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Monday, September 14, 2009

Answers to Health Care Questions

Note from Chris Buttars:
A few weeks ago I posted concerns about the health care bill. A group of local Democratic Party activists have spent some time preparing a response to those concerns. I don't agree with their point of view but I respect them for their interest and believe all sides should be heard - so we're posting their response here.
Answering Senator Buttars' Health Care Questions

By Craig Blanch

Co-Editor, The SideTrack

First, let me say thank you to The Senate Site for allowing us to respond to the questions and concerns offered up on these same pages by Senators Buttars and Valentine regarding the Health Care Reform Bill (HR3200).

It's very encouraging to know that they are listening to what our group of bloggers, volunteer researchers, and policy wonks have to offer this discussion. We feel such a response is important to the integrity of the debate as our research quickly led us to the believe that both Senators Chris Buttars and John Valentine are guilty of either 1) not reading the bill, or 2) not understanding the bill, or 3) willingly spreading misinformation about the bill to generate fear rather than promote understanding. The answers to their "questions and concerns" were not difficult for us to find.

Below are the 22 questions posed by Senator Buttars, and the answers culled from multiple sources, including CQ Politics, the CATO Institute, the Kaiser Foundation, the Education and Labor Committee, local legislative experts, and our own reading of the text of bill itself.

Page 124, Lines 24-25: Does this ban anyone from suing the federal government? And does it ban the entire judicial system from hearing cases on the legitimacy of the proposed plan?

No. It doesn't ban someone from suing the federal government, or ban the judicial system from hearing cases on the proposed plan. It bans anyone from suing the government over the payment rates set in the public option. If your doctor doesn't like the rates set by the public option, they don't have to accept it, and can opt out (similar to Medicare). If you don't like that your doctor doesn't accept it, you can also opt out of the public option and find different insurance. If the insurance industry doesn't like the rates because the public option pays too much, they'd better find a way to compete.

Are all federal employees exempt from the proposed national health care program(s)?

Not addressed specifically in the bill, but theoretically they wouldn't fall under the public option, since they (like a State Senator) already have excellent insurance from their government jobs. That doesn't preclude them (or a State Senator) from falling under the public option at some point, if their benefits planner decides the public option is better than what is offered by private insurance companies.

Pages 272 & 452: The entire bill is loaded with the comment, “As determined appropriate by the Secretary.” What does this mean?

It does come up often. As it does in homeland security laws, department of defense laws, agricultural laws, etc. When a law is put in place that deals with a particular federal department (HHS in this case) then a lot of the discretionary decisions get placed on the secretary in charge of that cabinet. Utah government functions in much the same way (i.e. "as determined by the division head" or "the division head may...").

Page 429, Lines 10-11: In addition to almost everything being subject to the Secretary’s approval, the words the “Secretary may” are also peppered throughout the bill. What does this mean?

See previous answer.

Page 226, Lines 12-22: An example of “governmentese.”

Despite any vast experience reading legislation, our research group was able to sort out the meaning of the bill language without much trouble, and the language is not vastly different from the legislation that makes it way through our own legislative sessions. These specific lines seem intended to apply consistency to interrelated agencies and previous laws.

Page 58, Lines 11-13: Will everyone be issued a government health care ID? Will it outline limitations of services we can receive?

The answer to the first question is yes, those who choose the public option would receive an ID card similar to the insurance company ID card those of you reading this lucky enough to have insurance currently carry. Even the coverage offered to state legislators in Utah issues you such an ID card which outlines -- for doctors and hospitals -- what type of coverage you have.

Page 317, Line 13-20: Prohibits doctors from purchasing or investing in health care facilities from the point of plan implementation.

The practice is not outright prohibited in this section, but made much more difficult to do (i.e. a person wishing to do so would have to apply for an exemption and show justified safety nets against abuse). The reasoning is pretty straight forward: If you could get paid twice for something, might there not be incentive for you to abuse that loophole? If you are both a physician and an investor in the facility you practice in, might there not be incentive for you to direct a patient to your facility, even if it's not in their best interest, to double dip? The risk is there, at least. But again, it's not a blanket prohibition in the language of the bill.

Page 91, Lines 4-7: Mandates that health care providers pay for interpreters for illegal aliens.

Completely false. The bill does require "culturally and linguistically appropriate communication and health services", but doesn't mandate that they only be used for illegal immigrants. There are legal citizens of the united states who's primary language isn't English, and in times of medical need would need to be able to communicate in their own language not only for their benefit, but for the benefit of doctors and hospital staff as well.

Page 170, Lines 1-3: Stipulates that all nonresident aliens are exempt from the tax penalty presented in this chapter. Does that mean nonresident aliens will pay nothing for their health care?

No. While the section listed does exclude nonresident aliens (read - not illegal aliens, just nonresident aliens) from the tax penalty, that doesn't say anything about how they'll pay for their health care. It simply gets them out of the 2.5% income tax penalty for not having insurance. So how do they pay for their health care? The same way everyone else who is exempt for other reasons (religious belief, cons. objector, etc.) or those not exempt from the 2.5% penalty will: out of their own pockets.

Page 272, Section 1145: Cancer treatment rationed “as determined appropriate by the Secretary.”

Not. Even. Close. This section includes not a single reference to rationing of any kind. What it says, in a nutshell, is that cancer treatment facilities are more costly and have greater expenses than hospitals that don't offer such treatment, and therefore payout rates can be adjusted. Instead of rationing, it's actually taking higher cost cancer treatment and paying for it (and allowing Medicare to do the same) more quickly and completely. It's worth looking at the exact text on this one, to see how far off the Senator's assertion is:
"‘‘(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as determined appropriate by the Secretary). ‘‘(B) AUTHORIZATION OF ADJUSTMENT.— Insofar as the Secretary determines under subparagraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.’’"
Not so much rationing as better payout structure for facilities providing cancer treatments.

Page 280, Section 1151: Imposes penalties and fines on hospitals for “preventable” visits.

Calling what is defined in this section a "penalty" is like someone saying they were "penalized" by their employer when they weren't payed for skipping a week of work. The design of this bill is to make health care more affordable and more efficient. Incentives for "first time fix" speak directly to that improved efficiency.

Page 298, Lines 9-11: Could impose penalties and fines on hospitals for re-admission after first treatment (fix on the first try or suffer the consequences).

See previous answer.

Page 341, Lines 3-9: Does this grant federal power to arbitrarily disqualify HMO’s, thereby forcing people into public health care at random?

There is nothing arbitrary in how these qualifications are defined. In fact, there is a clearly outlined set of rules for qualification/disqualification. It does give the secretary the ability to disqualify a Medicare Advantage Plan if "if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part", but could hardly be called arbitrary if there are rules that are written out before hand. The rules defined are also quite reasonable in terms of consumer protection.

Page 149, Lines 16-24: Imposes an 8 percent payroll tax penalty for any employer that makes more than $400,000 and fails to offer to its employees the option to enroll in a qualified health care plan.

Here's where we get to the ideological debate rather than hearsay and misleading analysis of the bill. Another goal of this bill is to decrease the number of uninsured. Reducing health care costs while providing such an incentive to employers to offer insurance would be a way to achieve this. If a company pays 10 people $40k a year, they would pay $3200 in taxes if they don't offer insurance. The money of course goes to the health insurance exchange trust fund which would help in funding the public option, so if the employer doesn't offer insurance, they still have to pay something for their employees health care (wasn't that the point of this employer based health care system to begin with?). As example, take a look at what Romney did in Massachusetts. You'd be shocked to see that his health care plan for that state included such provisions to prevent "free riding employers." If employers know there's a public option, what incentive do they have in offering a private plan to their employees? It would only cost them more money. This makes the public option cost them money if they choose to not offer a private plan. This clause will help the private sector remain competitive with a public option.

Page 195: The Secretary will have full access to every citizen’s most private records.

Misleading. ID number, filing status, modified AGI, number of dependents, other information as prescribed by the secretary "as might indicate whether the taxpayer is eligible for such affordability credits." Summary: If you can reasonably afford insurance, of course they're going to need to know a little bit about you. We would stop short of calling this "your most private records." It's worth noting that the data collected would be no different than what your current insurance provider collects about you for the exact same purposes (plus some, in the current system, i.e. justification for dropping you for existing conditions, or raising your premium if you actually use your health insurance to obtain health care).

Does everyone have a right to government health care? Where and when was that right established?

According to the Declaration of Independence everyone has a right to life, liberty, and the pursuit of happiness. Health care aides in all three of those much like food and drug safety, fire departments, transportation safety, police, and bank account guarantees. Should the federal government stop all of these protections to life because you can't find the direct designation as a right in the Constitution? We think that would be self defeating. We would designateing health care an "indirect right" which aides in protecting other rights. (Kind of hard to utilize that concealed weapons permit if a person can't afford to get treatment for that pneumonia, eh?)

Page 429, Lines 10-12, & Page 430, Lines 12-14: May seniors opt out of end-of-life consultations?

Nope. Mandatory based on age and last time you yelled at a kid to get off your lawn. The bodies of these "consulted" seniors will then be recycled into meal, which will be used in school cafeteria lunches and as mulch for the White House organic garden. All clothing and possessions of these "consulted" seniors will be sold, each Saturday, at the White House garage sale... No, Senator, of course seniors can opt out. That is why the word "voluntary" is used in this section. (For clarity, the page and line numbers the Senator references in his question do not match the relevant section discussing these consultation and how they will be paid. But we knew what he was getting at. We get Sarah Palin's Facebook updates too.)

Page 429, Lines 10-12: Empowers federal government to create physician payments for end-of-life plans under something called “advance care consultation.” Can decisions by the patient be overridden by the Secretary in an advance-care consultation plan?

Similar to previous question. There isn't a relevant section that could be found to even be partial construed as saying such. In fact, the portion of the bill discussing "end of life" consultation deals with paying doctors for being more directly involved in the consultation should a patient request it. Voluntarily.

Page 429, Lines 13-25: The health care bill is 1,018 pages. I would venture that the rules to implement these pages would, at least, double the size of the bill.

For a little perspective: A single volume of the Harry Potter series averages 255 words per page This bill averages 150 words per page. Do the math (Hint: This bill is shorter than a Harry Potter book!). Also, in 2007, President Bush's budget bill ran to 1,482 pages. Not a relevant criticism of such broad legislation, in our opinion.

One of the foundational reasons for the Affordable Health Choices Act is to reduce health care costs. Since the most conservative estimate to implement this program is $1 trillion (some say it will be multiples of that), how, then, can a dramatic rationing of health care services be avoided? How drastically will health care services be rationed?

Straw man argument, but it does stem from a valid ideological argument we should be having, rather than repeating the unfounded foolishness circulated in chain emails and shouted out at townhalls. If this were a single payer style solution being presented in this bill, then you would have a legitimate concern in need of addressing. But it's not, and there will be more money spent on health care outside of this bill, there will still be people in private insurance, and people will still be paying co-pays and deductibles. The question also neglects the fact that rationing of quality care does exist in our current system, where doctors are paid by quantity, not quality and your insurance company has every incentive to dump you or deny you coverage. This bill reverses that.

(Bonus Question) Page 768, Lines 20-24, and Page 769, Lines 1-3: Is the language concerning increasing the birth intervals between pregnancies mandatory?

No. We gathered this from the following lines in the bill (emphasis ours) - "SEC. 1713. OPTIONAL COVERAGE OF NURSE HOME VISITATION SERVICES."; "such services are effective in one or more of the following"; "Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies." Key word there: Optional.

Page 1018, Lines 6-19: In regards to “subtitle E, limitation on federal funds,” does this require compliance by the state to the entire bill or federal funds will be withheld?

States qualify for federal funds provided they follow the rules in division A, if you want to break the rules of division A, then you'll be denying Utah money. This how all federal funding to states works. There are always strings attached, and the only alternative is refusing federal funds or... well, secession.

(For those who would like to know more, or inquire about our sources and research, feel free to email us directly via The SideTrack, and thanks again to The Senate Site for taking interest in an honest discussion by allowing us to post our responses to the questions raised.)

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Anonymous Adano said...

My respect for the senatesite just went way up. Not because of the content of this post, but because you allowed guests to post a critical response to an earlier post.

That's what we need in this debate--an actual exchange of ideas.

9/15/2009 9:01 AM  
Anonymous Karl said...

I second Adano's comment. Agree or disagree with this or Chris Buttars original post, deepest gratitude is owed The Senate Site for encouraging a real debate of ideas.

9/15/2009 12:26 PM  
Anonymous Anonymous said...

Nice to see someone keep the Senators honest.

9/15/2009 1:36 PM  
Anonymous Provo Mom said...

Finally, some factual information! What does it say about our news media that bloggers working on their own dime can get better information out there than payed journalism staff?

9/15/2009 1:42 PM  
Anonymous matt said...

That's nice, although it doesn't really matter much since the health care bill is going to be completely different. Good effort though.

9/15/2009 3:41 PM  
Blogger Jason The said...

The house version hasn't changed at all, and that's the version both Senators referenced, so the version we used for research.

And thanks, Senate Site, for putting our responses up. It's encouraging to know you are listening.

9/15/2009 9:36 PM  
Anonymous Ken said...

I think it's great you would post a response to Senators from readers. Kudos.

9/18/2009 10:51 AM  

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