the employee. CLAIM: "You're stuck with one option" under Obamacare
FACT CHECK: Not true for the majority, but it has increasingly become the case.

Obamacare insurance exchanges have grown less competitive, as some insurance companies have lost money and left the market. One in five customers on the exchanges had just one insurance company to choose from this year (up from 2 percent in 2016). Nearly 6 in 10 customers have a choice of three or more companies. The lack of competition, which can lead to higher prices, tends to be worse in rural areas and the South.

Insurance companies have struggled, in part, because fewer young, healthy people have signed up for coverage than forecast. Backers of the Affordable Care Act say that could be remedied with more generous subsidies to encourage sign-ups or bigger penalties for those who fail to enroll. Obama also renewed the idea of a public insurance option to supplement private offerings. CLAIM: "The health care system has been ruined, dismantled under Obamacare" FACT CHECK: Prices were going up at faster rates before Obamacare. Most Americans under age 65 still get health insurance through an employer, although the percentage has been slowly dropping. The cost of employer-provided coverage has gone up since passage of the ACA. But the annual price hikes were considerably larger in the decade before the law was passed. Some of the savings from slower premium growth have been offset by higher deductibles.

While Republicans highlight the shortcomings of the Affordable Care Act, Democrats warn that repeal would be much worse.

"Instead of working to further ensure affordable care for all Americans, [Republicans] seek to rip health care away from millions of Americans, creating chaos in our entire economy," Democratic Senate leader Chuck Schumer said Wednesday. He and his fellow Democrats offered a mocking slogan for the GOP: "Make America Sick Again."

Schumer also suggested that repealing Obamacare would hurt rural hospitals, "right in their heartlands. The minute they enact this repeal, [hospitals] are going to suffer dramatically," he said.

CLAIM: ACA repeal would "rip health care away from millions" FACT CHECK: True, if Republicans don't protect them or replace ACA with something that provides coverage. The Affordable Care Act has expanded health care coverage to some 20 million Americans through a combination of subsidized individual policies, expanded Medicaid, and allowing young adults to stay on their parents' plans. The uninsured rate has fallen to an all-time low of around 10 percent. Coverage would be higher still if 19 states had not refused to expand Medicaid. If the Republican-controlled Congress repeals the Affordable Care Act, many of those newly insured Americans would be at risk of losing coverage. In addition, millions more who buy individual insurance policies off the exchanges could be at risk, if that market is disrupted. The Urban Institute estimates as many as 30 million people in all could lose their health care coverage, doubling the uninsured rate.

Republicans have promised an orderly transition as they work toward a replacement for Obamacare, and it's possible the effective date for any repeal could be delayed for a number of years. Insurance companies, however, may be reluctant to participate once it's clear Obamacare's individual market is being phased out.

CLAIM: Rural hospitals are going to suffer FACT CHECK: True, if repealed outright, but it's also because of the way the ACA was structured in the first place.

The concern for hospitals reflects a trade-off when the ACA was passed seven years ago. The government scaled back what it pays hospitals for treating Medicare patients and the indigent, with the expectation that would be offset by payments from millions of newly insured.

Hospitals worry that if repeal of the law cuts insurance coverage, but doesn't restore other payments, they could be left with a mountain of unpaid bills. The American Hospital Association and the Federation of American Hospitals urged Congress and the incoming Trump administration to either protect insurance coverage or replace the hospital payments. Copyright 2019 NPR. To see more, visit https://www.npr.org.