nickname, saying, "I have no problem with people saying Obama cares. I do care." Common misconceptions "Death panels" On August 7, 2009, Sarah Palin pioneered the term "death panels" to describe groups that would decide whether sick patients were "worthy" of medical care. "Death panel" referred to two claims about early drafts. One was that under the law, seniors could be denied care due to their age and the other that the government would advise seniors to end their lives instead of receiving care. The ostensible basis of these claims was the provision for an Independent Payment Advisory Board (IPAB). IPAB was given the authority to recommend cost-saving changes to Medicare by facilitating the adoption of cost-effective treatments and cost-recovering measures when statutory expenditure levels were exceeded within any given 3-year period. In fact, the Board was prohibited from recommending changes that would reduce payments before 2020, and was prohibited from recommending changes in premiums, benefits, eligibility and taxes, or other changes that would result in rationing. The other related issue concerned advance-care planning consultation: a section of the House reform proposal would have reimbursed physicians for providing patient-requested consultations for Medicare recipients on end-of-life health planning (which is covered by many private plans), enabling patients to specify, on request, the kind of care they wished to receive. The provision was not included in PPACA. In 2010, the Pew Research Center reported that 85% of Americans were familiar with the claim, and 30% believed it was true, backed by three contemporaneous polls. The allegation was named PolitiFact's "Lie of the Year", one of FactCheck.org's "whoppers" and the most outrageous term by the American Dialect Society. AARP described such rumors as "rife with gross—and even cruel—distortions". Members of Congress PPACA requires members of Congress and their staffs to obtain health insurance either through an exchange or some other program approved by the law (such as Medicare), instead of using the insurance offered to federal employees (the Federal Employees Health Benefits Program). Illegal immigrants PPACA explicitly denies insurance subsidies to "unauthorized (illegal) aliens". Exchange "death spiral" Opponents claimed that combining immediate coverage with no provision for pre-existing conditions would lead people to wait to get insured until they got sick. They individual mandate was designed to push people to get insured without waiting. This been called a "death spiral." In the years after 2013, many insurers did leave specific marketplaces, claiming that the risk pools were too small. The median number of insurers per state was 4.0 in 2014, 5.0 in 2015, 4.0 in 2016 and 3.0 in 2017. Five states had one insurer in 2017; 13 had two; 11 had three; and the remainder had four or more. "If you like your plan" At various times during and after PPACA debate, Obama stated that "if you like your health care plan, you'll be able to keep your health care plan". However, in fall 2013 millions of Americans with individual policies received notices that their insurance plans were terminated, and several million more risked seeing their current plans cancelled. Poltifact cited various estimates that only about 2% of the total insured population (4 million out of 262 million) received such notices. Obama's previous unambiguous assurance that consumers' could keep their own plans became a focal point for critics, who challenged his truthfulness. Various bills were introduced in Congress to allow people to keep their plans. Politifact later scored Obama's claims as the "Lie of the Year". Criticism and opposition Opposition and efforts to repeal the legislation have drawn support from sources that include labor unions, conservative advocacy groups, Republicans, small business organizations