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Tag: Corrections and Updates

  • Trump omits full story about FEC response to New York case

    Trump omits full story about FEC response to New York case

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    Former President Donald Trump has repeatedly attacked Manhattan District Attorney Alvin Bragg, saying Bragg  brought forward the case against him after other investigative bodies passed.

    In remarks to reporters after court May 6, Trump also singled out the actions of the Federal Election Commission and the U.S. attorney’s office in New York’s southern district.

    “The FEC said they threw it away,” Trump said, referring to the Federal Elections Commission. “They said, ‘You’ve got to be kidding.’ Southern district didn’t bring the case. Nobody brought the case and then Alvin Bragg brought the case.”

    Trump said Bragg brought the case “when I am running and leading” in the polls. He said, “They all want to keep me off the campaign trail.”

    Trump omitted the full story about the FEC’s actions. The independent federal agency administers and enforces federal campaign finance law. Six commissioners lead it, no more than half of whom can belong to the same political party. 

    Trump is charged in Manhattan with 34 counts of falsifying business records in an alleged scheme to cover up a hush money payment to adult film actor Stormy Daniels before the 2016 presidential election. (Daniels’ real name is Stephanie Clifford.)

    FEC commissioners split their vote on general counsel’s recommendation

    Trump’s statement that the FEC “threw away” the case and replied “you’ve got to be kidding” could be interpreted to mean the agency tossed the case quickly. That’s not what happened. The complaints were filed with the agency early in 2018 and not closed until three years later.

    The FEC received complaints against Trump; his lawyer Michael Cohen, who handled the payoff to Daniels; Trump’s campaign; and a few other people and entities.

    The complaints alleged that Cohen, Trump and others violated the Federal Election Campaign Act, the federal law regulating political campaign fundraising and spending, at Trump’s direction to influence the 2016 election.

    In a 70-page report released in December 2020, the commission’s Office of General Counsel recommended that the commission find there was reason to believe that the contributions were illegal and went unreported.

    “The available information indicates that Michael Cohen paid Stephanie Clifford $130,000 … with Trump’s express promise of repayment, for the purpose of influencing the 2016 election” by preventing Clifford from publicizing the allegation, it said. 

    However, in February 2021, the FEC deadlocked on a 2-2 vote on whether Trump willfully violated federal law. The commission often deadlocks along partisan lines when it considers controversial cases. (In this case, the FEC was down from six commissioners to four. One commissioner, an independent, was absent; and one commissioner, a Republican, opted to recuse.)

    The Republican commissioners, Sean J. Cooksey and James E. Trainor III, didn’t address the charges’ validity. They argued Cohen’s guilty plea in federal court made the public record “complete,” and that “pursuing these matters further was not the best use of agency resources.”

    The Democratic commissioners, Shana M. Broussard and Ellen L. Weintraub, argued that the charges against Trump — that he “knowingly and willfully accepted contributions nearly 5,000% over the legal limit to suppress a negative story mere days before Election Day” — were “well-grounded.”

    Book raises questions about Trump administration pressure on federal prosecutors

    In his 2022 book, “Holding the Line,” former U.S. Attorney Geoffrey Berman described ways that he said the Trump administration interfered in political prosecutions. Trump appointed Berman to the New York’s southern district in 2018. Berman’s office prosecuted Cohen although Berman recused himself. 

    Berman’s office also investigated Trump lawyer and former New York Mayor Rudy Giuliani. News reports said there were tensions between the prosecutor’s office and the White House in 2020. In June 2020, Attorney General Bill Barr asked Berman to resign and Berman refused, leading Trump to fire him.

    Berman wrote that before Cohen pleaded guilty in federal court to charges connected to the Trump hush money case, a Justice Department official “badgered” Berman’s office “without success to remove all references to Individual 1, President Trump, from the charging document.”

    When Bill Barr took over as attorney general in February 2019, “he not only tried to kill the ongoing investigations, but — incredibly — suggested that Cohen’s conviction on campaign finance charges be reversed,” Berman wrote.

    Barr summoned a deputy in Berman’s office to challenge the basis of Cohen’s plea and “the reason behind pursuing similar campaign finance charges against other individuals,” Berman wrote.

    Instructions from Barr and his administration were explicit, Berman wrote: “Not a single investigative step could be taken, not a single document in our possession could be reviewed until the issue was resolved. … It certainly seemed clear that Barr did not want the Cohen case spiraling in new directions.”

    Another deputy in Berman’s office later persuaded Barr to continue the investigation. It did not result in charges. The New York Times’ article about the book in September 2022 said that spokespersons for Barr and Trump did not immediately respond to a request for comment.

    We asked a spokesperson for Trump’s campaign if he had any evidence for us to consider related to the allegations in Berman’s book about pressure from Barr and did not receive a response. 

    New York investigation into Trump has roots during his presidency

    Although Trump criticizes his trial’s timing, he omits numerous factors that caused the case to take years to reach the charging stage.

    The Manhattan investigation into Trump began in 2018, during Trump’s presidency. It was subject to many twists, turns and delays amid the coronavirus pandemic, the 2020 presidential election and prosecutorial turnover. 

    After Cohen pleaded guilty to federal charges in 2018, then-Manhattan District Attorney Cyrus Vance Jr. began investigating the payments, Politico reported.

    Federal prosecutors could not charge Trump then because Justice Department policy bars bringing criminal charges against a sitting president, Politico reported.

    After federal prosecutors concluded their investigation, Vance in August 2019 subpoenaed Trump’s personal and corporate tax records. Trump’s lawyers fought the subpoena, and the U.S. Supreme Court in July 2020 ruled in Vance’s favor.

    By the time Vance obtained the records, it was February 2021, early in Joe Biden’s presidency. Bragg was elected to replace Vance and took office in January 2022.  

    The next month, Carey Dunne and Mark Pomerantz, two prosecutors who were heading the investigation into Trump’s business dealings, resigned.

    Days later, Bragg’s office said a new prosecutor had been assigned to lead the case. 

    But even then it wasn’t clear whether Bragg was pursuing the case against Trump. In March 2022, The New York Times published Pomerantz’s resignation letter, in which he told Bragg that he disagreed with his decision not to prosecute Trump and take the case to a grand jury. 

    Bragg said in an April 7, 2022, statement that the investigation against Trump was continuing. The grand jury indicted Trump in March 2023 and Bragg announced the charges in April 2023.

    PolitiFact Senior Correspondent Louis Jacobson contributed to this article.

    CORRECTION, May 8, 2024: The Federal Election Commission’s general counsel reviewed complaints, issued a report and recommended the commission find reason to believe that Trump engaged in wrongdoing. An earlier version of this fact-check used less precise terms to describe this process. The story has been updated.

    RELATED: Trump says business records case about hush money is a “Biden trial.” It’s a Manhattan trial

    RELATED: A fact-checker’s guide to Trump’s first criminal trial: business records, hush money and a gag order

    RELATED: Read all of PolitiFact’s coverage on Donald Trump indictments

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  • PolitiFact – More gun ownership does not lead to less gun violence

    PolitiFact – More gun ownership does not lead to less gun violence

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    A map claiming to show levels of gun violence across the United States says that states with more guns have lower levels of gun violence. But data shows that states with more gun ownership have higher rates of firearm deaths. 

    Instagram users shared an image of the map with text that read, “97% of all guns are in the red territory. 97% of all gun violence is blue.” 

    Portions of the map appeared to be divided by counties, with most of the blue regions where 97% of gun violence is allegedly occuring in areas of Democratic-led states such as California, Hawaii, Maryland, Michigan, New York, Vermont, Virginia and Washington

    (Screenshot from Instagram)

    The red regions, which purport to show where “97% of all guns are,” were largely in Republican states such as Mississippi, Louisiana, Alaska, Arkansas and Tennessee. But some blue-marked counties were in Republican states such as Texas and Florida.

    This post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)

    The graphic did not cite what statistics were used to create the map. But the map is not related to gun violence statistics. As Lead Stories found, it was created by a Medium blogger to show the results by congressional district of the 2016 presidential election between Hilary Clinton and Donald Trump.

    David Hemenway, director of Harvard University’s Injury Control Research Center and a firearm injury prevention expert, said there is no data on the number of firearms in each county, as the map suggests. 

    Because most states do not require gun owners to register their firearms, firearm registrations do not signal how many guns are in each state, reports Giffords Law Center, a nonprofit promoting gun safety legislation created by former Rep. Gabby Giffords, D-Ariz., after she was shot during a 2011 mass shooting.  

    Charles Branas, director of Columbia University’s Center for Injury Science and Prevention and a member of the Regional Gun Violence Research Consortium, said because there is no data collected on county-based gun ownership across the U.S., researchers will use gun manufacturing data and gun-related suicide rates as proxies for gathering region-specific gun ownership data. 

    The map also does not specify the type of gun violence. Branas said gun deaths are separated into three basic categories: homicide, accidental death and suicide. 

    The Gun Violence Archive collects data on firearm injuries and fatalities. Its database shows that in 2024, there have so far been 18 firearm injuries and eight firearm deaths in Massachusetts and 151 gun injuries and 98 gun deaths in Louisiana. Massachusetts has a population of more than 7 million people, and Louisiana has a population of more than 4.5 million people according to U.S. Census data. 

    The Centers for Disease Control and Prevention, which publishes the most reliable statistics on gun deaths, shows that in 2022 Mississippi, Louisiana, New Mexico and Alabama were the states with the highest firearm death rates, and Massachusetts, Hawaii, New Jersey and New York had the lowest gun death rates. 

    Those statistics show the map’s claims are reversed, with states that it purports to have the lowest levels of gun violence having the highest levels of gun deaths.

    Branas said the map shared on social media “doesn’t coincide with anything else we’ve seen.” A report on U.S. gun violence in 2021 by the Johns Hopkins Center for Gun Violence Solutions found that states with the highest gun death rates “tend to be states in the South or Mountain West, with weaker gun laws and higher levels of gun ownership, while gun death rates are lower in the Northeast, where gun violence prevention laws are stronger.” 

    Cass Crifasi, co-director of Johns Hopkins Center for Gun Violence Solutions, echoed Branas’ assessment: “There is no evidence to support the claim that more guns equals less violence,” Crifasi told PolitiFact. “In fact, the opposite is true. In places with higher levels of gun ownership, we see higher rates of gun deaths.”

    Crifasi said several factors contribute to gun violence, with the biggest being easy access to guns. Gun violence is more prevalent in areas with social vulnerability, she said. 

    Hemenway pointed to multiple studies, some of which he authored, that show U.S. households with guns have a higher likelihood of homicides, accidental gun deaths and suicides than U.S. households without guns. 

    The map also appeared to show that regions with large populations have higher gun violence. PolitiFact previously found that if only gun homicides are examined, big cities do account for a disproportionate amount of gun deaths. 

    But Branas said there are more gun suicides than there are gun homicides annually in the U.S. “In the past 20 years there’s been such a growth in suicides, that the risk in our small towns of gun death broadly, mostly driven by gun suicides, is now higher than the risk of gun death in our big cities,” Branas said.

    A Harvard’s School of Public Health report looked state-by-state at the median percentage of households with guns and rates of suicides. It found that the three states with the highest gun prevalence, Wyoming, Montana and Alaska, were also in the top four states with the highest suidice rates. The report also found that the nine states with the lowest gun prevalance also had the lowest suicide rates. 

    None of the experts that PolitiFact consulted with had seen the data to which the map on Instagram referred. 

    We asked 97Percent, a nonprofit that connects gun owners and researchers to reduce gun deaths, to ask if it was familiar with the image and claim. Spokesperson Stephanie Cunnane said 97Percent had no connection to the map and called the graphic misleading, partly because it identifies Hawaii and Massachusetts as having high levels of gun violence although those states have the nation’s lowest gun violence rates.

    We rate the claim that states that have 97% of guns are the states with the least amount of gun violence False. 

    UPDATE, Feb. 27, 2024: This fact-check has been update to include information about the origin of the map image. The rating is unchanged.

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  • PolitiFact – A Nevada glitch does not equal mail ballot fraud

    PolitiFact – A Nevada glitch does not equal mail ballot fraud

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    A Nevada database glitch led to misinformation about the state’s Feb. 6 presidential preference primary and voter fraud.

    A Feb. 19 Instagram post shared a screenshot of an X post that says, “Commission on Federal Election Reform, chaired by former President Jimmy Carter found vote by mail to be ‘the largest source of potential voter fraud.’ The media will try to gaslight you into believing there are no issues with it but they are misleading the American people.”

    The X post shared a link to a Las Vegas Review-Journal article, and text with the article link said, “Numerous Nevada voters looked at their voter history and found that their mail ballots were counted in the recent primary, even though they didn’t participate in it.” 

    (Screengrab from Instagram)

    The Instagram post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)

    The full Review-Journal article explained that a database coding glitch occurred but did not affect election results. 

    In Nevada, all voters receive mail ballots for each election they are qualified to participate in, unless a voter opts out. A majority of voters in Nevada cast ballots by mail.

    The Instagram post linked the recent Nevada database glitch to voter fraud, but Nevada election officials said the two are unrelated.  

    “I want to be clear that this issue had nothing to do with the tabulation of votes or results of any election,” Secretary of State Francisco V. Aguilar, a Democrat, said in a Feb. 22 statement. “There is no evidence of widespread voter fraud in our state, now or ever.”

    Republican Gov. Joe Lombardo, posted Feb. 19 on X, “The voter history glitch on the website does not impact vote tabulation, which happens at the county level,” and shared a link to an article with that information. 

    Both the Instagram post and the X post it shared were from Sean Parnell, a former Pennsylvania U.S. Senate candidate who was endorsed by former President Donald Trump before dropping out in 2021. Parnell is a U.S. Army veteran who hosts a podcast.

    We asked Parnell to send us evidence that voter fraud occurred in Nevada. He replied in an email that the point of his Instagram post was that “mail in voting is not the best way to conduct an election. It is also not the best way to build confidence in the electorate, the latest issue in Nevada is just one recent example.” (Parnell’s full response is linked at the end of this story.)

    Other people echoed Parnell’s claim. Elizabeth Helgelien, a Nevada Republican congressional candidate, said in a Feb. 18 X post that her online voter history showed she voted in the primary, although she did not. Helgelien said “voter fraud” appears to be happening in Nevada. 

    Nevada secretary of state’s office said glitch occurred 

    Nevada held its presidential preference primary Feb. 6. President Joe Biden won the Democratic primary while “none of these candidates” received the most votes in the Republican primary — more than former South Carolina Gov. Nikki Haley. Former President Donald Trump did not appear on the ballot because he competed in the caucus instead.

    About two weeks after the primary, voters notified the secretary of state’s office that, although they did not participate in the primary, the state’s website showed in their vote history that they had cast mail ballots.

    The secretary of state’s office said in a Feb. 21 memo that a miscommunication in computer code caused the glitch, “based on the state and counties interpreting the same data in different ways.” 

    Nevada has a “bottom-up” voter registration system in which counties send copies of their voter registration files to the state nightly via a secure upload. The state then stitches together 17 files from different systems and combines them into a statewide file.

    The counties use the mail ballot code “MB.” Until the 10th day after an election, the state database interprets “MB” to mean that a mail ballot has been sent to a voter. After the 10th day, the system interprets the “MB” code to mean the mail ballot was counted.

    In prior elections, counties took steps to ensure that this code was applied only to ballots of people who had voted. But some of those steps did not happen after the Feb. 6 presidential preference primary, the memo said.

    The coding issue didn’t affect the election results, the memo said. 

    Bottom-up systems have not been considered a best practice for decades, and the state will move to a new “top-down” system before this June’s primary election, in accordance with a 2021 law passed by the Legislature. 

    Voter fraud occasionally occurs, but on a very small scale and not enough to change the outcome in a presidential election. After Biden won Nevada in the 2020 presidential election, the state’s Republican party shared a story about a Republican voter, Donald Kirk Hartle, who claimed someone cast a mail ballot in his dead wife’s name. Hartle himself later pleaded guilty to one count of voting more than once in an election, because he had cast the ballot in his dead wife’s name. 

    The Heritage Foundation’s database of voter fraud shows only one other Nevada voter fraud conviction since 2020. Craig Frank was convicted in 2021 after voting in both Nevada and Arkansas during the 2016 general election.

    Parnell also sent us a 2012 New York Times article that said, “While fraud in voting by mail is far less common than innocent errors, it is vastly more prevalent than the in-person voting fraud that has attracted far more attention, election administrators say.” The article included anecdotal examples including a woman in Hialeah, Florida, who was charged with forging an elderly voter’s signature and possessing 31 completed absentee ballots, more than allowed under local law.

    Election website glitches or clerical errors occasionally have happened in other jurisdictions. But these problems are typically from human error, and do not signal fraud.

    Instagram post cherry picks one sentence from 2005 report

    The Instagram post says that the “Commission on Federal Election Reform, chaired by former President Jimmy Carter found vote by mail to be ‘the largest source of potential voter fraud.’” 

    Republican critics of voting by mail, including Trump, pluck one sentence from a 2005 report Carter co-wrote that said, “absentee ballots remain the largest source of potential voter fraud.”

    Although the nearly 20-year-old report generally communicated a dim view of absentee voting, it didn’t call for its elimination. Instead, it recommended ways to improve security and called for further research. 

    Since then, security improvements have been implemented, including:

    • Some states have passed laws to limit who can return a mail ballot on behalf of another voter.

    • States have added technologies so voters can track their own mail ballots. 

    • Many states are part of a consortium to share voter registration data to flag outdated registrations, reducing the chance that a mail ballot is sent to someone who has died or who is no longer eligible to vote at that address.

    In 2020 and 2021, Carter defended the use of voting by mail. He said that given advances in the process, he believed it could be conducted “in a manner that ensures election integrity.” Carter said he had cast mail ballots for years.

    Our ruling

    An Instagram post said a Nevada database glitch showing voters cast ballots when they didn’t is evidence that voting by mail is “the largest source of potential voter fraud.”

    A database coding glitch issue meant that some Nevada voters saw an inaccurate vote history online — showing their mail ballots as counted even if the voters did not vote —   after the Feb. 6 presidential preference primary. The Nevada secretary of state said the glitch was unconnected to vote tabulation and did not affect the election results.  

    The post’s quote comes from a report Carter co-wrote in 2005 that highlighted mail voting’s vulnerabilities but did not call for its elimination. Since then, security improvements to voting by mail have been implemented. 

    Carter has since said that voting-by-mail safeguards have advanced, that mail-in-voting can be done safely and that he votes by mail himself.

    We rate this statement False. 

    CORRECTION, Feb. 24: An earlier version of this story said Parrnell did not reply to our request for comment. Parnell did reply via email but in an error on our part, we did not see his response before publication. We updated the fact-check with his comments, and you can read his full response here. We regret the error.

    RELATED: Ask PolitiFact: What steps do election officials take to prevent fraud?

     

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  • PolitiFact – Fact-checking 3 claims in Tucker Carlson’s show on trans health care

    PolitiFact – Fact-checking 3 claims in Tucker Carlson’s show on trans health care

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    Since his firing from Fox News, former primetime host Tucker Carlson has taken his show on the digital road — to X, where he has interviewed public figures such as former President Donald Trump and independent presidential candidate Robert F. Kennedy Jr. 

    On Oct. 4, Carlson released an episode titled “Trans, Inc” that focused on gender-affirming health care provided to transgender people.

    “Genital mutilation is not just a fad. It’s a full-blown industry,” read the caption on Carlson’s X post sharing the episode. The 48-minute video criticized aspects of transgender health care, such as hormones, surgery and social affirmation. It describes “transgenderism” as “unnatural” and “demented,” comparing it with “human sacrifice.” Carlson could not be reached for comment. 

    In the video, Carlson interviewed Chris Mortiz, whom Carlson introduced as a “policy guy” who has “taken a close forensic look at where the money is coming from.” From his limited online presence, we found that Moritz has worked as a lawyer, investment banker and consultant. Mortiz did not respond to our requests for comment. 

    The video included some claims we have fact-checked before. But here are three new assertions involving hormone treatments, gender-affirming surgeries and the trans health care market. 

    Moritz: “With respect to the transgender pharmaceuticals, there are no long-term studies, peer-reviewed, that show the efficacy or not of taking these very powerful pharmaceuticals.”

    Moritz’s description of a total lack of research is inaccurate. The Endocrine Society’s Clinical Practice Guidelines state, “Prior to 1975, few peer-reviewed articles were published concerning endocrine treatment of transgender persons. Since then, more than two thousand articles about various aspects of transgender care have appeared.”

    PolitiFact found several published and peer-reviewed studies examining the long-term effects and efficacy of cross-sex hormone treatment on bone health, cardiovascular risk, mortality, psychosocial functioning and more. There is enough research that we found systematic reviews — analyses of large numbers of individual research studies —  on specific aspects of treatment like bone health.

    Although adolescent treatment for gender dysphoria started only in the late 1990s, transgender adults have received hormonal treatment and sex reassignment surgery since the early 1970s. 

    Additionally, people who aren’t transgender, including men with low testosterone and women in menopause, sometimes rely on hormone therapy. 

    “Hormone therapy for transgender males and females confers many of the same risks associated with sex hormone replacement therapy in nontransgender persons,” the Endocrine Society’s Clinical Practice Guidelines say. 

    The guideline outlines safe dosages and provides guidance for how physicians should monitor for potential adverse effects.

    Carlson: “I haven’t heard anybody mention female genital mutilation in the United States in quite some time now. Is that because we now officially engage in it?” 

    Female genital mutilation is a nonconsensual procedure that can include the partial or total removal of the clitoris, labia minora or the narrowing of the vaginal opening. The World Health Organization said it is mostly forced on girls younger than 15. More than 200 million women have been affected in 30 countries in Africa, Asia and the Middle East.

    The procedure aims to reduce or eliminate sexual function and pleasure. It is widely considered a human rights violation.

    Dr. Marci Bowers, a gynecological surgeon who does gender-affirming genital surgeries and restorative surgeries for female genital mutilation survivors, told PolitiFact that gender-affirming surgeries do not amount to genital mutilation — the two are entirely different.

    “Transgender surgery is done with full consent of the individual,” Bowers said.

    Female genital mutilation is usually forced on girls younger than 15 in nonmedical and unsterile conditions. Gender-affirming surgeries, however, are performed in hospitals by trained professionals, and are rarely performed on people younger than 18, said Bowers, president of the World Professional Association for Transgender Health. When gender-affirming surgery is performed on minors, it is “only under the most severe conditions of gender dysphoria,” she said.

    Bowers also noted the difference in how the two procedures affect women’s sexual functionality — such as the ability to have sensation or orgasm. Gender-affirming surgeries “are generally quite elegant surgeries that leave the individual fully functional versus (female genital mutilation), which robs a woman of functionality,” she said.

    Mariya Taher, co-founder of Sahiyo, an organization working in Asia to end female genital mutilation, agreed with Bowers. Taher told PolitiFact her organization “strongly” believes that gender-affirming health care does not equate to genital mutilation.

    “We are saddened to see the two issues are being conflated” and that female genital mutilation “is being used as a guise to target and harm trans youth and gender-diverse individuals” Taher said.

    Additionally, representatives from the End FGM network in both the U.S. and Europe told PolitiFact that female genital mutilation and gender-affirming surgeries are not the same.

    Moritz: “The combined value sales of sex reassignment surgeries and pharmaceutical products in 2018 was $2.94 billion. By 2022, that figure had rose to $4.18 billion.” 

    We are unsure how Moritz arrived at those numbers; he offered no evidence backing them up and did not answer our inquiries. 

    We found a few publicly available market research reports, which are often commissioned by investors deciding whether to invest in a given industry. But it is difficult to assess the reliability of these reports without knowing the methodology behind them, and estimates can vary widely, said experts.

    Carlson made a broader assertion that profits are driving transgender health care: “Transgenderism, it didn’t happen by accident,” he said. “Some people are profiting from it.”  

    None of the 2022 reports we found for the U.S. market added up to $4.18 billion, but some got close. Grand View Research, for example, values the U.S. sex reassignment hormone therapy market at $1.6 billion and the U.S. sex reassignment surgical market at $2.1 billion in 2022. 

    These values can be calculated using a combination of insurance data, federal and state data, and information directly from medical providers, explained Stephen Parente, professor of finance at the University of Minnesota Carlson School of Management. But for procedures not reimbursed by insurance, getting accurate estimates might prove more challenging. Coverage of health care services for transgender people can differ by state and health plan, according to HealthCare.gov.

    “Most types of health care, including gender affirming care, involve multiple types of providers of goods and services — e.g., drugs, visits, procedures, hospital stays, etc.” said Melinda Buntin, health economist and professor at Johns Hopkins Bloomberg School of Public Health. “For this reason, it is hard to assess how much is spent on specific categories of care in sum.”

    The market size can vary depending on what is included in a given estimate, said Supriya Munshaw, associate professor at Johns Hopkins Carey School of Business. Is it just surgery or is the hospital stay included? What about complications? How do they determine what mastectomies are gender-affirming and which are done for breast cancer?

    “How are you actually calculating the number?” said Munshaw. “It might differ in different research reports.”

    The U.S. health care market is large to begin with, totaling $4.3 trillion in 2021, according to federal data on national health expenditures. A market of billions is a “sizable market” from an investment perspective, Munshaw said, but “it doesn’t mean that if something is profitable that the healthcare industry is pushing it.”

    PolitiFact Researcher Caryn Baird contributed to this report.

    CORRECTION, Nov. 15, 2023: Melinda Buntin is health economist and professor at Johns Hopkins Bloomberg School of Public Health. Her name was misspelled in an earlier version of this story.

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