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Indianapolis, Indiana
United States
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"What we do, we do for all." -- AARP Founder Ethel Percy Andrus
"What we do, we do for all." -- AARP Founder Ethel Percy Andrus
Seven Deadly Myths of Health Care ReformMore Myths and Facts About Health Reform
Myths and misinformation continue to swirl around HR 3200, the chief health reform proposal now pending in the U.S. House of Representatives.
AARP has not endorsed this bill nor any other specific bill now pending in Congress. We do, however, support various elements of various proposals that we believe will advance our members' interest in quality, affordable health care options.
We also think it's important to separate myth from fact about some of those proposals, including these specific claims that have been made about HR 3200.
This is a somewhat long document, but we are confident it will bring important information to the forefront of our country's crucial national debate around health care reform.
Claim:
Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL
EMPLOYERS THAT SELF-INSURE!!
Response: FALSE.
The bill does not require the
government to audit the books of all employers that
self-insure. The bill simply requires that the government study
the health care market for large employers. The purpose of the
study is to learn more about:
- How employers who self-insure and who buy insurance are alike and differ.
- Whether self-insuring employers have sufficient funds to pay their health care obligations.
- Whether rate regulations cause some employers to buy insurance and others to self-insure.
The results of the study are
to be presented to Congress, along with any recommended changes,
within 18 months of the bill passing, and then again 18 months after
all the new regulations have taken effect. This will help
Congress learn how the reforms are working and if they need to make
any changes.
Claim:
Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that
decides what treatments/ benefits you get
Response: FALSE.
A government-appointed
advisory committee will recommend what essential benefits health
insurance should include for plans offered through the proposed health
insurance exchange, and what cost sharing should include. This
committee will not influence what benefits are offered by
grandfathered insurance plans outside the exchange. The committee is
not in charge of deciding what specific treatments are covered.
The committee will be made up
of representatives of the following groups: doctors and other health
care providers, consumers, employers, labor groups, insurers, and
experts on disability, children’s health, racial and other
disparities, and health financing. Public input is required as
the committee develops its recommendations. And as medical
care improves, the committee will be able to recommend benefit changes
to keep up with developments.
Claim:
Pg 354 Sec 1177 - Govt WILL RESTRICT ENROLLMENT of Special needs
people
Response: FALSE.
Special Needs Plans (SNPs) are
managed-care plans added to Medicare in 2003. Under current law,
a SNP may restrict enrollment to specified groups of Medicare
beneficiaries believed to benefit from specialty care tailored to
their group characteristics. But Congress has had doubts about whether
these plans were improving care for enrollees, so a law passed in 2008
would have ended the SNP program on December 31, 2009.
In fact, Section 1177 of the
House bill would give SNPs more time to prove themselves by extending
them from 2 to 5 more years, 2011 to 2014, depending on the type of
plan. This provision in no way affects the ability of people with
special needs to continue their traditional Medicare enrollment or
enrollment in regular Medicare Advantage plans.
Claim:
Pg 42 of HC Bill - The Health Choices Commissioner will choose
your HC Benefits for you.
Response: FALSE.
Just as state insurance
departments today see that health plans satisfy state insurance laws,
the federal Health Choices Commissioner would work with state
insurance departments and other federal agencies to make sure that
qualified health plans meet any new standards. The Commissioner
will also be responsible for seeing that Health Insurance Exchanges
are up and running to offer people without access to employer-provided
coverage a choice of qualified health plans, and for getting people
who qualify for help the credits available under the bill to make
premiums and cost sharing more affordable.
Claim:
PG 50 Section 152 in HC bill - HC WILL BE PROVIDED TO ALL NON-US
CITIZENS, illegal or otherwise
Response: FALSE.
People in this country
illegally would not be eligible for coverage and subsidies under the
new health insurance program (see p.143).
This section says nothing
about immigrants, legal or otherwise. Rather, it would ban
discrimination in health plans and health care based on personal
characteristics, such as gender, ethnicity, race, and disability.
Claim:
Pg 170 Lines 1-3 HC Bill- ALL NON-RESIDENT ALIENS will be exempt
from individual taxes. (Resident Americans will pay)
Response: TRUE.
Indeed, non-resident aliens
would not be required to pay the tax – but they would not be
eligible to receive health care subsidies or join the exchange either.
Claim:
Pg 58 HC Bill - Govt will have real-time access to individuals
finances & a National ID Healthcard will be issued
Response: FALSE.
This section of the proposed
legislation has nothing to do with individual personal finances or
with a National Health Identification card. In fact, in a search
of all 1,018 pages of the legislation, there is not one mention of any
such card, nor are there any sections that would permit expanded
government access to your personal financial records. (Keep in mind
that the Internal Revenue Service already has access to taxpayer
data.) This proposed section would set standards for electronic health
records – and it sets privacy standards to protect personal information.
Claim:
Pg 59 HC Bill lines 21-24 Govt will have direct access to your
bank accounts for electronic funds transfer, no choice
Response: FALSE.
Again, this proposed section
would set standards for electronic health records – and it sets
privacy standards to protect personal information.
Claim:
Pg 72 Lines 8-14 Govt is creating an HC EXCHANGE to bring private
HC plans under Govt control.
Response: FALSE.
A Health Care Exchange is
being proposed to make it easier for individuals and small businesses
to have access to a number of qualified health insurance
plans. The Exchange would contract with plans that meet benefit
standards in the same way that the federal government’s Office
of Personnel Management contracts with the health insurance providers
offered to members of Congress and federal employees. Similarly,
the Exchanges will provide central place where people eligible for
affordability credits can shop for coverage.
Claim:
PG 84 Sec 203 HC bill - Govt mandates ALL benefit pkgs for private
HC plans in the Exchange
Response: TRUE.
The bill would set broad
levels of benefit packages that private plans should offer in the
Exchange. The broad categories of benefits specified in the law
are like those for federal employees, and there are three different
levels of generosity so that people can choose the plan that meets
their needs. While the law sets certain aspects of the benefit
packages, insurers are allowed to vary within the rules, much as they
can under Medicare’s contracts with health plans for Medicare
Advantage and for the Medicare prescription drug program. This
has successfully spurred competition among providers that benefits consumers.
Claim:
PG 85 Line 7 HC Bill - Specs. for of Benefit Levels for Plans
Response: TRUE – see response above.
This section defines three
broad levels of generosity of benefit packages. As noted above,
there is room within these broad levels for private plans to vary the packages.
Claim:
Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN
& Americorps to sign up individuals for Govt HC plan
Response: PARTLY TRUE.
This section of the proposed
legislation talks in very broad terms about conducting outreach
activities to inform people about the important health insurance
benefits that they may be eligible for and help them to sign
up. But the section does not identify any specific organizations.
Experience shows that, when
any new program is launched, outreach is essential to let people know
about it and manage the required paperwork. For example, when the
Medicare prescription drug benefit began, the government worked with a
wide range of community groups, religious institutions and other
organizations to get the word out.
Claim:
pg 124 lines 24-25 HC No company can sue Government on price
fixing. No "judicial review" against Government Monopoly
Response: TRUE BUT…
Providers that choose to
participate in the proposed Exchange would not be able to
seek administrative or judicial review of the payment rates or
methodologies established under the plan. This is consistent with
long-standing practices in Medicare and in private insurance generally.
Claim:
pg 127 Lines 1-16 HC Bill -DOCTORS/ AMA - The Govt will tell you
what your salary will be.
Response: FALSE.
The government would not
employ physicians in the Exchange, so it would not set
salaries. The Secretary of Health and Human Services would set
the amount it will pay for different services that doctors who
participate in the public plan provide. This is the same way the
Medicare and private insurance plans now operate.
Claim:
Pg 145 Line 15-17 An Employers MUST auto enroll employees into
public option plan. NO CHOICE
Response: FALSE.
In fact, this section does not
even deal with a public option plan. This section seeks to encourage
automatic enrollment of workers in employer-sponsored health insurance
plans. But the provision makes it clear that the employer must provide
the worker with a 30-day period to choose whether to enroll or not enroll.
Claim:
Pg 146 Lines 22-25 Employers MUST pay for HC for part time
employees AND their families.
Response: PARTLY TRUE.
This section states that
employers must make some minimum contribution towards premiums for
employees who work less than full-time. This minimum contribution will
be a share of the contribution the employer makes for full-time
employees, based on the average number of hours worked weekly compared
to full-time status.
Claim:
Pg 150 Lines 16-24 ANY Employer with payroll 400k & above, who
does not provide public option, pays 8% tax on all payroll
Response: PARTLY TRUE.
This proposed section does not
refer to the public option plan. It states that employers with an
annual payroll of $400,000 or more who choose not to offer any
coverage to their employees will pay an 8% payroll tax. And amendments
have been proposed to raise this threshold to $750,000.
Claim:
pg 150 Lines 9-13 Businesses with payroll btw 251k & 400k who
doesn't provide public option pays 2-6% tax on all payroll
Response: TRUE.
Employers with annual payrolls
between $251,000 and $400,000 that don’t offer health coverage
and don’t make a contribution to the premium of their employees
will have to pay a payroll tax of 2 to 6%, to help the government pay
for health coverage. The amount of the tax rises as the total
payroll rises.
Claim:
Pg 167 Lines 18-23 ANY individual who doesn't have acceptable HC
according to the Govt will be taxed 2.5% of income
Response: PARTLY TRUE.
The goal of the bill is to
encourage people to have health insurance coverage so they have the
security of having affordable access to health care if they get
injured or sick. To give people an incentive to get coverage,
those without coverage will have to pay a tax equal to 2.5% of the
amount that their income exceeds an income threshold. The
threshold is the amount of income at which a taxpayer is required to
file a tax return. This income threshold varies by filing status
and age, and is adjusted each year for inflation. So people whose
incomes are below the filing threshold will not pay the tax, and the
tax will not apply to certain individuals exempt because of religious
beliefs, living abroad, or in the case of hardship (to be defined
in regulation),
To help make coverage more
available and affordable than it is today, the bill would change rules
so that private insurers can’t turn away applicants or make sick
people pay much more. It also provides subsidies to make coverage
more affordable to those with modest incomes. And, it expands
eligibility for Medicaid to more people with low incomes.
Claim:
Pg 195 HC Bill -officers & employees of HC Admin (GOVT) will
have access to ALL Americans finances/ personal records
Response: FALSE.
This section would not give
the Health Choices Commissioner access to financial records of all
Americans. This section would authorize the IRS, upon written
request, to disclose to the Commissioner limited information necessary
to determine if those applying for subsidies should qualify. It
strictly limits the type of information that IRS would share and
limits the ways the information can be used – and any
unauthorized disclosure of the information would be a felony.
Claim:
Pg 239 Line 14-24 HC Bill- Govt WILL REDUCE PHYSICIAN SERVICES for
Medicaid Seniors, and low income people.
Response: FALSE.
This section of the bill would
reform the system Medicare uses to set rates for service payments to
physicians. This section has nothing at all to do with seniors on
Medicaid or with other low-income people.
Claim:
Pg 241 Line 6-8 HC Bill - Doctors, doesn't matter what specialty
you have, you'll all be paid the same
Response: TRUE BUT…
This provision simply
clarifies that all physicians who participate in the Medicare program
will continue to be paid the same amount, regardless of their
specialty, for providing a specific service. That’s the way
Medicare now works, and it would stay the same. For example, if
you get an EKG from your primary care doctor, she gets paid the same
amount as a cardiologist would get for doing the same
EKG. Similarly, if a general surgeon operates on your broken
wrist, he receives the same payment from Medicare as an orthopedic
surgeon would get for doing the same operation.
The next set of claims all concern end-of-life counseling:
PG 425 Lines 4-12 Govt mandates Advance Care Planning
Consultations. (seniors)
Pg 425 Lines 17-19 Govt will instruct & consult regarding
living wills, durable powers of atty. Mandatory!
Pg 425 Lines 22-25, 426 Lines 1-3 Govt provides approved list of
end of life resources, guiding you in death
Pg 427 Lines 15-24 Govt mandates program for orders for end of
life. The Govt has a say in how your life ends
Pg 429 Lines 1-9 An "adv. care planning consult" will be
used frequently as patients health deteriorates
PG 429 Lines 10-12 "adv. care consultation" may include
an ORDER FOR END OFLIFE plans. AN "ORDER" from GOV
Pg 429 Lines 13-25 - The govt will specify which Doctors can write
an end of life order.
PG 430 Lines 11-15 The Govt will decide what level of treatment you
will have at end of life.
Response: ALL FALSE.
The bill would not require
people to make end of life decisions or take any specific action, and
suggesting otherwise is a misleading and cruel scare tactic. In fact,
this bill would provide a new optional benefit to help individuals
talk with their doctors in advance about difficult choices every
family faces when loved ones near the end of their lives. This bill
helps prepare for their care needs before they are in a crisis and
ensure that their wishes —whatever those are—are respected.
This measure would allow
Medicare to pay doctors for taking the time to talk with individuals
about difficult end-of-life care decisions. Such consultations
are not currently covered by Medicare. It would help provide people
with better information on the positives and negatives—both
physical and financial—that different treatments can mean for
them and their families.
Facing a terminal disease or
debilitating accident, some people will choose to take every possible
life-saving measure in the hopes that treatment will allow them more
time with their families. Others will decide that additional
treatment would impose too great a burden—emotional, physical
and otherwise—on themselves and their families, declining
extraordinary measures and instead choosing care to manage their
discomfort. Either way, it should be their choice.
This measure would not only
help people make the best decisions for themselves, but also better
ensure that their wishes are followed.
Lizzie6345 says:
there are too may ifs if the health care reform. I am happy with what I have heard, and I am finding that AARP supports most of it. If after researching this area more, and find that AARP is not supporting the seniors as I see fit, I will be canceling my membership in 2010.
Posted: September 19, 2009 11:02AM EDT
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