Part Two of Two
The National Right to Life
Committee today released an
analysis of provisions in
the Senate health care bill
crafted by Senate Majority
Leader Harry Reid (D-Nv.)
relating to the rationing of
lifesaving medical
treatment. A full analysis
follows this introduction.
By way of summary NRLC
concludes:
* The ability of senior
citizens to use their own
money, if they choose, to
avoid involuntary denial of
medical treatment under
Medicare could be severely
limited.
*State commissioners of
the new health insurance
“exchanges” created by the
bill would be given power to
deny people who are trying
to obtain policies in the
exchange the option of
choosing health plans less
likely to deny treatment, by
limiting what they would be
allowed to pay for such
policies.
*In response to public
reaction that denounced
efforts to encourage
patients to agree to reject
treatment as a way of saving
costs, the Senate avoided
including the "advance care
planning" provisions still
in the House bill. Instead,
it has sought to achieve a
similar result under a
different name. Under the
title "Shared Decisionmaking,"
the bill funds and promotes
"patient decision aids" to
"help" patients make
treatment decisions.
*A Medicare Advisory
Board is established to
force Medicare payments
below the rate of medical
inflation.
In releasing the
analysis, Burke J. Balch,
J.D., director of NRLC's
Robert Powell Center for
Medical Ethics, made the
following points:
Since its inception, the
pro-life movement has been
as concerned with protecting
the lives of older people
and people with disabilities
from euthanasia, including
the involuntary denial of
treatment, food, and fluids
necessary to prevent death,
as it has been dedicated to
protecting unborn children
from abortion. Sen. Reid's
bill contains multiple
provisions that threaten
these lives.
The Reid bill contains
important elements that
would greatly impact the
ability of patients to
receive unrationed medical
care. These elements,
combined with inadequate
funding-- a scheme of
"robbing Peter to pay Paul"
under which half of the
funding comes from cuts in
Medicare spending -- would
result in rationing
life-saving treatment for
senior citizens.
NRLC’s complete analysis
follows.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Seniors Beware: Reid Bill
Provisions Threaten Older
Americans and People with
Disabilities
INTRODUCTION
The U.S. Senate is poised
to begin debate on the
2,074-page health care bill,
crafted by Senate Majority
Leader Harry Reid, when
senators return to
Washington next week.
In a release last week,
NRLC noted that Sen. Reid's
bill would authorize the
federal government to pay
for any and all abortions
through a huge federal
health insurance program,
and also to subsidize
purchase of private plans
that cover abortion on
demand. (See www.nrlc.org/AHC/Release111809.html)
Further analysis finds
that the Reid bill, like the
House bill approved earlier
this month, puts the lives
of older Americans and
persons with disabilities at
great risk.
*Limits on Senior
Citizens’ Choice to Spend
Their Own Money to Ensure
Access to Lifesaving Care
The fundamental question
is whether seniors will be
prevented from using their
own money, if they wish, to
gain access to insurance
that will not ration medical
treatment. The significant
cuts that the Senate and
House health care bills make
in Medicare make it all the
more important to protect
the right of older
Americans, if they choose,
to use their own money to
save their own lives. It is
critical that seniors retain
this right which would be
eliminated by the Reid bill
as introduced. Specifically,
Under current law,
Medicare recipients have the
legal option, if they
choose, to add their own
money on top of the
government’s contribution in
order to obtain "private
fee-for-service" Medicare
Advantage plans to avoid
"managed care" limitations
on treatments and tests and
to ensure access by paying
providers market rates.
Presently, the Medicare
statute prevents the
government from
second-guessing or imposing
limits on the premiums for
private fee-for-service
plans. Beneficiaries can
balance cost, benefit, and
affordability in making
their own decisions whether
to purchase such plans.
However, Section 3209,
found on page 920 of the
Reid bill, amends that
provision. It empowers the
federal government to
exclude those plans whose
bids it does not like from
competing in Medicare
Advantage. The Centers for
Medicare and Medicaid
Services (CMS) would have
the discretion to deny older
Americans the choice of
plans whose premiums CMS
disallows. This amounts to
the imposition of price
controls, thus limiting what
older Americans are
permitted to spend for
health insurance. Again,
being prohibited from paying
what may be needed to obtain
unrationed health insurance
amounts to
government-imposed health
care rationing.
The provision duplicates
the little-noticed section
1175 of the bill passed by
the House of
Representatives. Neither
provision was in bills
reported by the committees
of either chamber. At the
last minute, both were
slipped into the versions
sent to the floor for
action.
Limiting the Ability of
Citizens to Spend Their Own
Money to Obtain Unrationed
Care in the Health Care
“Exchanges.”
Sen. Reid's bill limits
the right of those eligible
to participate in the
insurance exchange to spend
their own money to save
their own lives. Beginning
on page 37, Section 1003
empowers the State Exchange
Commissioner to exclude from
the exchange plans offered
by health insurance issuers
whom the State Commissioner
considers to have a pattern
of "excessive or unjustified
premium increases." It is
noteworthy that this
provision will also have a
chilling effect on health
plans offered outside the
exchange. Insurers will be
fearful that if they fully
meet the demand for health
insurance by employers and
others, it may be held
against them so as to keep
them out of the exchange.
While the exchanges are to
begin by serving individuals
and small businesses,
ultimately they are intended
to cover even the largest
employers, so the
possibility of exclusion
from so large a market is
likely to be a significant
deterrent.
This parallels a similar
provision (Section 104)
inserted in the House bill
when it went to the floor.
This essentially grants
government bureaucrats the
discretion to limit what
people are allowed to pay
for health insurance. Being
prohibited from paying what
may be needed to obtain
unrationed health insurance
amounts to
government-imposed health
care rationing.
Pushing Rejection of
Treatment to Save Money:
Renaming “Advance Care
Planning” as “Shared
Decisionmaking”
The Reid bill does not
include provisions
paralleling those in the
House bill designed to
create incentives for
"advance care planning." But
the Reid Bill does contain
a section titled "Shared
Decisionmaking.” Section 936
(which begins on page 1106)
provides funding to develop
and disseminate "patient
decision aids" which are to
include "relative cost of
treatment or, where
appropriate, palliative care
options" and to "educate
providers on the use of such
materials, including through
academic curricula" (p.
1110). Money is to be
awarded to establish "Shared
Decisionmaking Resource
Centers . . . to provide
technical assistance to
providers and to develop and
disseminate best practices .
. ." (p. 1112).
The concern with this
section is the same as that
with promoting advance care
planning. Given the strong
views many in the medical
community have about “poor
quality of life,” and given
the considerable emphasis on
saving costs (along with the
Reid bills defective process
for selecting the materials
the patients receive), there
is great danger that these
measures will in fact subtly
or otherwise "nudge"
patients in the direction of
rejecting life-saving
treatment to save costs.
Independent Medicare
Advisory Board Must Drive
Medicare Reimbursement Below
the Rate of Medical
Inflation
In Section 3403,
beginning on page 1000, the
Reid bill provides for an
"Independent Medicare
Advisory Board.” Its task is
to ensure that senior's
Medicare meets budget goals
that will tighten each year.
For fiscal years 2015
through 2019, the bill sets
a target rate of growth for
Medicare midway between
medical inflation and
average inflation; for
subsequent years the target
is the growth in Gross
Domestic Product per capita
plus 1%.
To the extent the Center
for Medicare and Medicaid
Services projects that
Medicare growth rates would
exceed these targets, the
Board would have to act to
reduce the gap by specified
percentages varying by year.
This gap-reducing would
likely come by reductions in
payments to health care
providers, leading those
providers to skimp on care
or leave the Medicare
program altogether.
The recommendations of the
Board would automatically go
into effect unless Congress,
through an expedited
procedure, adopted another
means resulting in the same
reductions; to waive this
would require a 3/5 vote.
Further details and
documentation can be found
at
www.nrlc.org/healthcarerationing/reidsubstitute.html
