Beware: Senate Bill Threaten Seniors, Disabled With Health Care Rationing

Bioethics   |   Steven Ertelt   |   Nov 25, 2009   |   9:00AM   |   WASHINGTON, DC

Beware: Senate Bill Threaten Seniors, Disabled With Health Care Rationing

by Burke Balch, JD
November 25, 2009

LifeNews.com: Burke Balch is a pro-life attorney who is the director of the Robert Powell Center for Ethics at the National Right to Life Committee. He is considered one of the foremost experts on health care, euthanasia and bioethics issues.

The U.S. Senate is poised to begin debate on the 2,074-page health care bill, crafted by Senate Majority Leader Harry Reid (D-Nv.), when senators return to Washington next week.

In a release last week, the National Right to Life Committee (NRLC), the federation of right-to-life organizations in all 50 states, noted that Senator 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.

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

Under current law, Medicare recipients have the legal option, if they choose, of adding their own money on top of the government contribution in order to obtain "private fee-for-service" Medicare Advantage plans that can use the additional premiums 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, allowing beneficiaries to balance cost, benefit, and affordability in making their own decisions whether to purchase such plans.

However, Section 3209, on page 920, amends that provision so as to empower the federal government to exclude from competing in Medicare Advantage those plans whose bids it does not like. The consequence is to give the Centers for Medicare and Medicaid Services (CMS) 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.

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 increase the importance of protecting 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.

LIMITING THE ABILITY OF CITIZENS TO SPEND THEIR OWN MONEY TO OBTAIN UNRATIONED CARE IN THE HEALTH CARE EXCHANGES

Also, for those eligible to participate in the insurance exchange Sen. Reid=s bill limits their right 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 have a pattern of Aexcessive or unjustified premium increases.

It is noteworthy that this provision will even have a chilling effect on health plans offered outside the exchange, since 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 inserted in the House bill when it went to the floor, Section 104.

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 contains a section titled "Shared Decisionmaking." The Reid bill does not include provisions paralleling those in the House bill designed to create incentives for Aadvance care planning.

But Section 936, beginning 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 AShared 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 the promotion of advance care planning. Given the strong views many in the medical community have about poor quality of life and the considerable emphasis on saving costs (along with the Reid bills defective process for selecting the materials the patients receive), the danger is great 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," given the task of ensuring 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 through 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:
https://www.nrlc.org/healthcarerationing/reidsubstitute.html

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