public health insurance plan

Health Reform Fact Check

Alex Lawson — Thu, 23 Jul 2009 20:02:53 -0400

Momentum is building. Strong health care legislation with a public plan option passed two House committees and the Senate's health committee. And polling continues to show wide support for the main provisions in those bills.

Yet the drumbeat for inaction continues to pound, with conservatives vowing to "break Obama," and the media headlining every hiccup and ignoring every success. And opponents are swamping Congress with calls and faxes against President Obama's reforms.

There is only one way to break the Washington culture of inertia and pass legislation this year. SPEAK UP. Even Senators and Congresspeople who want to be with us, are begging to hear from constituents. And the opponents of change can't be allowed to stand in the way of health reform.

That is why we need to push back against lies and smear tactics the right is employing against reform.

This page is updated with your tips, please send them to healthreformfactcheck@gmail.com

Health Reform Fact Check
Bill text: http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf
Section-by-Section Analysis: http://waysandmeans.house.gov/media/pdf/111/sbys3200.pdf
Other Health Care Reform Fact Checks

LIE #1: Health Reform is being rushed.
LIE #2: Reform will hurt seniors.
LIE #3: You won't be able to keep your plan if you like it.
LIE #4: You will not be able to buy additional care if you can afford it.
LIE #5: The House bill will insure illegal aliens.
LIE #6: The House bill is not deficit neutral over the next 10 years.
LIE #7: Health Reform will raise taxes on small businesses.
LIE #8: The House bill will keep you from being able to see a specialist.
LIE #9: Medicare is running out of money.
LIE #10: President Obama is "not familiar" with the text of the bill.
LIE #11: Studies show that 83.4 million people will lose their private insurance.
LIE #12: Health care crisis? What health care crisis? Anyone can go to an Emergency Room, everything's fine!
LIE #13: In Oregon, they ration care, and prioritize treatment for tobacco addiction over appendectomies.
LIE #14: If the healthcare bill is so good then why does Congress exempt themselves from the bill?
LIE #15: Massachusetts shows that health care reform is too expensive.
LIE #16: President Obama's plan will put government bureaucrats between you and your doctor.
LIE #17: The House bill includes a provision to create "death panels" that will determine whether or not to euthanize the elderly.

LIE #1: The Administration and Congressional leaders are trying to rush this bill through.

TRUTH: In his most recent press conference on health care, President Obama explained that he and other leaders are moving decisively because of the increasing urgency of passing reform. “If you don’t set deadlines in this town, nothing happens," he said. "The default position is inertia.”

Opponents of reform who talk of "rushing" forget that America has had a century of public debate on health care. Moreover, the current proposals have been carefully examined and debated by elected leaders since 2007.

The timeline of current reform began when Democratic and Republican candidates began offering health care proposals in 2007-2008. In Congress, the Senate Finance Committee held a day-long summit on health reform in June 2008 and issued a "Call to Action" on November 12, 2008. Reform gained steam with the signing of the State Children's Health Insurance Program on February 4, 2009, and the signing of the Economic Recovery and Reinvestment Act on February 17, 2009. On Tuesday, February 24th, President Obama addressed both houses of Congress, saying specifically health care reform "cannot wait another year." On Wednesday, February 25th, the Senate Finance Committee kicked off the formal legislative process by holding a hearing on health care. And then on Thursday, February 26th, President Obama released his budget proposal, calling for $634 billion to be set aside for health care reform . President Obama then held a "health care summit" at the White House, where he reiterated his support for health care reform this year.

With three committees in the House of Representatives and two committees in the United States Senate considering every aspect of proposed legislation, lawmakers, independent advocacy and research organizations, the news media, and ordinary Americans are able to follow the process and the debate carefully. The timeline, far from being "rushed," is bold enough to keep reform moving, but long enough to have a real national dialogue about reform.

LIE #2: The bill is an assault on the seniors in our country.

PART A: The cuts in care to pay for this bill come directly from seniors, about 500 billion dollars.
See also here .

TRUTH: As a factsheet from the Ways and Means Committee explains, "By eliminating wasteful overpayments to private plans under Medicare, reforming how doctors are reimbursed, and creating new incentives for coordinated, high quality care we will extend Trust Fund solvency and improve Medicare for generations to come." The figure of $500 billion represents savings - not cuts - that will result from specific reforms designed to increase efficiency for Medicare and Medicaid.

PART B: The bill is effectively a repeal of Medicare.

TRUTH: The House bill strengthens Medicare and Medicaid by “reallocating U.S. taxpayer dollars already being spent on health care to achieving more efficiency, higher quality, and broader coverage.”
• $156 billion in savings by eliminating overpayments to private Medicare Advantage plans over 10 years. According to the Medicare Payment Advisory Commission, private Medicare Advantage plans are currently paid, on average, 14 percent more than traditional Medicare providers – and overpayments to certain plans exceed 50 percent.
• $102 billion in savings over 10 years by incorporating productivity adjustments into Medicare payment updates for hospitals. This adjustment will encourage greater efficiency in health care provision, while more accurately aligning Medicare payments with hospital costs.
• $110 billion in savings over 10 years by: 1) codifying the recent PhRMA- White House agreement, which provides that Medicare Part D beneficiaries will get a 50 percent reduction in price on any brand-name drugs they need while in the so-called “donut hole” where drug costs are not reimbursed at certain levels; and 2) requiring that drug companies provide rebates for individuals enrolled in both Medicare and Medicaid that are at least as large as the Medicaid rebates that were provided prior to the enactment of Medicare Part D.
• $100 billion in additional savings over 10 years through numerous other provisions, including incorporating productivity adjustments into Medicare payment updates for home health agencies; and key delivery system reforms such as incentives to reduce readmissions to hospitals and promoting accountable care organizations.

Source: http://waysandmeans.house.gov/MoreInfo.asp?section=52

The bill requires hospitals, doctors, and pharmaceutical companies to achieve key efficiencies and eliminate waste in Medicare (including eliminating overpayments that are driving up profits for Medicare Advantage plans) and toughens our ability to root out fraud and abuse – but does not make cuts that hurt seniors. It also does nothing to take away choices for seniors.
On the contrary, the bill includes several key provisions that improve Medicare benefits for seniors, including the following:

Phases in completely filling in the “donut hole” in the Medicare prescription drug benefit (where drug costs are not reimbursed at certain levels), potentially savings seniors thousands of dollars a year.
Eliminates co-payments and deductibles for preventive services under Medicare.
Limits cost-sharing requirements in Medicare Advantage plans to the amount charged for the same services in traditional Medicare coverage.
Improves the low-income subsidy programs in Medicare, such as by increasing asset limits for programs that help Medicare beneficiaries pay premiums and cost-sharing.

Source: http://waysandmeans.house.gov/MoreInfo.asp?section=52

PART C: WSJ: The House bill being pushed by the president...ensures that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it (pp. 425-446). In Oregon, some cancer patients are being denied care by the state that could extend their lives and instead are afforded the benefit of physician-assisted suicide instead.

TRUTH: According to a Section-by-Section Analysis of the bill (p. 18), Section 1233, on "Advance care planning consultation," "provides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment" and "instructs CMS to modify "Medicare & You" handbook to incorporate measures on advance care planning into the physician's quality reporting initiative."

The legislation seeks to provide seniors with counseling that will educate them about all of their options. This provision does not mean that seniors will be denied otherwise available end-of-life care, nor does it mean they will be forced into "physician-assisted suicide."

As Rep. Blumenauer's office explains, "Advance planning consultations are not mandatory; this benefit is completely voluntary. The provision merely provides coverage under Medicare to have a conversation once every five years if – and only if – a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes." Additionally, "There is no mandate in the bill to complete an advance care directive or living will. If a patient chooses to complete an advance directive or order for life sustaining treatment, these documents will help articulate a full range of treatment preferences, from full and aggressive treatment to limited, comfort care only. Patients that choose to have these documents and can customize them so that their wishes are appropriately reflected." And finally, "There are no government-chosen professionals involved. The legislation simply allows Medicare to pay for a conversation between patient and their doctors if patients wish to talk with their doctor about end of life care preferences." The provision has been supported by the AARP, American Academy of Hospice and Palliative Medicine, American Hospice Foundation, Consumers Union, Gundersen Lutheran Health System, Medicare Rights Center, National Hospice and Palliative Care Organization, and Providence Health System.

Compassion and Choices has more here and here, Snopes has more here, and Media Matters has more here.

PART D: WSJ: Comparative effectiveness research...is generally code for limiting care based on the patient’s age. The cost of a treatment is divided by the number of years (called QALYs, or quality-adjusted life years) that the patient is likely to benefit. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients. Rep. Paul Ryan (R-Wisc), Sen. Tom Coburn (R-Okla), Rep. Ginny Brown-Waite (R-Fla.), Rep. Paul Broun (R-Ga.) have all made a similar argument, see here.

TRUTH: Comparative effectiveness research in reality is not an attempt to implement QALYs used by countries such as Britain and Canada. Rather, as columnist Paul Krugman stated in his column July 24, "the Obama administration and Congressional Democrats have also been emphasizing the importance of “comparative effectiveness research” — seeing which medical procedures actually work." Even conservative columnist David Brooks commended comparative effectiveness research as one of the ideas that "sounds good" in his column from the same day. Below is an explanation from the legislation's text of what comparative effectiveness research is, and its roll in fixing the nation's health care problems.

SUBTITLE A—COMPARATIVE EFFECTIVENESS RESEARCH

Sec. 1401. Comparative effectiveness research. Establishes a Center for Comparative Effectiveness Research
within the Agency for Healthcare Research and Quality (AHRQ) to conduct, support and synthesize research
relevant to the comparative effectiveness of the full spectrum of health care items, services, and systems.

Establishes a public/private stakeholder commission known as the “Comparative Effectiveness Research
Commission” to oversee the Center, determine national priorities for research, identify research methods and
standards of evidence, support forums to increase stakeholder feedback, appoint advisory panels on specific
national priorities to advise the center on research questions and methods, and make recommendations for the
dissemination of findings.

The 17-member Commission will be appointed by the Secretary with input from the Comptroller General and
the Institute of Medicine and will include the Director of AHRQ, the Chief Medical Officer of CMS and
stakeholders including clinicians, patients, researchers, third-party payers and consumers. Clinical perspective
advisory panels will provide advice on specific research questions, methods and gaps in evidence in terms of
clinical outcomes for priorities identified by the Commission in order to ensure that the research is clinically
relevant. The Commission and the advisory panels it appoints will be subject to strict conflict of interest
requirements. The Center and the Commission are prohibited from mandating coverage, reimbursement or
other policies to any public or private payer. The Center and the research it conducts are funded out of the
Comparative Effectiveness Research Trust Fund (CERTF) which will receive contributions from Medicare and
private health insurance plans.

PART E: CNS News claims that health reform will place seniors in "medical homes" without doctors.

TRUTH: First of all, CNS News' article on medical homes relies heavily on quotes from the Center for Medicine in the Public Interest, an institution that receives funding from the pharmaceutical industry and has been described as a "nest of ex-moles who served the industry in one capacity or another in the Bush Administration's FDA."

Visions of "FEMA camps" and "government-enforced euthanasia" may dance in rightwingers' heads, but the truth about Section 1722 of HR 3200 is much more mundane. In reality, the concept of a Patient-Centered Medical Home is a mainstream medical practice that has existed since the American Academy of Pediatrics developed the idea in 1967. Forty years later, a joint statement by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA) explained the principles behind the Medical Homes concept, emphasizing that quality of care, safety, and coordination are key objectives.

Legislation proposed in America's Affordable Health Choices act merely builds on existing concepts and facilities. According to the bill summary, HR 3200 "establishes a 5-year pilot program to test the medical home concept with high-need Medicaid beneficiaries. Including medically fragile children and high-risk pregnant women. The federal government would match costs of community care workers at 90% for the first two years and 75% for the next 3 years, up to a total of $1.235 billion."

LIE #3: Pages 16 and 17 say the President is lying when he says you may keep your existing plan.

TRUTH: As Ezra Klein explains, "Your insurance doesn't become illegal. It just has to offer itself through the Exchange and follow the new rules, like not jacking up your prices because you had strep throat last year. As for the 93 percent of us who don't purchase coverage on the non-group market? Our insurers are unchanged."

As blogger Shadowfax adds, "What does [the bill's language] mean in the real world? 1. Individual health insurance policies already in effect may continue but may not be altered. 2. Employer-sponsored plans have five years to get in compliance with the new regulations. 3. New individual health insurance policies will only be available through the National Insurance Exchange (NIE)."

Shadowfax's lightly edited version of the bill text:

SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.
(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:
(1) LIMITATION ON NEW ENROLLMENT- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.
(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
(b) Grace Period for Current Employment-based Health Plans-
(1) GRACE PERIOD-
(A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.
(c) Limitation on Individual Health Insurance Coverage-
(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

Republican Leader, John Boehner's recent Op-Ed on the subject of health reform claims incorrectly that 100 million Americans would be forced onto a government-run health plan under the House bill.

As the Office of the Speaker says,

"First of all, under our bill, no one can ever be “forced onto a government-run health plan.” Under our bill, the public health insurance plan is available to all those using the Exchange. All those using the Exchange will have a choice of options – various private plans, as well as the public plan. If an employer is providing their employees health insurance through the Exchange, it is the employee – not the employer – choosing the plan. (Under the bill, in the first two years of the Exchange, small employers may participate; in later years, the Administration has the discretion to permit larger employers to participate but there is no timeline for this participation.)

Second, the nonpartisan Congressional Budget Office predicts the number of Americans in private insurance plans will actually increase under the bill (rather than millions being forced out of private plans and into a public plan).

Thirdly, the nonpartisan CBO has estimated that, by 2019, about 9 or 10 million Americans – or 90 million fewer Americans than claimed by Republican Leader Boehner – will be enrolled in the public plan. CBO projects that two-thirds using the Exchange will choose a private plan – not the public plan. Even if more Americans end up choosing the public plan, it will be their choice – no one can force them into the plan."

LIE #4: You are denied the right to purchase extra medical care if you can afford it.

TRUTH: As the House Ways and Means Committee Section-by-Section Analysis explains (p. 5), Section 203, the Health Choices Commissioner establishes minimum standards for plans within the exchange, but plans are free to offer different types of plans and "multiple premium-plus options."

As the House Ways and Means Committee Section-by-Section Analysis explains (p.8), Section 246, entitled "NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS," "prohibits anyone not lawfully present in the United States from obtaining affordability credits."

The bill clearly excludes undocumented immigrants from receiving federal funds to buy health insurance from either a private or government plan.

Part B: Rep. Steve King (R-IA) has claimed that "5,600,000 Illegal Aliens May Be Covered Under Obamacare."

TRUTH: Think Progress has thoroughly debunked Rep. King's claims, noting that "none of the figures that King cites — including the 5.6 million number that he uses to strike fear in xenophobic hearts — are included in the CBO’s infamous health care bill predictions. The CBO’s analysis does not reference the undocumented population other than to point out that the percentage of the uninsured population increases if undocumented immigrants are included in its estimates. There is no reference as to how many undocumented immigrants would be covered by the proposed health care bill because the entire CBO analysis was essentially written under the assumption that undocumented immigrants will not be eligible." Think Progress has more here.

Part C: President Obama wants to cover illegal aliens' children.

TRUTH: The President has stated repeatedly that the bill will not cover illegal aliens, but he mentioned that providing some form of care to children may be desirable from a public health standpoint. Here are his remarks in context:

"First of all, I'd like to create a situation where we're dealing with illegal immigration, so that we don't have illegal immigrants," he said. "And we've got legal residents or citizens who are eligible for the plan. And I want a comprehensive immigration plan that creates a pathway to achieve that."

"The one exception that I think has to be discussed is how are we treating children," he continued. "Partly because if you've got children who may be here illegally but are still in playgrounds or at schools, and potentially are passing on illnesses and communicable diseases, that aren't getting vaccinated, that I think is a situation where you may have to make an exception."

Part D: By rejecting Nevada Rep. Dean Heller's amendment requiring an individual, before he is able to enroll in the public health insurance plan or receive an affordability credit, to have his eligibility verified under the Income Eligibility Verification System and the Systemic Alien Verification System programs under the Social Security Administration (the approval would be the responsibility of the health insurance provider offering the public plan through the Health Insurance Exchange), the House Ways and Means Committee opened the door to the participation of illegal immigrants in the public plan. Source

TRUTH: See Part A. Immigrants will not receive any assistance to purchase coverage. It is possible that illegal immigrants might enroll in the Health Insurance Exchange, but they would do so at full cost.

Part E: Mexico's government operates programs in about a dozen American cities referring its nationals - living in the U.S. illegally - to publicly funded health centers where they can get free medical care without being turned over to immigration authorities. The program is called Ventanillas de Salud (Health Windows) in Spanish and its mission is to help illegal immigrants find U.S. hospitals, clinics and other government programs where they can get free services without being deported for violating federal immigration laws. Imagine the campaign Mexico will launch when Obama's national health care bill passes.

TRUTH: Ventanillas de Salud is one part of the Health Initiative of the Americas, a program designed by the University of California, Berkeley. The program aims not to serve illegal immigrants, but rather to provide bilingual counseling and referral services to residents who need them. As far as we know, the government of Mexico has not taken a position on the US health reform debate and has no plans to launch a campaign to exploit reform.

Part F: U.S. taxpayers already spend billions of dollars annually to provide free medical care for illegal immigrants...The expense has become so unbearable in California that several municipalities eliminated the perk this year to save tens of millions of dollars in the midst of the state's dire financial crisis.

TRUTH: While it is true that some California counties have stopped providing emergency medical care to illegal residents, the suggestion that the passage of federal health reform will result in massive costs to provide care to undocumented workers has no basis in reality. Careful analyses of the bill by the Congressional Budget Office and various independent groups have in fact projected substantial savings.

LIE #6: The House bill is not Budget neutral over the next 10 years

TRUTH: As the Committee on Energy and Commerce has written, "The Congressional Budget Office (CBO) [estimates have confirmed] that H.R. 3200, America's Affordable Health Choices Act, is deficit neutral over the 10-year budget window - and even produces a $6 billion surplus. CBO estimated more than $550 billion in gross Medicare and Medicaid savings. More importantly, the bill includes a comprehensive array of delivery reforms to set the stage for lowering the future growth in health care costs."

LIE#7: The House bill will raise taxes on small businesses

TRUTH: According to the nonpartisan Congressional Joint Committee on Taxation, 96% of small businesses would see no tax increases under this proposal. Furthermore, all small businesses will greatly benefit from the insurance market reforms in the bill. Small businesses face many obstacles in achieving health care that other larger companies and organizations are able to overcome. Source: Citizens for Tax Justice

Small businesses often find that health insurance is unaffordable in the current marketplace. Small businesses owners, employers and their dependents currently account for 28 million of the uninsured in America today. As relatively small buyers in the market place, small businesses have very little bargaining power to reduce premiums and negotiate lower prices. When small businesses employ a worker who has a pre-existing condition or gets sick, premiums skyrocket for both the employer and all the other employees in the firm.

Insurance costs for small businesses have increased dramatically over the last decade, rising 129 percent since 2000. Small businesses pay an average of 18 percent more in health premiums than those in larger firms for the same benefits. Furthermore, small businesses face much higher administrative costs than larger firms, as administrative costs account for up to 25 percent of the cost of premiums compared to 10 percent for larger firms.

The House’s legislation gives small businesses access to affordable coverage by changing market dynamics and incentives in a way that empowers small businesses. The bill provides small businesses access to the new health insurance “exchange”, giving them the benefits of large-group rates normally enjoyed only by large employers. As participants in the exchange, small businesses will join with other buyers to negotiate lower premiums, lower administrative costs, greater transparency and maintain the ability to offer choice of plans to their employees and their families.

The bill includes key insurance reforms, which are of particular benefit to small businesses. The legislation prohibits insurers from excluding coverage based on pre-existing coverage, from selectively refusing to renew coverage, and from charging people different premiums based on their gender, occupation or pre-existing condition. Finally, the bill requires a standardized annual out-of-pocket limit so that no small business owner or employee’s family face bankruptcy due to medical expenses.

The bill also includes a permanent tax credit to help small, low-wage businesses in offering coverage. The smallest firms with average wages below $20,000 would receive a tax credit equal to 50 percent of the employer’s share of the premium. The credit would phase out for employers with between 10 and 25 employees and average wages between $20,000 and $40,000. Source: Citizens for Tax Justice

LIE #8: WSJ: The House bill shifts resources from specialty medicine to primary care based on the misconception that Americans overuse specialist care and drive up costs in the process (pp. 660-686). In fact, heart-disease patients treated by generalists instead of specialists are often misdiagnosed and treated incorrectly. They are readmitted to the hospital more frequently, and die sooner...The House bill being pushed by the president reduces access to such cures and specialists.

TRUTH: The House bill aims not to reduce access to specialists, but to make sure that health care is being delivered in an efficient and effective manner.

LIE #9: WSJ: Medicare is running out of money.

TRUTH: Medicare is currently experiencing funding problems, but H.R. 3200 will help Medicare budget problems rather than inflame the problem. As the Treasury secretary Timothy F. Geithner, said, the only way to keep Medicare solvent was to “control runaway growth in both public and private health care expenditures.” And he said Mr. Obama intended to do that as part of his plan to guarantee access to health insurance for all Americans. Achieving real health care reform is essential to solve medicare problems.

This bill strengthens a number of problems that Medicare is currently experiencing, documented in the Ways and Means fact sheet on Medicare.

LIE #10: Heritage and Weekly Standard: President Obama is "not familiar" with the text of the bill.

TRUTH: The actual quote, included in Heritage's piece, runs as follows:

During the call, a blogger from Maine said he kept running into an Investors Business Daily article that claimed Section 102 of the House health legislation would outlaw private insurance. He asked: “Is this true? Will people be able to keep their insurance and will insurers be able to write new policies even though H.R. 3200 is passed?” President Obama replied: “You know, I have to say that I am not familiar with the provision you are talking about.”

The President was "not familiar" with that provision because that provision does not exist. See Lie #5.

Lie #11: Heritage/Lewin: A July 17 study by the Lewin Group, commissioned by the Heritage Foundation, projects that if the House bill becomes law, 83.4 million people—nearly half of those with private coverage—will lose private insurance as employers drop their plans.

TRUTH: The nonpartisan reputation of the Lewin group has been called into question by the Washington Post, which reported on July 22nd that Lewin is "wholly owned by UnitedHealth Group, one of the nation's largest insurers."

Additionally, John Holahan and Limba Blumberg of the Urban Institute have questioned Lewin's assumptions and put forward their own estimates regarding the number of Americans who would enroll in the public plan and the number who retain private insurance. Holahan and Blumberg, arguing that private insurers will respond to competition from the public plan, write that the number of Americans with private coverage will fall from 177 million to 161 million, while around 47 million Americans will choose to enroll in the public plan.

Joe Sudbay argues that: "No reporter should ever quote a Republican citing the Lewin Group without this full disclosure: 'the Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers.'"

More specifically, Sudbay explained: "the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association, a physician's group, of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied its parent company and other insurers with data that allegedly understated the "usual and customary" doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care."

In January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.

More on Republicans' love of Lewin here and here.

Lie #12: There’s no health care crisis because anyone can get treated in an emergency room.

TRUTH: The existence of emergency rooms and public hospitals does not mean there is no health care crisis. As Steve Benen writes, "First, it's true that if you're uninsured and get sick, there are public hospitals that will treat you. But it's extremely expensive to treat patients this way, and it would be far cheaper, and more effective, to pay for preventative care so that people don't have to wait for a medical emergency to seek treatment. For that matter, when sick people with no insurance go to the E.R. for care, they often can't pay their bills. Since hospitals can't treat sick patients for free, so the costs are passed on to everyone else. In that sense, Republicans are endorsing the most inefficient system of socialized medicine ever devised."

And as Matt Corley writes, "The fact is that many Americans are forced to go without care: 'The chances of working-age adults experiencing at least one access problem due to costs (delaying care, forgoing medical care, forgoing dental care, or forgoing prescription drugs) grew from 18.2% in 1997 to 21.3% by 2006. While the size of the problem and the growth rate may seem small, combined with growth in the population, they translate into substantial numbers of people. The number of working-age adults who experienced at least one access problem due to costs grew from a total of 29.8 million in 1997 to 39.3 million by 2006.' In November 2008, a Kaiser Family Foundation survey found that 'nearly half of Americans report that someone in their household skipped necessary health care in the past year because of the cost.' As ThinkProgress has previously noted, uninsured Americans are less likely to seek health care and more likely to die because of a lack of insurance. In 2002, the Institute of Medicine estimated that there were 18,000 unnecessary adult deaths because of a lack of insurance while the Urban Institute estimated in 2006 that 22,000 died for the same reason. Finally, studies have found that the uninsured 'are 30 to 50 percent more likely to be hospitalized for an avoidable condition” and if they do seek care in an emergency room, “they are usually sicker than patients who have health insurance'."

Lie #13: The government bureaucrats who administer Oregon's public health insurance plan ration care, and prioritize treatment for tobacco dependence over an emergency appendectomy.

TRUTH: The Oregon Health Plan is a Medicaid program. It is not a state equivalent of a national public health insurance plan. The Prioritized List of Health Services, a component of OHP overseen by doctors and other citizens, places an emphasis on preventive care and attempts to use state resources in the most effective manner, but the Prioritized List does not provide any sort of model for any of the proposals included in HR 3200.

Lie #14: If the healthcare bill is so good then why does Congress exempt themselves from the bill?

TRUTH: As Think Progress explains, the House bill "does not specifically exempt federal employees — who receive coverage through the Federal Employees Health Benefits (FEHB) Program — from enrolling in the new public plan. Rather, the legislation treats the American government — the largest employer in the country — like any other large employer: it can enroll its employees in the Exchange (where they can choose a public health insurance option) after a period of 2 years."

Lie #15: Massachusetts' experience proves that health reform is too expensive, as this article shows.

TRUTH: Massachusetts' attempt at health reform aimed to increase coverage but, as with other state-level reforms, Massachusetts' program was not able to control costs. The House bill, which is not modeled on the Massachusetts system, will promote coverage and affordability, and will control costs through a set of measures (the exchange, the public plan, regulations on insurers) that the federal government can implement far more effectively than any state. Massachusetts' experience is not a guide for how the United States will fare under a broader and stronger reform.

Lie #16: President Obama's plan will prevent doctors from being able to make their own decisions.

TRUTH: Presumably, this claim stems from the use of "comparative effectiveness research," which is used to determine the most effective treatments for various ailments and directs doctors and patients towards the most effective treatment. According to the Washington Post, this research is already used by "many private health plans," and would only be applicable to those who enroll in the public plan. This was a concern for the American Medical Association, who initially opposed the public option, but who, in a July 27, 2009 press release, endorsed H.R. 3200 specifically because such concerns were allayed by the text of the bill.

Lie #17: The government wants to create "death panels" which will decide whether or not someone is fit to live or die.

TRUTH: While this is one assertion that has managed to gain some momentum in the past few weeks, it has been shown, time and time again, to be utterly baseless and a fantasy of the extreme right. The non-partisan FactCheck.org has described the claim as "false," and "scare tactics." In addition, even members of the Republican party are coming out to repudiate these claims, leading Sen. Lisa Murkowski (R-AK) to say "Quite honestly, I'm so offended at that terminology because it absolutely isn't (in the bill). There is no reason to gin up fear in the American public by saying things that are not included in the bill."

Other Myth/Fact Sheets:

MedPAC Debunks Cost-Shifting Claims of Hospital, Insurance Industries

Alex Lawson — Sat, 04 Jul 2009 10:33:36 -0400

A report done for Health Care for America Now

A recent Milliman, Inc. analysis on behalf of America’s Health Insurance Plans (AHIP) argues that Medicare doesn’t pay hospitals enough, causing private payers to pay well above costs to keep hospitals solvent. This is referred to as ‘cost-shifting.’ (1) The non-partisan Medicare Payment Advisory Commission (MedPAC) refutes this argument and finds that a hospital’s relative market strength – and not Medicare-related cost-shifting – determines what a hospital is paid by private payers. This issue is central to the current debate on establishing a new public health insurance plan option and the authority of the new plan to establish reasonable provider rates.

History of Hospital – Private Payer Relative Market Strength

The history of private insurers and hospital price negotiations is a telling one, as MedPAC explained in its March 2009 report to Congress. (2)

Hospital leverage: From 1987 through 1992, hospital profits from private payers grew, and from 1987 through 1993 the rate of hospital cost growth was above the rate of inflation in goods and services purchased by hospitals.

Insurer leverage: From 1994 through 2000, managed care restrained private-payer payment rates, and hospital cost growth fell below the rate of inflation in hospital-purchased goods and services.

Hospital leverage returns: “By 2000, hospitals had regained the upper hand in price negotiations due to hospital consolidations and consumer backlash against managed care,”(3) MedPAC reported.

With the loss in leverage over hospitals, private insurers have in turn passed along these costs through higher premiums to enrollees and employers. MedPAC reported, “While insurers appear to be unable or unwilling to ‘push back’ and restrain payments to providers, they have been able to pass costs on to the purchasers of insurance and maintain their profit margins.”(4)

Findings on Hospital Revenues, Costs and Pricing

Hospitals with the greatest resources are less aggressive about containing costs and therefore have the highest Medicare ‘losses’ (the difference between Medicare rates and a hospital’s average costs). The most profitable and powerful hospitals spend more and increase their costs per unit of service. Hospitals with high profits, low financial pressure, large endowments or robust fundraising have the highest costs, and a higher cost base leads to lower Medicare margins. If Medicare were to increase payment rates, hospitals with market power would be unlikely to voluntarily cut prices charged to insurers and reduce revenue. Instead, hospitals might spend some or all of that revenue, pushing costs higher still. (5)

Hospitals in markets with little or no competition force private insurers to pay excessive rates, driving prices too high. That is the finding of MedPAC,(6) corroborated by insurance industry leaders, including AHIP President Karen Ignagni, who said hospital industry consolidation had increased hospitals’ market power, thereby reducing insurers’ ability to negotiate discounts.(7) In areas with more robust hospital competition, insurers have the power, much like Medicare, to set provider rates.

The real issue is not whether private plans pay doctors and hospitals more than government programs, but what is a fair rate based on the actual cost of providing quality care. The Milliman report itself discloses the limitations of its study, noting that it "does not assess appropriate levels of payment.” (8) It only compares how much different payers reimburse providers for the same service. MedPAC reports that Medicare aims to establish payment rates that cover costs that reasonably efficient providers would incur in furnishing high-quality care, thereby rewarding providers whose costs fall below the payment rates and giving an incentive to those with costs above the payment rates to become more efficient. (9)

MedPAC concluded, “Increasing Medicare payments is not a long-term solution to the problem of rising private insurance premiums and rising health care costs. In the end, affordable health care will require incentives for health care providers to reduce their rates of cost growth.” (10)

Relation of Cost to Quality
Although efficient hospitals have lower costs, they often deliver better medical care, MedPAC found in a separate study. (11) In a review of 300 hospitals that performed well on a mix of quality measures and costs, the agency found these hospitals tended to have lower patient death rates than other hospitals.

1. Milliman, “Hospital & Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers,” December 2008. Accessed at http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/hospit....
2. Medicare Payment Advisory Commission, “Report to the Congress: Medicare Payment Policy,” March 2009. Accessed at http://www.medpac.gov/documents/Mar09_EntireReport.pdf.
3. Ibid. Pg 58.
4. Ibid. Pg. 59.
5. Ibid.
6. Ibid.
7. “Daschle to Face Tough Questions on Competition in Health Insurance,” Robert Pear, The New York Times, January 8, 2009. Accessed at http://www.nytimes.com/2009/01/08/us/politics/08daschle.html.
8. “Consumers and Employers Paying Almost $90 Billion Due to Under-Payments to Hospitals and Physicians by Medicare and Medicaid,” Press Release, America’s Health Insurance Plans, December 9, 2008. Accessed at http://www.ahip.org/content/pressrelease.aspx?docid=25218.
9. Medicare Payment Advisory Commission, “Hospital Acute Inpatient Services Payment System," October 2008. Accessed at http://www.medpac.gov/documents/MedPAC_Payment_Basics_08_hospital.pdf.
10. Ibid, p 64.
11. Medicare Payment Advisory Commission, “Statement for the Record,” March 10, 2009, Committee on Ways and Means.

[HCIP] HELP health plan, Reform without public plan, Urban Institute report

Alex Lawson — Fri, 03 Jul 2009 15:00:59 -0400

***HEALTHCARE FOR ALL INFORMATION PROJECT***
Sign up to receive our Health Care Information Project by email. Check the box next to Health Care for All
---------------------------------------------
http://www.ourfuture.org/healthcare

Contents:
1. CBO-KAY! Senate HELP Bill Rebounds
2. Important new report on public insurance plans from the Urban Institute
3. Memo To Deficit Hawks: Public Plan Option Indisputably Saves Money
4. Health Care Deform: Afraid of the public option? This is what America will look like without it
5. WeWantThePublicOption.com
6. Tell Congress: Take the Pledge!

1. CBO-KAY! Senate HELP Bill Rebounds
By Tim Foley
Change.org
Click for source

Republicans have made hay for the past few weeks on how Ted Kennedy's bill cost too much ($1 trillion dollars) and covered too few (only an additional 16 million). Of course, that score was on a partial bill, one that the Congressional Budget Office itself claimed "[does] not represent a formal or complete cost estimate for the draft legislation" (italics theirs.) It also lacked the details on the individual mandate, the employer "pay or play" mandate, and the public health insurance option. But Kennedy and Chris Dodd have kept at it, undeterred from the catcalls, and have finally delivered the goods. According to Jon Cohn on The Treatment, the new, full bill is in.
Read more here

2. Important new report on public insurance plans from the Urban Institute
By John Holahan and Linda Blumberg
Urban Institute
Click for source

John Holahan and Linda Blumberg make the economic case that the public health insurance option will drive competition and control costs in what is currently a non-competitive marketplace, in a new paper released by the Urban Institute last week. The report, called "Is a Public Health Insurance Option an Essential Part of Reform?" describes both the heavy consolidation in the insurer and hospital markets and its implications as well as the benefits of a public health insurer competitor. The authors find that a robust national public plan would save the federal government between $224 and $400 billion. They assume such a plan would not only be able to offer Americans a lower-cost insurance option, but it would set a benchmark for private plans that would lead them to be more efficient and bring down their costs.
Read the whole report here

3. Memo To Deficit Hawks: Public Plan Option Indisputably Saves Money
By Bill Scher
Campaign for America's Future
Click for source

When the CBO scored an early draft of the health care form bill from the Senate HELP committee as costing $1 trillion over 10 years but only covering one-third of the uninsured, obstructionists pounced and proclaimed the public plan option dead.
But the CBO had not assessed the cost of the public plan option, nor a mandate on most employers to either provide insurance or contribute to the public plan.

Now they have. And as serious reform advocates long claimed, including those two key provisions drops the 10-year cost of reform by nearly $400 billion, while achieving near universal coverage. Will the self-proclaimed deficit hawks now embrace the public plan option since it would save money?
Read more here

4. Health Care Deform: Afraid of the public option? This is what America will look like without it
By Jacob Hacker and Rahul Rajkumar
The New Republic
Click for source

The issue sucking up the oxygen in Washington today is whether to have a public health insurance plan compete with private insurers for the business of Americans without secure workplace coverage. Americans overwhelmingly back the idea, President Obama strongly supports it, and House Democratic leaders have drafted legislation that shows how it can be done. But the insurance and pharmaceutical lobbies and some medical provider groups have cried foul, and they have found a receptive ear not just among Republicans but also some Democrats who demand that reform be bipartisan, even if they have to cut the heart out of it.
Read more here

5. WeWantThePublicOption.com
Progressive Change Campaign Committee
Click for source

76% of Americans say "we want the public option," and the Progressive Change Campaign Committee is going to make sure that Democratic Senators listen to them. The PCCC is currently airing an ad showing popular support for the public health insurance plan in Washington, DC on MSNBC, CNN, and during the Daily Show. Lend your support to making sure that your Senators hear your voice.
Read more here

6. Tell Congress: Take the Pledge!
Firedoglake.com
Click for source

Progressive members of Congress need to draw a line in the sand and demand a public health insurance option -- something 76% of Americans want.

They need to Take the Pledge to vote against any health care bill that doesn't have a public plan which is:

available nationwide
on day one
and accountable to Congress and the voters
Please call progressive members of Congress and ask them to Take the Pledge now.

Take part in the whip count here

Additional Resources:
Public Health Insurance Resource Page

Health-Care Market Characterized By Consolidation, Not Competition

Alex Lawson — Tue, 30 Jun 2009 22:33:50 -0400

Health Insurance Coverage Keeps Shrinking as Premiums, Family Costs Climb Ever Higher

Alex Lawson — Sun, 21 Jun 2009 00:21:03 -0400

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The insurance industry shouldn't get between you and your doctor

Alex Lawson — Tue, 12 May 2009 10:27:06 -0400

Health Care for America Now (HCAN) – the nation’s largest health care campaign – debuted a new TV ad in six key states today emphasizing the need for a public health insurance option in health care reform and asking nine specific Senators to support that choice: Senator Arlen Specter (D-PA), Senator Ben Nelson (D-NE), Senator Mike Johanns (R-NE), Senator Ron Wyden (D-OR), Senator Blanche Lincoln (D-AR), Senator Mark Pryor (D-AR), Senator Evan Bayh (D-IN), Senator Richard Lugar (R-IN), and Senator Thomas Carper (D-DE). The ad names the Senators in each state who have not yet publicly signed on in support of a public health insurance option.

“Doctor” features Dr. Valerie Arkoosh, MD, MPH who was born and raised in Omaha, Nebraska and practices in Philadelphia, PA. Dr. Arkoosh explains that private health insurance companies have been in control of decision making for too long. She says members of Congress should support giving everyone the choice of a public health insurance plan as part of real health care reform so doctors and patients are no longer at the mercy of private health insurance companies making decisions doctors and patients should be making together. Dr. Arkoosh is with the National Physicians Alliance, a Health Care for America Now member organization representing 20,000 physicians across specialties and throughout the United States.

“Health Care reform is happening now, and now is the time Congress should be supporting the key components of President Obama’s health care proposal, including giving everyone the choice of a public health insurance plan,” said Richard Kirsch, National Campaign Manager, Health Care for America Now. “As we see health care industry stakeholders volunteer to control costs in a system that covers everyone, it becomes even more urgent we create a new public health insurance option to drive true savings and innovation and guarantee quality and transparency.”

“Opponents of reform can try to scare the public with threats of rationing and denied care, but we as physicians see health insurance companies rationing and denying care in practice every day,” said Dr. Valerie Arkoosh, MD, MPH, National Physicians Alliance. “It’s time our patients had a real choice – a choice of a public health insurance plan.

The “Doctor” ad will run for a week starting today in Pennsylvania, Nebraska, Oregon, Arkansas, Indiana, and Delaware. All of the ads are available online at http://www.healthcareforamericanow.org/doctor.

Public Health Insurance Page

Alex Lawson — Tue, 31 Mar 2009 17:13:34 -0400

Introduction

President Barack Obama, three committees in the House, and one committee in the Senate have proposed frameworks for reforming the health care system that would allow Americans to keep their employer-provided coverage or, if they do not have such coverage, obtain it through a public or private insurance plan that is available through a “national health insurance exchange,” where plans would compete with each other for members. Like the public Medicare program, the new public health insurance plan in this exchange would be managed by the federal government but would pay private health care providers to deliver care.

The choice of a public health insurance plan is an important part of comprehensive health care reform. It is needed to bring down costs, make coverage affordable, force private health insurance companies to compete, and guarantee that quality, affordable coverage will be there for people no matter what happens.