Saturday, August 29, 2009
Republicans' rundown is a mix of false, true and misleading claims.
August 26, 2009
The Republican National Committee this week posted a “Health Care Bill of Rights for Seniors,” which RNC Chairman Michael Steele and others have taken to the airwaves to publicize. It contains a number of claims we’ve seen and criticized before, but also contains one new one that has some truth to it, and another fresh one that has very little.
• The RNC says that cuts proposed by Democrats "threaten millions of seniors with being forced from their current Medicare Advantage plans." That’s certainly possible. Ratcheting down payments to the private insurance plans in Medicare Advantage would likely cause them to reduce benefits or even withdraw from the market. That might force an unknown number of beneficiaries to find new plans or go back to the traditional system, which still covers 78 percent of the Medicare population.
• Another new wrinkle in the RNC’s "Bill of Rights" is a claim that Democrats have proposed raising TRICARE insurance costs for retired military and their families. This one is false. It was actually the Bush administration that most recently proposed changes in TRICARE, which the hospital industry said would cost hospitals $458 million in its first year.
The RNC "Bill of Rights" document also recycles claims that Democrats are proposing $500 million in Medicare cuts without mentioning that much of that is offset by proposed Medicare increases. It falsely says that a comparative effectiveness research panel set up earlier this year could limit care based on a patient’s age, when in fact the law expressly prohibits the council from issuing such mandates. And the RNC implies, wrongly, that seniors who meet with their doctors to discuss end-of-life care could have their treatment cut off involuntarily. In fact, these discussions would be voluntary and any directives limiting treatment would have to come from the patient.
At this particular point in the health care debate, we’re finding that there’s not much new under the sun when it comes to false claims being made about the overhaul proposals. But just in case pretty new packaging threatens to rope unwary citizens into believing some of these misrepresentations, we stand at the ready, and it is in that spirit that we tackle the Republican National Committee’s new "Health Care Bill of Rights for Seniors." RNC Chairman Michael Steele and others in his party have been touting the document all week; Steele penned an op-ed that ran in The Washington Post, and did interviews on National Public Radio, ABC’s Good Morning America, and Fox News Channel, among other outlets. Here’s what he said in the Post:
Steele, Washington Post, Aug. 24: The Democrats’ plan will hurt American families, small businesses and health-care providers by raising care costs, increasing the deficit, and not allowing patients to keep a doctor or insurance plan of their choice. Furthermore, under the Democrats’ plan, senior citizens will pay a steeper price and will have their treatment options reduced or rationed.
Republicans want reform that should, first, do no harm, especially to our seniors. That is why Republicans support a Seniors’ Health Care Bill of Rights, which we are introducing today, to ensure that our greatest generation will receive access to quality health care.
We’ll take the particulars of the "Health Care Bill of Rights" in the order they are presented.
RNC: PROTECT MEDICARE AND NOT CUT IT IN THE NAME OF HEALTH CARE REFORM: President Obama and Congressional Democrats are promoting a government-run health care experiment that will cut over $500 billion from Medicare to be used to pay for their plan. Medicare should not be raided to pay for another entitlement.
FactCheck.org: As we noted in our article More ‘Senior Scare,’ the bill that’s currently pending in the House would indeed "cut" $500 billion or so from Medicare, but it would also increase expenditures in some areas. The net amount that would be taken from the program would be about $219 billion, according to the Congressional Budget Office. That’s a 10-year figure, by the way. And any implication that seniors’ Medicare benefits would be cut is false. Rather, the bill calls for holding down payments to hospitals and other providers, other than physicians.
As we’ve noted before, Republicans are accusing Democrats of pretty much the same thing that Obama wrongly accused John McCain of doing last year, when the GOP nominee proposed to pay for part of his own health care measure with "savings" in Medicare. We called it a false scare tactic when Obama’s TV ads said benefit levels would be reduced. The RNC document doesn’t go quite that far, but fails to make clear that what Democrats are proposing isn’t a cut in benefits.
Government Boards and Rationing by Age?
RNC: PROHIBIT GOVERNMENT FROM GETTING BETWEEN SENIORS AND THEIR DOCTORS: The Democrats’ government-run health care experiment will give patients less power to control their own medical decisions, and create government boards that would decide what treatments would or wouldn’t be funded. Republicans believe in patient-centered reforms that put the priorities of seniors before government.
PROHIBIT EFFORTS TO RATION HEALTH CARE BASED ON AGE: The Democrats’ government-run health care experiment would set up a "comparative effectiveness research commission" where health care treatment decisions could be limited based on a patient’s age. Republicans believe that health care decisions are best left up to seniors and their doctors.
FactCheck.org: Both of these claims have their root in fundamental miscastings of the Federal Coordinating Council for Comparative Effectiveness Research, a body created by the economic stimulus bill signed into law in February. The council isn’t an "effort to ration health care based on age," nor would it get "between seniors and their doctors." As we’ve explained repeatedly, the council was created to monitor government research on the efficacy and cost-effectiveness of various treatments, and to help get the findings out to practitioners. But the stimulus legislation even specifies that no dictates would come from this body regarding coverage of or reimbursement for any treatments: "Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. … None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment." And just in case that wasn’t clear enough, the House Energy and Commerce Committee adopted an amendment to the House health care bill expressly prohibiting the comparative effectiveness research from being used to "deny or ration" care.
According to the RNC, the first claim also refers to something called the Independent Medicare Advisory Council, which the administration wants to create and imbue with the power to make an annual package of changes in what Medicare pays doctors. The President could only block them by rejectiing the entire package, and Congress could only do so by means of a congressional resolution. The idea is to take politics out of these decisions, which could indeed ease the way for unpopular cost-cutting measures and possibly for reductions in some future benefit levels. But IMAC is not a part of the pending bills.
Operative Word: Optional
RNC: PREVENT GOVERNMENT FROM INTERFERING WITH END-OF-LIFE CARE DISCUSSIONS: The Democrats’ government-run health care experiment would have seniors meet with a doctor to discuss end-of-life care that could mean limiting treatment. Republicans believe that government should not interfere with end-of-life care discussions between a patient and a doctor.
FactCheck.org: This is a somewhat milder version of the claim that was going around in a chain email that the Democrats wanted to require seniors to undergo counseling every five years on how to end their lives sooner. Former New York Lieutenant Gov. Betsy McCaughey furthered the myth, and in former Alaska Gov. Sarah Palin’s interpretation it took the form of so-called "death panels" that would decide whether elderly Americans are "worthy of care." We dealt with that in our piece False Euthanasia Claims as well as in Palin vs. Obama: Death Panels. It’s simply not true. What the bill would do is allow seniors to have counseling sessions on end-of-life care issues with their doctors, which Medicare would pay for once every five years. The sessions would be voluntary, and the discussions would only involve "limiting treatment" if that’s the sort of directive that a senior wanted to give, say, in a living will.
Medicare’s Private Plans
RNC: ENSURE SENIORS CAN KEEP THEIR CURRENT COVERAGE: As Democrats continue to propose steep cuts to Medicare in order to pay for their government-run health care experiment, these cuts threaten millions of seniors with being forced from their current Medicare Advantage plans. Republicans believe that seniors should not be targeted by a government-run health care bill and forced out of their current Medicare coverage.
FactCheck.org: The vast majority of Medicare recipients would see little change in their interactions with the health care system under the bills currently pending. But it’s probable that some unknown number of the 22 percent of seniors, or more than 10 million individuals, who participate in Medicare Advantage programs would indeed need to pay more out of pocket, change plans, or face reduced benefits – though never less than participants in traditional Medicare receive.
A little background: Medicare recipients since the 1970’s have been able to choose to receive their benefits through private health plans, rather than through the traditional, government-run, fee-for-service form of Medicare. Medicare Advantage is the most recent incarnation of this alternative. Republicans have generally favored these private options more than Democrats, and in 2003 the GOP Congress and president increased the amount Medicare paid to the plans to handle Medicare beneficiaries.
At this point, government payments to Medicare Advantage plans are 114 percent higher per enrollee, on average, than the cost of traditional fee-for-service in a given geographical area, according to the Kaiser Family Foundation. What do the plans do with the additional money? Often they use at least some of it to reduce premiums or cost-sharing for recipients. In some cases, though not all, seniors have been able to save money by signing up for a Medicare Advantage program.
But according to the Medicare Payment Advisory Committee, which is an an independent congressional agency, the additional spending for Medicare Advantage programs – which adds up to billions each year – is hastening the depletion of the Medicare trust fund. It has also meant higher premiums for all Medicare beneficiaries, according to the Government Accountability Office, another nonpartisan arm of Congress. As GAO put it, "beneficiaries covered under Medicare FFS
are subsidizing the additional benefits and lower costs that MA beneficiaries receive."
Long recognized as a possible source of savings – and mentioned as such by Obama during the presidential campaign – payments to Medicare Advantage programs under the House bill would be reduced over several years until they are equal to the costs of traditional Medicare. (Medicare payments are calculated by county). The measure would reduce the growth of future Medicare spending by $156 billion over 10 years. The result, based on prior experience with tinkering with the payment formulas, could be that some plans decide to withdraw from the Advantage program, said Brian Biles of George Washington University’s Department of Health Policy in a telephone interview, leaving them to choose from surviving Medicare Advantage plans or return to the traditional Medicare fee for service program that currently covers the other 78 percent of beneficiaries.
Riling the Vets, Too
RNC: PROTECT VETERANS BY PRESERVING TRICARE AND OTHER BENEFIT PROGRAMS FOR MILITARY FAMILIES: Democrats recently proposed raising veterans’ costs for the Tricare For Life program that many veterans rely on for treatment. Republicans oppose increasing the burden on our veterans and believe America should honor our promises to them.
FactCheck.org: The RNC tells us this refers to a budget proposal floated last spring by the Obama administration that would have allowed the Department of Veterans Affairs to bill vets’ private insurance companies for the cost of treating combat-related injuries. But as we noted earlier this year, the idea was quickly dropped and never made it into the president’s budget, due in part to protests from veterans. But more to the point, it had nothing to do with TRICARE, which is the Department of Defense health program covering active duty and retired military members and their families, or TRICARE for Life, which is for military retirees or family members who are 65 or over or otherwise eligible for Medicare.
In attempting to back up this claim, the RNC also cites a series of budget-cutting options issued by the nonpartisan Congressional Budget Office last January. The ideas included raising out-of-pocket costs and other fees for veterans in TRICARE. But that was just one of 115 ideas for cutting costs or otherwise changing federal health care programs, and CBO made clear that "the report makes no recommendations." The TRICARE isea does not appear in the pending health care overhaul bills.
And in fact, one of the news articles the RNC cites in support of this claim mentions that it was the Bush administration that most recently proposed TRICARE cuts, which were protested by many hospitals. The news item speculated that "Obama also might follow the lead of his predecessor" and seek higher TRICARE fees, but so far Obama has not done so.
–by Viveca Novak
U.S. House. "H.R. 3200."
Obama, Barack and Joe Biden. “Barack Obama and Joe Biden’s Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Care Coverage for All.” barackobama.com. Accessed 28 Aug 2009.
Philpott, Tom. “Obama Drops Vet Insurance Plan.” Military.com. 19 March 2009, accessed 28 Aug 2009.
Rucker, Philip. “Obama’s Turnabout on Vets Highlights Budgeting Nuances.” The Washington Post. 21 March 2009.
Morgan, Paulette. “Medicare Advantage.” Congressional Research Service. 3 March 2009.
Steele, Michael. “Protecting Our Seniors.” The Washington Post. 24 Aug 2009.
The Henry J. Kaiser Family Foundation. “Medicare Advantage.” April 2009.
Biles, Brian, Jonah Pozen and Stuart Guterman. “The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009.” The Commonwealth Fund Issue Brief. May 2009.
U.S. Government Accountability Office. “Medicare Advantage: Higher spending relative to Medicare fee-for-service may not ensure lower out-of-pocket costs for beneficiaries.” Statement of James Cosgrove. 28 Feb 2008.
Medicare Payment Advisory Commission. “Report to the Congress: Medicare Payment Policy.” March 2009.
Posted by Viveca Novak on Wednesday, August 26, 2009 at 10:43 pm
Filed under Articles • Tagged with health care, medicare, Republican National Committee, RNC
Great video in honor of a man who fought all of his life for health care for the least of us. If the measure of our country is indeed how we treat those who are less fortunate, then Senator Ted Kennedy is to be loved, respected and remembered for his consistent efforts in health care.
The neoconservatives worst nightmare: A Health Care Reform Bill that would honor the greatest fight for health care in American Senatorial History. This is a cause worth discussing, particularly since the Republican and Health Care Insurance Industry would prefer to make no changes whatsoever.
Friday, August 28, 2009
Twenty-six Lies About H.R. 3200
A notorious analysis of the House health care bill contains 48 claims. Twenty-six of them are false and the rest mostly misleading. Only four are true.
August 28, 2009
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Our inbox has been overrun with messages asking us to weigh in on a mammoth list of claims about the House health care bill. The chain e-mail purports to give "a few highlights" from the first half of the bill, but the list of 48 assertions is filled with falsehoods, exaggerations and misinterpretations. We examined each of the e-mail’s claims, finding 26 of them to be false and 18 to be misleading, only partly true or half true. Only four are accurate. A few of our "highlights":
* The e-mail claims that page 30 of the bill says that "a government committee will decide what treatments … you get," but that page refers to a "private-public advisory committee" that would "recommend" what minimum benefits would be included in basic, enhanced and premium insurance plans.
* The e-mail says that "non-US citizens, illegal or not, will be provided with free healthcare services" but points to a provision that prohibits discrimination in health care based on "personal characteristics." Another provision explicity forbids "federal payment for undocumented aliens."
* It says "[g]overnment will restrict enrollment of SPECIAL NEEDS individuals." This provision isn’t about children with learning disabilities; instead, it pertains to restricted enrollment in "special needs" plans, a category of Medicare Advantage plans. Enrollment is already restricted. The bill extends the ability to do that.
* It claims that a section about "Community-based Home Medical Services" means "more payoffs for ACORN." ACORN does not provide medical home services. The e-mail interprets any reference to the word "community" to be some kind of payoff for ACORN. That’s nonsense.
This chain e-mail claims to give a run-down of what’s in the House health care bill, H.R. 3200. Instead, it shows evidence of a reading comprehension problem on the part of the author. Some of our more enterprising readers have even taken it upon themselves to debunk a few of the assertions, sending us their notes and encouraging us to write about it. We applaud your fact-checking skills and your skepticism. And skepticism is warranted.
Chain e-mail: Subject: A few highlights from the first 500 pages of the Healthcare bill in congress Contact your Representatives and let them know how you feel about this. We, as a country, cannot afford another 1000 page bill to go through congress without being read. Another 500 pages to go. I have highlighted a few of the items that are down right unconstitutional. ⬐ Click to expand/collapse the full text ⬏
• Page 22: Mandates audits of all employers that self-insure! • Page 29: Admission: your health care will be rationed! • Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.• Page 58: Every person will be issued a National ID Healthcard. • Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer. • Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN) • Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange. • Page 84: All private healthcare plans must participate in the Health care Exchange (i.e., total government control of private plans) • Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens • Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan. • Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter. • Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed. • Page 127: The AMA sold doctors out: the government will set wages. • Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives. • Page 146: Employers MUST pay healthcare bills for part-time employees AND their families. • Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll • Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll • Page 167: Any individual who doesn’t’ have acceptable health care (according to the government) will be taxed 2.5% of income. • Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them). • Page 195: Officers and employees of Government Health care Bureaucracy will have access to ALL American financial and personal records. • Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that. • Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected." • Page 241: Doctors: no matter what specialty you have, you’ll all be paid the same (thanks, AMA!) • Page 253: Government sets value of doctors’ time, their professional judgment, etc. • Page 265: Government mandates and controls productivity for private healthcare industries. • Page 268: Government regulates rental and purchase of power-driven wheelchairs. • Page 272: Cancer patients: welcome to the wonderful world of rationing! • Page 280: Hospitals will be penalized for what the government deems preventable re-admissions. • Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government. • Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies! • Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval. • Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN. • Page 335: Government mandates establishment of outcome-based measures: i.e., rationing. • Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc. • Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals. • Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone). • Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia? • Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time. • Page 425: Government provides approved list of end-of-life resources, guiding you in death. • Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends. • Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT. • Page 430: Government will decide what level of treatments you may have at end-of-life. • Page 469: Community-based Home Medical Services: more payoffs for ACORN. • Page 472: Payments to Community-based organizations: more payoffs for ACORN. • Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage. • Page 494: Government will cover mental health services: defining, creating and rationing those services.
A few readers alerted us to the fact that a state representative in North Carolina, Rep. Curtis Blackwood, published a version of the e-mail in a newsletter to constituents, telling them that while going through e-mail, he came across "some interesting information on the Democrats’ big health care bill, H.R. 3200. … While this is federal legislation and not state, the topic is of enough significance that I thought many of you would be interested in reading it." We’d refer Rep. Blackwood to our special report on viral messages titled, "That Chain E-mail Your Friend Sent to You Is (Likely) Bogus. Seriously."
We can trace the origins of this collection of claims to a conservative blogger who issued his instant and mostly mistaken analyses as brief "tweets" sent via Twitter as he was paging through the 1,017-page bill. The claims have been embraced as true and posted on hundreds of Web sites, and forwarded in the form of chain e-mails countless times. But there’s hardly any truth in them. We’ll go through each of the claims in this message:
Claim: Page 22: Mandates audits of all employers that self-insure!
False: This section merely requires a study of “the large group insured and self-insured employer health care markets.” There’s no mention of auditing employers, only of studying “markets.” The purpose of the study is to produce “recommendations” to make sure the new law “does not provide incentives for small and mid-size employers to self-insure.”
Claim: Page 29: Admission: your health care will be rationed!
False: This section says nothing whatsoever about “rationing” or anything of the sort. Actually, it’s favorable to families and individuals, placing an annual cap on what they could pay out of pocket if covered by a basic, “essential benefits package.” The limits would be $5,000 for an individual, $10,000 for a family.
Claim: Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
False: Actually, the section starting on page 30 sets up a “private-public advisory committee” headed by the U.S. surgeon general and made up of mostly private sector “medical and other experts” selected by the president and the comptroller general. The advisory committee would have only the power “to recommend” what benefits are included in basic, enhanced and premium insurance plans. It would have no power to decide what treatments anybody will get. Its recommendations on benefits might or might not be adopted.
Claim: Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice. None.
False: The new Health Choices Commissioner will oversee a variety of choices to be offered through new insurance exchanges. The bill itself specifies the “minimum services to be covered” in a basic plan, including prescription drugs, mental health services, maternity and well-baby care and certain vaccines and preventive services (pages 27-28). We find nothing in the bill that prevents insurance companies from offering benefits that exceed the minimums. In fact, the legislation allows (page 84) any company that offers an approved basic plan to offer also an “enhanced” plan, a “premium” plan and even a “premium plus” plan that could include vision and dental benefits.
Claim: Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
False. That’s simply not what the bill says at all. This page includes "SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE," which says that "[e]xcept as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services." However, the bill does explicitly say that illegal immigrants can’t get any government money to pay for health care. Page 143 states: "Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States." And as we’ve said before, current law prohibits illegal immigrants from participating in government health care programs.
Claim: Page 58: Every person will be issued a National ID Healthcard.
False. There is no mention of any “National ID Healthcard” anywhere in the bill. Page 58 says that government standards for electronic medical transactions "may include utilization of a machine-readable health plan beneficiary identification card,” to show eligibility for services. Insurance companies typically issue such cards already, but if such a standard were issued the cards would need to be in a standard form readable by computers. The word “may” is used to permit such a standard, but it does not require one.
Claim: Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
False. This section aims to simplify electronic payments for health services, the same sort of electronic payments that already are common for such things as utility bills or mortgage payments. The bill calls for the secretary of Health and Human Services to set standards for electronic administrative transactions that would "enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice." There is no mention of "individual bank accounts" nor of any new government authority over them. Also, the section does not say that electronic payments from consumers is required.
Claim: Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
Misleading. Page 65 is the start of a section (SEC. 164. REINSURANCE PROGRAM FOR RETIREES) that would set up a new federal reinsurance plan to benefit retirees and spouses covered by any employer plan, not just those run by labor unions or nonprofit groups. Specifically, it covers “retirees and . . . spouses, surviving spouses and dependents of such retirees” who are covered by “employment-based plans” that provide health benefits. It’s open to any “group health benefits plan that . . . is maintained by one or more employers, former employers or employee associations,” as well as voluntary employees’ beneficiary associations (page 66). Furthermore, the aim of the fund is to cut premiums, copays and deductibles for the retirees. Payment “shall not be used to reduce the costs of an employer.”
Claim: Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
True. This page begins a section setting up a new, national Health Insurance Exchange through which individuals and employers may choose from a variety of private insurance plans, much like the system that now covers millions of federal workers. Any private insurance plans offered through this exchange must meet new federal standards. For example, such plans can’t deny coverage for preexisting medical conditions (page 19).
Claim: Page 84: All private healthcare plans must participate in the Health care Exchange (i.e., total government control of private plans)
Partly true. Nothing like this appears on page 84. No insurance company is required to sell plans through the exchange if it doesn’t want to. Any employer may choose to buy coverage elsewhere. In fact, the vast majority of employers will still be buying private plans through the normal marketplace, because only employers with 10 or fewer employees are even allowed to buy through the exchange in the first year. The limit rises to 20 employees in the second year. However, new plans sold directly to individuals will only be sold through the exchange. Individuals who currently buy their own coverage can keep those plans if they wish, and if the insurance company continues to offer them.
Claim: Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
Misleading. It’s true that page 91 says that insurance companies selling plans through the new exchange “shall provide for culturally and linguistically appropriate communication and health services.” The author’s “translation,” however, assumes that anyone speaking a foreign language or from another culture is an illegal immigrant, which is false.
Claim: Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
False: This page is the start of “SEC. 205. OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN.” It says a newly established Health Choices Commissioner “shall conduct outreach activities” to get people covered by private or government health insurance plans. The section says on page 97 that the Commissioner “may work with other appropriate entities to facilitate … provision of information.” But there is no authorization anywhere in the entire section for the Commissioner to pay money to any group to engage in outreach.
Claim: Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
Partly true. Page 102 says certain Medicaid-eligible persons will be “automatically enrolled” in Medicaid (which is the state-federal program to provide insurance to low-income workers and families) IF they are not already covered by private insurance. That would happen only if they had “not elected to enroll” in one of the private plans offered through the new insurance exchanges, however. So on paper at least, they would have a choice. Also, it’s estimated that one in four persons who lacks health insurance is already eligible for Medicaid or its offshoot, the state Children’s Health Insurance Program, but simply haven’t signed up or been enrolled by their parents.
Claim: Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed.
Half true. It’s true that page 124 forbids any review by the courts of rates the government would pay to doctors and hospitals under the new “public option” insurance plan. But there’s no mention of “price fixing” in the bill; that’s the e-mail author’s phrase. It also remains to be seen if the “public option” plan would grow to become a “government monopoly,” as the author predicts.
Claim: Page 127: The AMA sold doctors out: the government will set wages.
Misleading. Nothing in the bill would “set wages” for doctors in general. Page 127 says the government would ask doctors to accept below-market rates set by the government for their patients who are covered by a new “public health insurance option,” just as they now are asked to do so for patients covered by Medicare. Physicians would still be free to charge what they wish for other patients, and free not to accept patients covered by the new program just as they are now free to refuse Medicare patients. That’s not a choice many doctors make, however, so as a practical matter the government would be setting rates (not “wages”) for many patients. On the other hand, the new “public” plan is aimed mainly at covering people who have no insurance now and can afford to pay doctors little if anything.
Claim: Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
False. It’s true that employers would be required to sign up their workers for coverage automatically, but it doesn’t have to be the “public plan.” It would be the employer-offered plan “with the lowest applicable employee premium” (pages 147- 148). This would only be the "public option" if the employer was eligible to buy coverage through the Health Insurance Exchange (not likely, at least during the first two years when only small businesses would have access), and the "public option" was the cheapest plan (which would be likely). Furthermore, while the employer isn’t given an alternative, the workers are. They may reject auto-enrollment under an opt-out provision (page 148).
Claim: Page 146: Employers MUST pay healthcare bills for part-time employees AND their families.
Half true. There’s nothing in this section about part-time employees’ families, but this provision does call for employers to contribute toward part-time employees’ health insurance. The bill says that “for an employee who is not a full-time employee … the amount of the minimum employer contribution” will be a proportion of the minimum contribution for full-time employees. This proportion will depend on the average weekly hours of part-time employees compared with the minimum weekly hours required to be a full-time employee, as specified by the Health Choices Commissioner. (For a point of reference: The minimum contribution for individual plans of full-time employees is not less than 72.5 percent of the premium of the cheapest plan the employer offers.)
Claim: Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll Claim: Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll.
Both Partly True. The bill requires employers either to offer private health insurance coverage or pay a percentage of their payroll expenses to help finance a public plan. The 8 percent payment would indeed apply to employers with payrolls over $400,000 in the previous year, and lesser amounts would apply to smaller firms. Those with payrolls of $250,000 or less would pay nothing. But the penalty isn’t incurred if an employer "does not offer the public option," as the e-mail claims. Rather, it’s a penalty for not offering health insurance to employees.
Claim: Page 167: Any individual who doesn’t have acceptable health care (according to the government) will be taxed 2.5% of income.
True. This is the mechanism in the bill to enforce the individual mandate requiring everyone to have insurance. A person who doesn’t have insurance that meets minimum benefit standards (or other acceptable coverage, such as a plan that was grandfathered in) would pay a penalty of 2.5 percent of modified adjusted gross income for the year. The total penalty can’t exceed a national average premium for individual coverage, or family coverage if applicable.
Claim: Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
False. “Non-resident aliens” are generally those who have spent less than 31 days in the U.S. during the year. The claim that “Americans will pay for them” assumes that such visitors would somehow be getting federal benefits that would cost taxpayers money. In any case, they are not “exempt from individual taxes” at all. Under current law, the Internal Revenue Service says: “If you are a nonresident alien, you must file Form 1040NR (PDF) or Form 1040NR-EZ (PDF) if you are engaged in a trade or business in the United States, or have any other U.S. source income on which the tax was not fully paid by the amount withheld.” All that page 170 says is that non-resident aliens who don’t obtain health coverage don’t have to pay an additional 2.5 percent federal tax that would apply to U.S. workers who fail to get coverage, or to immigrants who are working here legally under green cards and who fail to obtain coverage. The tax is spelled out in subsection (a) starting on page 167.
Claim: Page 195: Officers and employees of Government Health care Bureaucracy will have access to ALL American financial and personal records.
False. This section of the bill discusses “Disclosures To Carry Out Health Insurance Exchange Subsidies.” It says that government employees of the health insurance exchange will have access to federal tax information for purposes of determining eligibility for affordability credits available for low- and moderate-income Americans. In other words, in order to qualify for a government subsidy to purchase health insurance, the government needs to confirm your income. And, no surprise, the government already has access to your federal tax information. The bill also says nothing about “ALL … financial and personal records.” Instead it says “Such return information shall be limited to—(i) taxpayer identity information with respect to such taxpayer, (ii) the filing status of such taxpayer, (iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)), (iv) the number of dependents of the taxpayer, (v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof).” The bill goes on to limit use of this information “only for the purposes of, and to the extent necessary in, establishing and verifying the appropriate amount of any affordability credit … and providing for the repayment of any such credit which was in excess of such appropriate amount.”
Claim: Page 203: “The tax imposed under this section shall not be treated as tax.” Yes, it really says that.
Misleading. What this actually says is: “The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55,” which deals with the Alternative Minimum Tax. It would limit the ripple effects of the new taxes the bill would impose on individuals making over $350,000 a year.
Claim: Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected. Claim: Page 241: Doctors: no matter what specialty you have, you’ll all be paid the same (thanks, AMA!)
Both False. Both of these claims pertain to Section 1121, which updates the physician fee schedule for 2010 for Medicare. It doesn’t "reduce physician services for Medicaid" (which wouldn’t pertain to seniors anyway); instead it modifies a section of the Social Security Act that defines physicians’ services. The section also doesn’t say that doctors will be paid the same “no matter what specialty you have.” Instead it sets up two categories of physician services with different growth rates for fees under those categories. As the Kaiser Family Foundation says of this section of the bill: "Allows the revised formula to be updated by the gross domestic product (GDP) plus 2% for evaluation and management services and GDP plus 1% for all other services." The measure will cost $228.5 billion over 10 years, according to the Congressional Budget Office and Joint Committee on Taxation.
Claim: Page 253: Government sets value of doctors’ time, their professional judgment, etc.
Misleading. It’s true that page 253 refers to “relative value units” to be used when determining payment rates for doctor’s services, and that such RVUs would weigh factors “such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk.” But this is nothing new; the government already uses RVUs when setting rates it will pay under Medicare. For example, the RVUs assigned to a colonoscopy are currently double the RVUs assigned to an intermediate office visit. In fact, page 253 is part of a section (Sec. 1122) that sets up a process for correcting existing but “potentially misvalued” rates.
Claim: Page 265: Government mandates and controls productivity for private healthcare industries.
Misleading. This claim doesn’t even make sense. How can anyone "mandate” that somebody else be productive, or “control” how productive they are? The author has simply misunderstood what this controversial item would do. In fact, page 265 is the start of a section (Sec. 1131) that is among several designed to slow future growth of Medicare payments to help offset the cost of the bill. It would require that “productivity improvements” be taken into account when setting annual “market basket” updates to Medicare rates for hospital-based services. The hospital industry has estimated this would translate into a 1.3 percent cut next year and a total of $150 billion in reduced payments over 10 years, and is opposed to it.
Claim: Page 268: Government regulates rental and purchase of power-driven wheelchairs.
Misleading. What page 268 does is to stop Medicare for paying for “mobility scooters,” which have been widely marketed as a Medicare-financed benefit, leading to ballooning costs to the program. They would no longer qualify as a “power-driven wheelchair.” Only a "complex rehabilitative power-driven wheel chair recognized by the Secretary” would be covered. The Congressional Budget Office estimates this will save the government $800 million over 10 years (see page 2).
Claim: Page 272: Cancer patients: welcome to the wonderful world of rationing!
False. This page merely calls for a study of whether a certain class of hospitals incur higher costs than some others for the cancer care they deliver. It also says the secretary of HHS “shall provide for an appropriate adjustment” in payments “to reflect those higher costs.” It’s hardly “rationing” to pay hospitals more to compensate for higher costs.
Claim: Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
True: This does say that “the Secretary shall reduce the payments” to hospitals with too many “potentially preventable” readmissions of patients that they previously had discharged.
Claim: Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
False. That section is part of a list of potential physician-centered approaches to reducing excess hospital readmissions. The bill states that the secretary of Health and Human Services will conduct a study on the best ways to enforce readmissions policies with physicians. One of the approaches the secretary must consider is the option to reduce payments to physicians whose treatment results in a hospital readmission. Another is the option to increase payments to physicians who check up on recently released patients. Neither of these approaches is mandated in the bill – what’s mandated is that the secretary consider them, among others.
Claim: Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
False. It’s already illegal, with certain exceptions, for doctors to refer Medicare patients to hospitals, labs, medical imaging facilities or other such medical businesses in which they hold a financial interest. Page 317 would modify an exception to that “self-referral prohibition” for rural providers, and says doctors can’t increase their stake in an exempt hospital after the bill becomes law.
Claim: Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
False. Expansion is forbidden only for rural, doctor-owned hospitals that have been given a waiver from the general prohibition on self-referral. It does not apply to hospitals in general. The bill provides for exceptions to even this limited expansion ban (page 321).
Claim: Page 321: Hospital expansion hinges on “community” input: in other words, yet another payoff for ACORN.
False. Page 321 says rural, doctor-owned hospitals that are exempt from the Medicaid self-referral prohibition can ask to be allowed to expand under rules that must allow “input” from “persons or entities in the community.” Under that language, anybody in the community could offer their opinion, but nobody – not ACORN or anybody else – would be paid for it.
Claim: Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
Misleading. This section does deal with establishing quality measures for Medicare. It does not make any recommendations for treatment, or empower anyone to make treatment recommendations based on those measures. The only effect of these outcome-based measures established in the bill would be ranking and potential disqualification of underperforming Medicare Advantage plans – that’s disqualification of the plans, not of any medical procedures.
Claim: Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
True. The bill allows for the possibility of disqualifying underperforming Medicare Advantage plans, which include Medicare HMOs. Medicare Advantage plans are private health plans that provide Medicare benefits. Under the bill, the secretary of Health and Human Services has the authority to disallow plans that are providing low-quality care under the new quality measures (which include evaluations of patient health, mortality, safety and quality of life). If a plan is disqualified, this will not leave seniors without care. The Kaiser Family Foundation reports that “virtually all” Medicare beneficiaries have access to at least two Medicare Advantage plans, and most have access to three or more. In 2008, 82 percent of beneficiaries had access to six or more private fee-for-service plans, one type of Medicare Advantage plan (along with HMOs, PPOs and medical spending accounts). Beneficiaries are also always free to return to the regular Medicare fee-for-service program.
Claim: Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
Misleading. Insurance companies already restrict enrollment in so-called “special needs” plans, a special category of Medicare Advantage plans that were created in 2003. Page 354 merely extends the authority to do that beyond the end of next year, when it was set to expire. Furthermore, what’s being restricted isn’t the number of patients, but the type of patients. Plans can be restricted to accepting only those patients who fall into in one or more special categories. These include those who are institutionalized (think, nursing homes), those who qualify both for Medicare and Medicaid (think, both low-income and over age 65) and those with severe or disabling chronic conditions such as diabetes, emphysema, chronic heart failure or dementia. And of course, this has nothing to do with children with learning problems.
Claim: Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
Misleading. The advisory committee would not be a “bureaucracy” or have any administrative functions, but instead would bring together experts from the private sector to give advice on how Medicare and Medicaid should treat the practice of medicine via telecommunication, something used in rural hospitals and such places as cruise ships, battlefield settings and even on NASA space missions. Pages 380-381 call for the committee to consist of five “practicing physicians,” two “practicing non-physician health care workers” and two “administrators of telehealth programs.”
Claim: Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia? Claim: Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time. Claim: Page 425: Government provides approved list of end-of-life resources, guiding you in death Claim: Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends. Claim: Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT. Claim: Page 430: Government will decide what level of treatments you may have at end-of-life.
All False. These six claims are a twisted interpretation of a provision in the bill that says Medicare will cover voluntary counseling sessions between seniors and their doctors to discuss end-of-life care. Medicare doesn’t pay for such sessions now; it would under the bill. End-of-life care discussions include talking about a living will, hospice care, designating a health care proxy and making decisions on what care you want to receive at the end of your life. Doctors do the consulting, not the "government" or a "bureaucracy." The e-mail author’s assertion that the bill calls for "an ORDER from the GOVERNMENT" for end-of-life plans rests on language about a patient drawing up such an order stipulating their wishes, and having that order signed by a physician. There’s nothing about "an order from the government." The bill defines an order for life-sustaining treatment as a document that "is signed and dated by a physician …[and] effectively communicates the individual’s preferences regarding life sustaining treatment." See our article "False Euthanasia Claims" for more on such assertions.
Claim: Page 469: Community-based Home Medical Services: more payoffs for ACORN.
False. This section defines the term "community-based medical home" as a "nonprofit community-based or State-based organization" that "provides beneficiaries with medical home services." ACORN does not provide medical home services. The section goes on to say such a medical service is one that "employs community health workers, including nurses or other non-physician practitioners, lay health workers, or other persons as determined appropriate by the Secretary, that assist the primary or principal care physician or nurse practitioner in chronic care management activities." The only thing ACORN has in common with that description is the word "community." It’s a community organization that offers services such as free tax preparation help and first-time home buyer counseling for low- and moderate-income people. It also works to register people to vote, and a few of its canvassers have been investigated for registration fraud, a point of concern during the presidential campaign.
Claim: Page 472: Payments to Community-based organizations: more payoffs for ACORN.
False. This section is referring to community-based medical homes.
Claim: Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
Half true. It’s true that pages 489 and 490 make state-licensed “marriage and family therapist” services a covered expense “for the diagnosis and treatment of mental illnesses.” But the therapists wouldn’t be employed by the government, and there’s no requirement for anybody to receive their help. So the claim that this would mean that “government intervenes in your marriage” is false.
Claim: Page 494: Government will cover mental health services: defining, creating and rationing those services.
Misleading. The provision amends Section 1861 of the Social Security Act laying out what services Medicare will cover. It expands coverage for mental health services, stipulating that a "mental health counselor" who can perform mental health counseling is someone with a master’s or doctorate degree, a state license, and two years of practice as a counselor. Is this the government "defining" mental health services? Well, it’s certainly the government defining what government programs will cover.
– by Brooks Jackson, Lori Robertson and Jess Henig, with D’Angelo Gore
Posted by Brooks Jackson, Jess Henig and Lori Robertson on Friday, August 28, 2009 at 11:55 am
Filed under Articles • Tagged with health care
The FactCheck Wire
Thursday, August 27, 2009
Tuesday, August 18, 2009
Good discussion about whether or not the bi-partisan discussion of Health Care Reform may or may not work. Check out Roger Simon's article on Politico. http://www.politico.com/news/stories/0809/26197.html. Is Reconciliation the best path to passing the Health Care Reform Act?
Discussion about the Public Option with Anthony Weiner, congressman from NY. I like this guy, he makes sense when he discusses the insurance model. Very intelligent distinction that the government wishes to change insurance companies, not the relationship that patients have with their doctors.
Discussion about the Public Option with Anthony Weiner, congressman from NY. I like this guy, he makes sense when he discusses the insurance model. Very intelligent distinction that the government wishes to change insurance companies, not the relationship that patients have with their doctors.
This is an important video. This is a discussion of a lobbying groups that are well-funded by neoconservative interests who use paid 'actors' to disrupt town halls and a genuine discussion about Health Care. These disruptors are not usually even residents of the district. Is this why the Republicans asked for more time to consider the bill in August? Things that make you go hmmmm?
Discussion about how the Republican will never support any form of Health Care Reform. Perhaps the President should give up on the bi-partisan input in the Health Care Reform Bill? When do we give up on negotiations?
Love Rachel. Armey is a guy that admits on the air that he is opposed to Social Security, Medicaid, and Medicare, too. Calls Medicare tyranny? Maybe seniors should be afraid of THIS guy. Check out the Ronald Reagan part of this vid too. Some old arguments, same old GOP. Let's scare everybody because we have nothing else to say.
The White House seems to be re-embracing the Public Option again. The question is whether it makes any sense to continue to negotiate with the Republicans who have taken the position that no matter what the bill contains, they will not support a Health Care Reform Bill solely on the basis of cost.
Discussion of why the public option is need in the Health Care Reform Bill. Today the White House seems to be backing off its statement that the Public Option did not need to be included in the final bill. The liberals have started to fight back!
Monday, August 17, 2009
This guy is a liar and a jerk. For the record, there is NO get rid of grandma provision in the bill!! It is a living will provision that enables people and the families to make plans ahead while compensating the family doctor for his time in giving advice. There is no such thing as a death squad!
The President fights back against the fake, staged protests at town halls. He expresses here that there is real concern for the Millions of people that do not have health care coverage. Some very good points are being made by the President at these events.
Thursday, August 13, 2009
A living will is an Advance Health Care Directive; a series of instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. A living will is one form of advance directive, leaving instructions for treatment. Here’s how it works: a person while he/she is still healthy, and while still in his/her right mind (usually in conjunction with writing a will), assert what he wants to happen in the event he/she becomes incapacitated and in unable to communicate his choices. This occurs frequently in near death or coma situations.
A patient would naturally communicate with his doctor to get his advice on the potential seriousness of his illness, disease, abnormality in order to make an informed choice as to what steps need to be taken or not taken in the event that due to a health problem you become incapacitated and cannot communicate your wishes. For example, I have Polycystic Kidney Disease. Suppose someday, it progresses to the point that I am on dialysis, suffering from kidney failure, and I am not able to tell my doctor or my family what my wishes are in terms of attempting to keep me alive or letting me go if it is highly unlikely that I can be saved. I can make that decision in advance of such an occurrence so my family is not left to guess what my wishes would be. I can decide if I want a DNR order to appear in my chart (Do Not Resuscitate) or if I want every necessary medical step possible taken to attempt to keep me alive.
This is hardily the equivalent of the old Viking Funeral where we place grandma on a wooden raft, light it on fire, and bid her farewell, as some prominent Republican/Conservative/Neoconservative pundits would have you believe. There is no plot to kill the elderly in the Health Reform Bill.
To actively lie, misrepresent and misstate the facts on such an important issue, like the Health Care Reform, is despicable. To scare, frighten, and terrorize the elderly or seniors who are already fighting for their lives in some cases, is unforgivable.