Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.

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Paragraph: "Del. Steve Landes says Gov. Terry McAuliffe’s long-sought initiative to expand Medicaid in Virginia is financial quicksand. ""Do you support or oppose Medicaid expansion in Virginia?"" Landes, R-Augusta, asked constituents in a recent survey about issues. ""While expansion would enroll up to 400,000 currently uninsured Virginians in Medicaid, it could cost the Commonwealth of Virginia over $1 billion per year, forcing cuts to other key services like education, mental health and public safety."" Landes is hardly the first Republican to sound the $1 billion-a-year alarm about the potential cost of expanding Medicaid. Others, including House Speaker Bill Howell, also have tossed around the number during the GOP’s successful three-year effort to block expansion. Democrats say the state has a moral obligation to make Medicaid available to all low-income Virginians who are qualified - particularly because the federal government has agreed to pay for the vast majority of the expansion. Republicans counter that Medicaid already is unwieldy and that Uncle Sam, deeply in debt, can’t be relied upon to pay his promised share. The issue is certain to re-emerge this winter when the General Assembly convenes for a 60-day session starting Jan. 13. So it’s a good time to look into the accuracy of the $1 billion-a-year claim. Let’s start with some background. The costs Under the Affordable Care Act, also known as Obamacare, states have the choice of extending their Medicaid programs to people who earn 138 percent of the U.S. poverty level. The federal government pays all of the expansion costs through this federal fiscal year, which ends Sept. 30, and gradually will drop its future share to a standing 90 percent after 2019. To date, 31 states have decided to expand Medicaid. Virginia’s Medicaid program is run by the state Department of Medical Assistance Services which, in September, issued annual cost estimates for Medicaid expansion through 2022. They show the expansion would cost a total of $800 million in fiscal 2017, with the state shouldering $32 million of that amount. In 2022, the cost would be $3.1 billion, with the state responsible for $325 million. But these gross figures don’t take into account savings that DMAS says the state would realize by expanding Medicaid. For example, Virginia now covers all the costs of hospitalizing a state prisoner; under Medicaid expansion, the federal government would pay 90 percent of the bills. Virginia pays most of the costs for uninsured low-income residents who receive behavioral health treatment from community service boards; under Medicaid expansion, the federal government again would pay 90 percent of those bills. DMAS concluded that the savings would outweigh the costs of Medicaid expansion through 2020, when Virginia would see a $34 million net gain from joining the program. After that, there would be some - but not much - red ink. DMAS estimated that the bottom-line cost to expand would be $3 million in 2022. Landes’ figure So how does Landes reach his estimate of a potential $1 billion-a-year cost to Virginia taxpayers? His calculation rests on the premise that the federal government, already over-committed, will renege on its legal promise to never pay less than 90 percent of expansion costs. ""If the federal government cut the expansion match rate back to 50/50, it would cost Virginia over $1 billion per year in the out years,"" Landes wrote to us in an email. He pointed out that the bottom-line price of expansion - combining Washington’s share with the state’s net cost - is estimated to exceed $2 billion a year starting in 2018. If the federal government tosses half of the expense back to Virginia that year or later, the state would be shackled with annual bills of at least $1 billion. Craig Markva, a spokesman for DMAS, told us the state has every reason to believe that won’t happen. For one thing, legislation would be required to cut the federal contribution. Edwin Park, the vice president for health policy at the Center on Budget and Policy Priorities, a liberal think tank, told us there’s no movement afoot in Congress to take such an action. In 2012, the Obama administration proposed a budget-cutting measure that would have changed the formula for how much it pays for Medicaid patients, boosting the federal match for current enrollees and lowering the match for people who became newly insured under the law. But after the Supreme Court ruled in 2012 that expansion was an option, not a mandate, the White House dropped that proposal, because it wanted to assure states the match would stay at 90 percent, Park said. It also should be noted that the Obama administration notified states in December 2012 that if they enrolled in expansion, they could drop out of the program at any time. That assurance was repeated in a March 20, 2014 letter that Cindy Mann, then the White House’s top Medicaid official, wrote to Bill Hazel, Virginia’s secretary of health. McAuliffe, a Democrat who has been pushing to broaden Medicaid, has proposed a state law that would require Virginia’s withdrawal if Washington reduced support for expansion. Republicans have been skeptical the state could extricate itself from the expansion once it began. Our ruling Landes, in a constituent survey, said Medicaid expansion ""could cost the Commonwealth of Virginia over $1 billion per year."" That contradicts the latest estimates on expansion. Virginia’s gross cost in 2022 - the furthest out the projections go - would be $324 million. The net cost, after taking into account a variety of savings the expansion offers, would be $3.1 million. That’s light years away from Landes’ figure. Landes’ estimate rests on the eye-popping supposition that the federal government could decide in the future to cut nearly half of its commitment to pay 90 percent of the costs for expansion, leaving states holding the bag. But this is pure speculation of his part. There’s no effort in Congress now to cut the federal share at all, let alone by the proportion Landes suggests. There’s a burden on Landes to prove his statement with facts, and he comes up short." Claim: "Medicaid expansion ""could cost the Commonwealth of Virginia over $1 billion a year..."

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0


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Paragraph: Costs are not mentioned at all. The costs of acupuncture treatment can vary widely, but most people can expect to pay at least $60 per session (and often considerably more). Given that this study involved 16 sessions, and that not all health plans would cover acupuncture to treat ASD, the expense could be considerable. According to the news release, the researchers “identified the most positive outcome of the study as the high compliance rate, with all parents of the children ages 3-10 completing the intervention.” While it is good to know that the patients were able to complete the study, most readers probably wanted to know if the patients benefited from the treatment in any way. The release notes that “researchers measured the effects of the intervention on factors such as the children’s behavior, ability to pay attention, sleep, and aspects of parenting stress” — but doesn’t tell readers whether any of those things changed as a result of treatment. The closest the release comes to quantifying a benefit is when it states that “most parents reported that the intervention had a positive impact on their relationship with their child.” It’s not clear what they mean by “most parents,” how much their relationship improved, how it improved, or why it may have improved. In fairness, the release states that the goal of the study was “to determine if young children with autism spectrum disorder and their parents would tolerate and adhere to an office- and home-based acupuncture/acupressure intervention.” However, the release also says “While a small study, the tolerance and adherence with acupressure this pilot [sic] are both hopeful signs for families of those in their care with autism spectrum disorder.” Why should families be hopeful? Who knows? Given that there had been more than a dozen clinical trials involving acupuncture and children with ASD as of 2012, it’s not clear what questions this new study has answered. Potential harms aren’t discussed at all. To be clear, the risks here are low. As the Mayo Clinic notes, “The risks of acupuncture are low if you have a competent, certified acupuncture practitioner.” But, then again, the release also doesn’t mention the importance of finding a certified acupuncture practitioner. And even with certified practitioners, there are risks, from soreness and bruising to infections. In addition, individuals with bleeding disorders are not good candidates for acupuncture. The release offers very little information about the study. For example, while the release refers to it as a “pilot feasibility study,” it doesn’t even tell readers how many patients participated (there were 10). No disease mongering here. The release doesn’t mention who funded the work. In this case, the work was funded by Autism Speaks. Many people have strong feelings about Autism Speaks, one way or the other, making the funding organization particularly worth mentioning here. It also doesn’t mention any conflicts of interest but there don’t appear to be any. The release doesn’t describe potential benefits for ASD patients, so it’s not clear what alternatives are relevant in this context. Alternatives to what? Ergo, we’ll rank this as not applicable. The release doesn’t address availability at all. While many (or most) readers are aware that acupuncture therapy exists, they may be less familiar with how widely available it is. Readers may not be aware of pediatric acupuncture at all, much less pediatric acupuncture for children with ASD. Is there a special certification for pediatric acupuncture therapy? What about for pediatric ASD acupuncture therapy? The release doesn’t tell us. Acupuncture research related to ASD is not new. Here’s a systematic review of the relevant literature from 2011, and another from the same year. The Cochrane review, among the collection of studies included in the reviews above, concludes that: “We need high quality trials of larger size and longer follow-up as the evidence base at present has many limitations.” But the study described here tackles the subject in a new way, that of the feasibility of being able to complete therapy. Prior studies haven’t shown that it’s feasible for families to commit to longer term acupuncture therapy. The release doesn’t rely on sensational language. We do caution that when a news release includes a quote that says a study offers “hopeful signs for families,” it should be obvious why those families should be hopeful. This release doesn’t do that, because it is not clear how or whether these patients were better off at the end of the study than they were at the beginning. It’s not as egregious as releases (or news stories) that claim amazing results based on limited data, but no release (or news story) should leave readers no wiser at the end than they were at the beginning. Claim: New study from KKI shows feasibility of acupuncture in young children with ASD

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0


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Paragraph: On 10 June 2016, the Daily Beast reported that Sen. David Perdue urged attendees of the Faith & Freedom Coalition’s Road to Majority conference to pray for misfortune and death to befall President Barack Obama: At a major event for conservative Christians this morning, a Republican senator joked about praying for President Obama’s “days to be short.” Sen. David Perdue, a freshman senator from Georgia, opened his remarks at the Faith & Freedom Coalition’s Road to Majority conference by encouraging attendees to pray for President Obama. But, he added in a joking tone, they need to pray for him in a very specific way: “We should pray for him like Psalms 109:8 says: Let his days be few, and let another have his office,” the senator said, smiling wryly. The crowd chuckled and he moved on with his address. The rest of that passage, which Perdue did not recite, reads, “May his children be fatherless and his wife a widow. May his children be wandering beggars; may they be driven from their ruined homes.” The psalm is a pointed, lengthy death wish for one of David’s enemies. Video depicted Purdue’s 10 June 2016 remarks:  Psalms 109:8 (alternately named “Song of the Slandered”) was rendered in the manner below in the King James Bible: Hold not thy peace, O God of my praise; For the mouth of the wicked and the mouth of the deceitful are opened against me: they have spoken against me with a lying tongue. They compassed me about also with words of hatred; and fought against me without a cause. For my love they are my adversaries: but I give myself unto prayer. And they have rewarded me evil for good, and hatred for my love. Set thou a wicked man over him: and let Satan stand at his right hand. When he shall be judged, let him be condemned: and let his prayer become sin. Let his days be few; and let another take his office. Let his children be fatherless, and his wife a widow. Let his children be continually vagabonds, and beg: let them seek their bread also out of their desolate places. Let the extortioner catch all that he hath; and let the strangers spoil his labour. Let there be none to extend mercy unto him: neither let there be any to favour his fatherless children. Let his posterity be cut off; and in the generation following let their name be blotted out. Let the iniquity of his fathers be remembered with the LORD; and let not the sin of his mother be blotted out. Let them be before the LORD continually, that he may cut off the memory of them from the earth. As many pointed out, the Senator’s Biblical reference wasn’t a new or even uncommon scripture-based jab at President Obama. A 2009 article reported that the verse was traction across the internet as a veiled threat cloaked in the guise of prayerful intent: There’s a new slogan making its way onto car bumpers and across the Internet. It reads simply: “Pray for Obama: Psalm 109:8” A nice sentiment? Maybe not. The psalm reads, “Let his days be few; and let another take his office.” Presidential criticism through witty slogans is nothing new. Bumper stickers, t-shirts, and hats with “1/20/09” commemorated President Bush’s last day in office. But the verse immediately following the psalm referenced is a bit more ominous: “Let his children be fatherless, and his wife a widow.” The slogan comes at a time of heightened concern about antigovernment anger. Earlier this year, the president’s senior adviser, David Axelrod, said that Tea Parties could lead to something unhealthy. In September, authorities shut down a poll on Facebook asking if President Obama should be killed. Still, that doesn’t push the Psalms citation into the realm of hate speech, says Chris Hansen, a staff attorney with the American Civil Liberties Union (ACLU). That particular piece was published during President Obama’s first term in office. Some argued at the time that the reference to the verse simply expressed a hope that he not be re-elected to a second term: Deborah Lauter, director of civil rights at the Anti-Defamation League agrees that the bumper sticker falls within acceptable political discourse. “The problem is you don’t know if people who are donning that message in a shirt or on a bumper sticker are fully aware of the quote or what follows. Obviously that message makes the ambiguity disappear. If they’re just referring to him being out of office, that’s one thing. If they’re referring to him being dead, that’s so offensive. It’s protected speech, but it’s clearly offensive.” However, that motive ceased to be relevant after Obama’s 2012 re-election. A representative for the Senator provided a terse statement to a Bloomberg reporter about the controversy: David Perdue spokeswoman Caroline Vanvick responds in an email: “He in no way wishes harm towards our president” pic.twitter.com/PPj5jtZv0n — Sahil Kapur (@sahilkapur) June 10, 2016  The statement read: Senator Perdue said we are called to pray for our country, for our leaders, and for our president. He in no way wishes harm towards our president and everyone in the room understood that. However, we should add the media to our prayer list because they are pushing a narrative to create controversy and this is exactly what the American people are tired of. It is true Sen. David Perdue laughed and referenced Psalms 109:8 during a 10 June 2016 conservative Christian event. A representative for the Senator addressed the ensuing controversy, blaming the media for “pushing a narrative” for the outcry. Claim: Sen. David Perdue advised attendees to offer up an ominous prayer aimed at President Obama during the 2016 Faith & Freedom Coalition’s Road to Majority conference.

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2