AP FACT CHECK: Health Overhaul A Prickly Business

The struggle over the proposed Republican health care overhaul in the Senate has covered a lot of territory, even veering into the mating habits of porcupines.

It's a prickly situation, trying to replace the Obama-era law with something palatable to enough lawmakers, and some of what is being said in the debate just isn't right.

A sampling of recent statements and how they stack up with the facts:

SEN. PAT ROBERTS, R-Kan., reaching for an analogy to illustrate how difficult it is to negotiate health care: "Once in Glacier National Park I saw two porcupines making love. I'm assuming they produced smaller porcupines. They produced something. It has to be done carefully. That's what we're doing now."

THE FACTS: He is correct, it's tricky, but unlike lawmakers, porcupines have their mission figured out.

Porcupine spines are an intimidating mechanism to protect the animals from predators. But when it comes time to mate, they have the ability to let down their defenses, said Duke University biologist Stuart Pimm. Courtship rituals can be aggressive but when the animals have negotiated the art of the deal, the females relax and reposition their quills.

It's not entirely different from people, Pimm said. "We humans are quite capable of arming ourselves with the most ferocious weaponry but I don't take my broadaxe to bed with me."

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PRESIDENT DONALD TRUMP: "Democrats purposely misstated Medicaid under new Senate bill - actually goes up." - tweet Wednesday.

KELLYANNE CONWAY, White House senior adviser: "These are not cuts to Medicaid, George. This slows the rate for the future and it allows governors more flexibility with Medicaid dollars because they're closest to the people in need." - Sunday on ABC's "This Week."

THE FACTS: The stalled Senate bill would cut Medicaid - by phasing out ex-President Barack Obama's expansion of the program and reducing over time the number of people who can be on it.

The nonpartisan Congressional Budget Office estimates the program would cover 15 million fewer people by 2026, a 16 percent reduction. Although Trump and Conway are correct that Medicaid spending overall would continue to rise - and at a slower rate than projected - the effect would be a deep cut in the program.

Governors indeed would have more flexibility, but they'd also have to dig deeper into their state budgets to make up missing money from Washington or scale back the program.

The Republican emphasis on spending growth is a sleight of hand that both parties resort to when it suits their political purposes.

Obama's law slowed the growth of Medicare spending, primarily by reducing projected payment increases to hospitals and other providers, and Republicans roundly denounced that as the cut that it was.

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HOUSE SPEAKER PAUL RYAN, R-Wis.: "They want government-run health care. Government-run health care is collapsing as we speak. It's not working." - Fox News interview on Tuesday.

THE FACTS: Obama's overhaul is not government-run health care like many other economically advanced countries have, but a U.S.-style hybrid involving the government, private companies and individuals.

His law kept the system centered on private insurance companies, doctors in private or group practice and employer-subsidized coverage, with new subsidies for private insurance and an expansion of the government-financed Medicaid program that's been in place since 1965.

Obama introduced more standards and controls, like the prohibition on denying insurance to sick people, which Republicans want to maintain. Most Democrats are not pushing for a single-payer system of universal coverage with the government paying for the care.

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REP. KATHY CASTOR, D-Fla.: "Most children in the country receive their basic medical care through Medicaid. And if a child is born with a complex condition or, God forbid, your child is diagnosed with childhood cancer, it's Medicaid that makes sure that you not live a life of poverty." - remarks to media Tuesday.

THE FACTS: More children are covered by private insurance than by Medicaid. Employer-based and other private plans cover 54 percent of children and Medicaid covers 39 percent, according to 2015 statistics from the Kaiser Family Foundation.

Also, Medicaid is not designed as an escape from poverty. The health coverage is generally only a safety net for those who are on it. It doesn't catch low-income people who suddenly face catastrophic costs driving them into poverty. They have to be poor to qualify for Medicaid.

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SEN. RAND PAUL, R-Ky.: "President Obama, I thought, was trying to do the best for people. He really did try to help get more people health care. It didn't work but I don't think he was trying to kill people." - Fox News interview Tuesday.

THE FACTS: Obama did more than try to expand health care. Millions of Americans gained coverage either through the health care law's insurance exchanges - most of it subsidized - or through the expansion of Medicaid in states that opted to do so with additional federal money. The uninsured rate dropped to a historic low, about 9 percent.

It's also premature to conclude that the law "didn't work," as Paul asserted. Premiums have risen, in some states dramatically, and coverage choices have dwindled in many areas. But the most recent assessment by the Congressional Budget Office found that the law's exchange markets are "stable" overall. And Republican governors who have adopted Obama's Medicaid expansion are lobbying to preserve it.

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SARAH HUCKABEE SANDERS, White House spokeswoman, on why she thinks the Congressional Budget Office is credible on matters involving revenue and spending but not reliable in predicting 22 million people would lose coverage under the Republican bill: "The CBO is a budget office ... We don't always agree that it does a great job predicting coverage." She added: "I think when they focus on the budget side, that's probably a good thing." - briefing Tuesday.

THE FACTS: She's cherry-picking. It's a Washington ritual to talk up favorable findings from the CBO and talk down negative ones.

She likes the office's budget projections because they anticipate a cut in the deficit and health-related taxes as a result of the legislation. She dislikes the nonbudget projections that anticipate a substantial rise in the uninsured.

But the two cannot be unlinked: A law's effects on the budget can only be forecast if analysts make assumptions on how that law changes people's behavior. The expectation that fewer people would buy health insurance under the Republican bill is central to measuring the bill's impact on federal finances.

The CBO is highly respected on Capitol Hill for its impartiality, and its projections, while sometimes far off, are considered more reliable than those by other analysts. But that doesn't stop partisans from assailing the office's credibility when it suits them - Democrats did the pummeling when they didn't like CBO forecasts on Obama's law.

As Republican Sen. Lindsey Graham of South Carolina put it earlier this year: "We like the CBO when they agree with us. When they don't, they're a bunch of losers."

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Associated Press writers Seth Borenstein, Ricardo Alonso-Zaldivar and Andrew Taylor contributed to this report.