Frequently Asked Questions about the Affordable Health Care For America Act (HR 3962)
After a full review of the Affordable Health Care for America Act, I will support this important legislation. I support health care reform. The status quo is unacceptable.
The Affordable Health Care for America Act brings stability and security to families struggling with increasing health care costs. It gives much-needed financial relief to small business owners who cannot afford coverage for their employees. It provides coverage to the 104,000 individuals lacking insurance in Washington’s 2nd Congressional district. The bill improves the Medicare program for our seniors. And the bill stops the discrimination for people who have been denied coverage, or charged through the roof, because of their age or gender, or because they have a pre-existing condition such as diabetes or cancer.
Since July, I have held two in-person town hall meetings on health care reform that were attended by over 3,000 people, and two telephone town halls listened to by over 7,600 people. I participated in a League of Women Voters health care forum in Coupeville that was attended by over 300 people. And I held nearly 30 meetings on health care reform in the district with local doctors, patients, small businesses, families and hospitals. I have responded to nearly 5,000 constituent letters, emails and calls on health care reform to this point, and will respond an additional 5,000 letters, emails and calls after I take this vote.
After reading through your emails and letters, I have noticed several common questions and concerns about health care reform. I have prepared this Frequently Asked Questions document to help answer some of your questions and concerns. I hope that you will find it helpful.
Please scroll down to read the entire list of questions or use the links below to go directly to a specific section.
- Congressman Larsen’s Positions on Health Care Reform
- How will this affect me?
- Medicare
- Employers and Small Businesses
- Costs
- Public Option
- Veterans
- Legislative Process
- Health Care Reform Myths
CONGRESSMAN LARSEN’S POSITIONS ON HEALTH CARE REFORM
Q: Do you support the House health care reform bill? If so, why?
After a full review of the Affordable Health Care for America Act, I will support this important legislation. I support health care reform. The status quo is unacceptable.
The Affordable Health Care for America Act brings stability and security to families struggling with increasing health care costs. It gives much-needed financial relief to small business owners who cannot afford coverage for their employees. It provides coverage to the 104,000 individuals lacking insurance in Washington’s 2nd Congressional district. The bill improves the Medicare program for our seniors. And the bill stops the discrimination for people who have been denied coverage, or charged through the roof, because of their age or gender, or because they have a pre-existing condition such as diabetes or cancer.
Since the House of Representatives began crafting health care reform legislation, we have made great progress for Washington state. I brought local concerns to the attention of leadership in Washington, D.C. and fought hard to make sure the health care reform bill includes a fair deal for Washington state. Specifically, I pushed to protect access to health care for Washington state patients by ensuring that Washington state is rewarded, not penalized, for providing high-quality, low-cost patient care.
I believe that a vote in favor of the Affordable Health Care for America Act is the right vote for Washington’s 2nd Congressional district.
Q: What do you like about the bill?
This bill includes language to fix the long-standing Medicare reimbursement problems that have hurt access to health care in Washington state. This is a huge victory for our state.
The bill also bans discrimination for pre-existing conditions, age and gender. No one should be denied coverage, or be charged through the roof, because of their age or gender, or because they have a pre-existing condition.
It is also important to point out that this bill protects people’s choice of doctors and health plans. If you like your doctor or your health plan, you can keep your doctor or health plan. If you have good insurance that you like, nothing in this bill will take it away from you.
And the Affordable Health Care for America Act expands access to quality, affordable health insurance options by setting up a Health Insurance Exchange that includes a public option that works for Washington state. This exchange provides one-stop, comparison shopping for qualifying individuals and small businesses.
Small businesses currently pay 18 percent more than larger firms to provide the same health insurance benefits to their employees. This exchange will help bring much-needed financial relief and stability to small business owners and their employees.
And finally, the bill improves Medicare benefits, strengthens the solvency of the Medicare program, and closes the “donut hole” in the Medicare Prescription Drug Program to better serve our seniors.
Q: Do you support a public option?
After reading the section of the bill containing the public option, I have come to the conclusion that I support the public option in this bill. This new public option will work for Washington state. In the original bill, payment rates in the public option would have been based on Medicare, which would have shortchanged Washington state. But the payment rates in this new public option will be negotiated between doctors and the Secretary of Health and Human Services. This will ensure that doctors and hospitals are paid closer to market rates. Paying doctors fair market rates will ensure that they are able to accept patients covered by the public plan.
I have also said that I believe any public option must compete under a “level playing field” with the private health insurance market. The public option in this bill will do just that: it will be subject to the same rules that private insurance plans are subject to, and it will not be subsidized by the government.
Q: Do you support single-payer health care?
I do not support HR 676, legislation that would create a single-payer system by expanding Medicare, because I believe in preserving patient choice and competition, which creates incentives for doctors to provide a high level of care. I would vote against an amendment to create a single-payer system if it came up for a vote in the House.
I want health care reform to happen – and that’s why I’m working to reform health care and get reform that works for Washington state.
Reforming health care will mean no discrimination for pre-existing conditions. No dropping your coverage because you get sick. No more job or life decisions made based on loss of coverage. No need to change doctors or plans. No co-pays for preventive care. No excessive out-of-pocket expenses, deductibles, or co-pays. No yearly or lifetime cost caps on what insurance companies cover.
Q: Where do you stand on tort reform? Why isn’t this being discussed as a way to reform our health care system?
I am open to well-thought out medical malpractice reform as part of the solution on health care reform. Right now there is no agreement on how reform could be achieved. Setting caps on non-economic damages in medical malpractice suits has produced varied results. Some states with caps have seen their malpractice insurance rates increase more slowly than states without caps, but some states with caps have seen their rates increase faster than in states without caps. Capping damages can’t be the only answer to solving our health care problems. But we do need to recognize that increased litigation and the rising cost of medical malpractice insurance has contributed somewhat to the overall rise in health care costs. We need to find a balance between curbing frivolous lawsuits while still protecting those patients who truly have been wronged.
The new House health care reform bill establishes a new voluntary state program designed to encourage states to implement alternatives (“early offer” or certificate of merit approach) to traditional medical malpractice litigation. I support this provision.
Q: Do you believe that health insurance plans should be allowed to sell coverage across state lines?
I support the ability of health insurance plans to be offered across state lines, as long as state coverage mandates and state regulation of insurance are not undermined. The House health care reform bill permits states to enter into agreements to allow for the sale of insurance across state lines when the state legislatures of the states in question agree to do so. It also provides grants to states to enter into compacts, which could increase insurance choices for consumers in a state. I support these provisions.
Q: Why do we need health care reform? I already get great health insurance from my employer and I am afraid health care reform will mess up what I already have.
We need health care reform because the status quo is unacceptable. Business as usual is unacceptable for small business owners who cannot afford coverage for their employees. The status quo does not work for families who are worried about their jobs and sky-high health costs. The current system must be reformed for taxpayers who have seen health care costs explode the federal budget deficit. Discrimination must stop for my constituents who are denied coverage, or charged through the roof, because of their age or gender, or because they have a preexisting condition such as diabetes or cancer.
If you like the status quo, if you like your health insurance, nothing will change for you. If anything, your health insurance will improve and be more affordable to you. If you get sick, you will be able to get care without worrying that your premiums are going to skyrocket the next year. The bill requires your employer coverage to cap your out-of-pocket costs and prohibits annual or lifetime limits on benefits, so if you have unexpected medical needs you don’t have to worry about going bankrupt due to unexpected costs. And because millions of people without coverage today will have coverage in the future, your premiums will be lower.
Q: Will I be forced to give up my current health care coverage and take something that is going to be forced on me?
No. No one will be forced to give up their current health insurance if they like it. If you have employer-sponsored health care today – as most people do – then little to nothing will change. If anything, your health care benefits will be improved. The bill mandates minimum standards that all health insurance plans will have to meet, but employers have until 2017 to come into compliance with the new rules. Most employer-based plans already meet these minimum standards. If you buy your health insurance on the individual insurance market, then you can keep your plan permanently and it will be considered acceptable coverage. Health care plans that have been negotiated through collective bargaining agreements will remain the same.
Q: I’m uninsured – how will health care reform help me now?
Although most of the major provisions of the bill go into effect in 2013, some of the reforms will happen right away. Immediate help for the uninsured will be available until the Health Insurance Exchange is up and running – the bill creates a temporary insurance program for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions. And if you’re young, this bill will require insurance companies to allow young people through age 26 to remain on their parents’ insurance policy.
Q: I have health insurance – how will I benefit under this bill?
If you get sick, you will be able to get care without worrying that your premiums are going to skyrocket the next year. The bill requires your employer coverage to cap your out-of-pocket costs and prohibits annual or lifetime limits on benefits, so if you have unexpected medical needs you don’t have to worry about going bankrupt due to unexpected costs. And because millions of people without coverage today will have coverage in the future, your premiums will be lower.
If you have insurance, but it’s unaffordable to you, you may be eligible to purchase cheaper coverage in the Health Insurance Exchange. You may also be eligible for affordability credits to help you afford your premiums and co-pays.
Q: What is the Health Insurance Exchange?
The Exchange will provide one-stop, comparison shopping for individuals and small businesses to purchase affordable coverage. The Exchange would not be an insurer; it would provide eligible individuals and small businesses with access to insurers’ plans in a comparable way. Think of the Exchange as a Travelocity or Expedia for health insurance plans.
Beginning in 2013, individuals would be eligible for Exchange coverage unless they were enrolled in an employer-based plan, Medicaid or Medicare. In 2013, employers with 25 or fewer employees would also be Exchange-eligible. In 2014, employers with 50 or fewer employees would be Exchange-eligible. In 2014, employers with 100 or fewer employees would be Exchange-eligible. Beginning in 2015, the Commissioner could permit larger employers to participate in the Exchange.
The Exchange will make coverage more affordable for individuals and small businesses because they will be pooled together with other individuals in the Exchange. This means that people can get the benefits of large-group rates normally enjoyed only by large employers, lower administrative costs, greater transparency, and increased price competition.
Q: Will I have to buy health insurance?
Under the House bill, all individuals who can afford it have a responsibility to obtain health insurance. If families do not obtain health insurance, then they pay a tax penalty equal to 2.5 percent of the family’s income above the income tax filing threshold, but no more than the cost of the average premium. If you believe that your premiums are unaffordable, you may apply for a hardship waiver to exempt you from purchasing health insurance.
Fixing our broken healthcare system will provide real benefits for every part of our society – patients and consumers, businesses, hospitals, physicians and nurses. Fixing this will have a cost. I believe that everyone must take some responsibility to fix the system. That means that individuals must take personal responsibility to obtain health insurance, and employers must take responsibility to support the health coverage needs of their workers. Otherwise, everyone pays if individuals without health coverage end up in the emergency room.
Q: What is the public option?
Under the House health care reform bill, the Secretary of Health and Human Services would establish a public health insurance option that would be available through the Health Insurance Exchange. Any individual eligible to purchase coverage through the Exchange would be eligible to enroll in the public option. The public option would have to meet the requirements that apply to all Exchange-participating plans, including those related to benefits, provider networks, consumer protections, and cost-sharing. Limited start-up funding would be available, but it would be repaid within 10 years.
Q: Will I be forced to join the public option?
No. The public option is one health insurance option that will be available in the Health Insurance Exchange. If you are eligible to receive coverage from the Exchange, you will be able to choose between several private health insurance options and a public option. If you want to choose a private plan, you are free to do so. If you want to choose the public plan, you are free to do so. No one will be forced in any way to join the public option.
Because most people will not be eligible to purchase coverage from the Exchange, most people will not be eligible to receive coverage from the public option. For the first several years, only uninsured individuals and people employed by small businesses will be eligible to obtain coverage from the Exchange. If you are covered by employer-provided insurance, Medicare, or Medicaid, you will not be eligible to obtain coverage from the Exchange.
Q: Will health care reform or the public option destroy the employer-based health care system? Will it lead to single payer health care?
No. In fact it will do just the opposite: it will expand the employer-based health care system. According to the nonpartisan Congressional Budget Office, under the House health care reform bill the number of people obtaining coverage through employers would increase by about 6 million. Health care reform builds on the current system and improves it by making health care more affordable for families and businesses.
Q: Can I get YOUR health care plan? That’s what I want – the same health care Members of Congress get.
As a member of Congress, I get the same choice of health care insurance plans as all other federal employees. I have a choice of insurance providers with different benefits and different premiums. My family chooses to receive coverage from CareFirst, a Blue Cross Blue Shield plan.
I want all American to get to choose their insurance the same way that federal employees and Member of Congress do – that’s why I support establishing a health insurance exchange. A health insurance exchange would be a place for individuals and small businesses to comparison shop among insurers.
Q: Can I keep my health savings account (HSA), flexible spending account (FSA), or health reimbursement account (HRA)?
Yes. Employees may still receive benefits under employer-provided HSAs, FSAs and HRAs. Nothing in the bill would eliminate these options.
I support HSAs and believe they should continue to be an affordable health insurance option for individuals and small businesses.
Q: Are you going to tax my employer-provided benefits?
No. The House bill does not tax employer-provided benefits. These benefits are currently excluded from an employee’s taxable income and the House bill does not change this tax exclusion.
Q: Will health care reform increase my taxes?
Only the wealthiest 0.3% of Americans will see a tax increase under the House bill. Middle-class Americans will not be taxed to pay for health care reform.
That said, if you choose not to obtain health insurance coverage for you and your family – either by declining your employer-provided health insurance or by not purchasing coverage from the Health Insurance Exchange – then you will have to pay a penalty. That penalty would be equivalent to 2.5 percent of your family’s income above the income tax filing threshold, but no more than the cost of the average premium. If you believe that your premiums are unaffordable, you may apply for a hardship waiver to exempt you from purchasing health insurance.
Q: Will health care reform result in rationing?
That will not happen. The House health care reform bill will expand and improve the availability of quality health care for all Americans, not ration it. Doctors, nurses and patients will make medical decisions, not bureaucrats.
Q: What is Medicare and how will it change under this bill?
Medicare is the nation’s health insurance program for people over the age of 65 and permanently disabled individuals under 65. Medicare covers hospitalizations, physician services, prescription drugs, nursing home care, home health visits, and hospice care, among other services.
The House health care bill will improve Medicare benefits, strengthen the solvency of the Medicare program, and close the “donut hole” in the Medicare Prescription Drug Program. It will make preventive care free for Medicare beneficiaries. It will lower the cost of prescription drugs by finally allowing the government to negotiate with drug companies to get cheaper drugs. This bill will begin closing the Medicare Part D “donut hole” immediately, and close it completely by 2019. And according to the Department of Health and Human Services, this bill will lengthen the solvency of the Medicare program by five years or more, protecting both beneficiaries and taxpayers.
The bill will also fix the long-standing Medicare reimbursement problems that have hurt access to health care in Washington state. I have been fighting to protect access to health care for Washington state seniors by ensuring that Washington state is rewarded, not penalized, for providing high-quality, low-cost patient care. This language will finally restore fairness to Washington state and make it easier for local seniors and other patients to see a doctor when they need to.
Q: Why is Washington state reimbursed so low?
Under the current system, Washington state is penalized for providing higher-quality, lower-cost care. The average federal Medicare payment per patient in Everett, Washington is $6,905 a patient in McAllen, Texas averages $14,946. But while the quality of care in Everett is the same if not better compared to McAllen, medical providers there get paid more than twice as much, costing taxpayers more than twice as much and punishing Washington providers. This inequity makes Washington physicians less likely to accept patients on Medicare, making it more difficult for local seniors to find a doctor who will accept their insurance.
Q: I heard that you are cutting over a half trillion dollars out of Medicare. Is that so and what will it mean for my Medicare benefits?
Congress is making significant changes to payment policies in the Medicare program. These payment changes strengthen Medicare by making the program more sustainable in the long run and holding down increases that would otherwise occur in Medicare premiums.
The changes Congress is making have been recommended by a non-partisan expert advisory board called the Medicare Payment Advisory Commission (MEDPAC) that advises Congress on changes that should be made to Medicare. It is made up of doctors, hospitals, and other health professionals.
Q: Are my Medicare benefits going to decrease?
No. In fact, the House health care reform bill improves your Medicare benefits. It fills the Medicare Part D drug program “donut hole” which currently leaves a gap in your prescription drug benefits when you need help the most. It will make preventive care free for Medicare beneficiaries. It will lower the cost of prescription drugs by finally allowing the government to negotiate with drug companies to get cheaper drugs. It improves the low-income subsidy programs in Medicare so that more seniors get the financial help they need to make sure Medicare is affordable for them. And this bill will lengthen the solvency of the Medicare program, protecting both beneficiaries and taxpayers.
Q: What are you doing to fix the Medicare Prescription Drug Program donut hole?
The House health care reform bill eliminates the donut hole by 2019. [The donut hole is the coverage gap in the Medicare Prescription Drug Program (Part D). Under Part D, Medicare does not contribute toward the cost of drugs when some individuals’ annual drug expenses fall into a certain range.] I strongly support fixing the donut hole so that Washington state seniors are no longer faced with paying thousands of dollars in out-of-pocket drug costs.
Q: I’ve heard that this bill will get rid of my Medicare Advantage plan. Is that true?
No. The House health care reform bill does not eliminate Medicare Advantage plans – instead, it simply phases out the overpayments going to these plans. Currently, the private insurance companies that offer Medicare Advantage plans are paid an average of 14 percent more than it costs to provide traditional Medicare. Since most Medicare Advantage plans simply offer standard Medicare benefits at a higher cost to the federal government and U.S. taxpayers, the bill eliminates the extra subsidies. Most private Medicare Advantage plans will still continue to operate once the current overpayments are phased out.
Q: I’ve heard that Medigap plans will no longer be available. Is that true?
No. Nothing in the bill will affect Medigap plans. Medigap plans will continue to be available to Medicare beneficiaries.
EMPLOYERS AND SMALL BUSINESSES
Q: How will the House health care reform bill help small businesses?
This legislation will bring down costs for small businesses and families. Because they lack bargaining leverage, small businesses pay 18 percent more than larger businesses for the same health insurance. Insurance market reforms will make coverage more affordable. Small business owners and their employees will have new options to purchase affordable health insurance that are not available to them now. Through a new Health Insurance Exchange, small business owners and employees can comparison shop for a plan that offers lower rates that large groups and large employers get, stable pricing from year to year and lower administrative costs. And for those small businesses with workers who are uninsured, a high risk pool will immediately offer insurance and assistance to help pay the premiums.
Q: I’m a small business owner - will I be required to provide health care to their employees?
While most employers would be required to either offer their employees health care or contribute towards the cost of their health care, many small businesses would be exempt from this requirement. The House health care reform bill exempts small businesses with less than $500,000 in payroll from an employer mandate that they provide health insurance, which would exempt approximately 86 percent of small businesses. This provision was improved from the original bill, which only exempted small businesses with less than $250,000 in payroll.
For small businesses that want to offer health insurance coverage, a tax credit over a two-year period will help them provide health benefits to their employees – paying up to 50% of their costs based on size and average wages.
Q: I’m a business owner - will I be required to provide health care to their employees?
The House health care bill requires employers to either offer coverage to their employees or pay a payroll tax. If an employer decides to offer coverage or continue to offer coverage for their full time employees, then the employer must make a contribution of 72.5 percent of the premium for individual coverage and 65 percent of the premium for family coverage. If an employer has part time employees, this amount will be reduced relative to the hours these employees work. If an employer decides not to offer coverage, the employer pays a payroll tax of 8 percent of the employer’s payroll.
Fixing our broken healthcare system will provide real benefits for every part of our society – patients and consumers, businesses, hospitals, physicians and nurses. Fixing this will have a cost. I believe that everyone must take some responsibility to fix the system. That means that individuals must take personal responsibility to obtain health insurance, and employers must take responsibility to support the health coverage needs of their workers. Otherwise, everyone pays if individuals without health coverage end up in the emergency room.
Q: How much is this health care bill going to cost?
The total cost of the House health care reform bill is $894 billion over ten years. Some of that money is already being spent on Medicare and Medicaid. The bill is fully paid for. Roughly half of the cost is paid for by achieving significant efficiencies and savings in Medicare and Medicaid – using the money we are already spending more effectively by rewarding high-quality, efficient care and expanding coverage to bring down emergency costs. The other half is paid for by a surcharge on the wealthiest 0.3% of Americans. Middle-class Americans will see no tax increases. The bill will actually reduce the deficit over ten years.
Here is a rough breakdown of the increased costs and increased revenues of the bill over 10 years (source: Congressional Budget Office):
Increased Costs |
Increased Revenues |
||
Increased Medicaid and CHIP Coverage |
$425 billion |
Changes to Medicare and Medicaid |
$426 billion |
Affordability Credits |
$605 billion |
Surcharge to wealthiest 0.3% of Americans and other tax provisions |
$572 billion |
Small Business Tax Credits |
$25 billion |
Penalties paid by individuals and employers |
$167 billion |
Total: |
$1,055 billion |
Total: |
$1,165 billion |
Increased Revenues – Increased Costs = -$110 billion |
|||
Q: Our country is in a serious economic recession. Shouldn’t Congress focus on that first?
Health care reform is a critical part of our economic recovery. If we don’t act now, skyrocketing health care costs will only get worse – threatening the budgets of families, businesses, and the nation.
According to the White House Council of Economic Advisors, reforming health care can increase families’ incomes and decrease the deficit. For a typical family of four, health care reform could put $2,600 more back in their pockets by 2020, and nearly $10,000 more in their pockets by 2030. Moreover, health care reform could have a positive and far-reaching impact on our economy, from reducing the deficit, to improving our standard of living, to strengthening the labor market.
Q: How are you going to address the increases in government spending?
Health care reform will be fully paid for. Moreover, making our health care system more efficient will decrease government spending and our federal deficit in the future. Moving forward, we must do even more to restore fiscal discipline to Washington, D.C.
Q: What is the public option?
Under the House health care reform bill, the Secretary of Health and Human Services would establish a public health insurance option that would be available through the Health Insurance Exchange. Any individual eligible to purchase coverage through the Exchange would be eligible to enroll in the public option. The public option would have to meet the requirements that apply to all Exchange-participating plans, including those related to benefits, provider networks, consumer protections, and cost-sharing. Limited start-up funding would be available, but it would be repaid within 10 years.
Q: Do you support a public option?
After reading the section of the bill containing the public option, I have come to the conclusion that I support the public option in this bill. This new public option will work for Washington state. In the original bill, payment rates in the public option would have been based on Medicare, which would have shortchanged Washington state. But the payment rates in this new public option will be negotiated between doctors and the Secretary of Health and Human Services. This will ensure that doctors and hospitals are paid closer to market rates. Paying doctors fair market rates will ensure that they are able to accept patients covered by the public plan.
I have also said that I believe any public option must compete under a “level playing field” with the private health insurance market. The public option in this bill will do just that: it will be subject to the same rules that private insurance plans are subject to, and it will not be subsidized by the government.
Q: Will I be forced to join the public option?
No. The public option is one health insurance option that will be available in the Health Insurance Exchange. If you are eligible to receive coverage from the Exchange, you will be able to choose between several private health insurance options and a public option. If you want to choose a private plan, you are free to do so. If you want to choose the public plan, you are free to do so. No one will be forced in any way to join the public option.
Because most people will not be eligible to obtain coverage from the Exchange, most people will not be eligible to receive coverage from the public option. For the first several years, only uninsured individuals and people employed by small businesses will be eligible to obtain coverage from the Exchange. If you are covered by employer-provided insurance, Medicare, or Medicaid, you will not be eligible to obtain coverage from the Exchange.
Q: Won’t the public option destroy the employer-based health care system? Will it lead to single payer health care?
No. In fact it will do just the opposite: it will expand the employer-based health care system. According to the nonpartisan Congressional Budget Office, under the House health care reform bill the number of people obtaining coverage through employers would increase by about 6 million. Health care reform builds on the current system and improves it by making health care more affordable for families and businesses.
Q: The government has proven over and over that it can not run anything efficiently. Why do you think a public option would be any different?
I would argue that the federal government has already been running a health care plan efficiently for over 45 years. It’s called Medicare. Medicare has been hugely successful in providing seniors with health coverage and bringing them out of poverty. And it has the lowest administrative costs of all health care plans – 2-3 percent as opposed to an average of 12 percent for private health insurance plans.
Q: Is there any provision related to veteran’s coverage in the health care reform bill? Will this bill affect my VA health care?
The House health care reform bill would not significantly affect the VA health system or service members and their families covered by TRICARE. Veterans in the VA system and service members and their families covered by TRICARE will be allowed to continue seeing your doctor and your care will not be affected.
Specifically, page 302 of the bill includes VA and TRICARE coverage as “acceptable coverage” under the bill. That means that if you have VA or TRICARE health coverage, you have fulfilled your responsibility to have health insurance. You would not have to pay any penalties, your employer would not be required to provide other health coverage for you and would not have to pay any penalties.
Veterans, service members and their families have access to the Health Insurance Exchange to obtain additional health insurance if they choose.
Finally, the House bill provides that TRICARE is not changed by the essential benefits package.
Q: Have you read this bill? Are you going to read it?
Yes, I have read the bill.
Q: Why are you trying to jam this bill through the House? Why not take your time and properly debate this bill? Why is the House in such a hurry to get things done?
I agree that reforming health care is a major undertaking, and Congress needs to take the time to do it right. Congress has held more than 100 hearings on health care since 2007. Democrats in Congress have held close to 3,000 health care events in our districts. Three committees in the House have spent 160 hours on hearings and markups of health care legislation. Much of the new health care reform bill has been available for review and comment for more than three months. And the full text of the bill and the manager’s amendment will be publicly available for at least 72 hours before Members of Congress are asked to vote.
I believe that it is important to get as much feedback as possible from my constituents before I vote on health care reform. I have been holding town halls and meetings with folks back in the district during the past several months – including meetings with local doctors, patients, small business and hospitals. Since July, I have held two in-person town halls attended by over 3,000 people, and one telephone town hall listened to by over 3,500 people. I participated in a League of Women Voters health care forum in Coupeville that was attended by over 300 people. I have held nearly 30 meetings on health care reform in the district. I have responded to nearly 5,000 constituent letters about health care reform. Before I vote on the new health care reform legislation, I will hold a telephone town hall and 6 conference calls with doctors, hospitals, small business leaders, and senior groups.
Q: HR 3200 was 1017 pages. HR 3962 is 1990 pages. Why is the new bill almost twice as long as the old bill?
The bill was amended by three committees, and bills get longer as they are amended and move through the legislative process. HR 3962 also includes two separate pieces of legislation (the Community Living Assistance Services and Supports Act and the Indian Health Care Improvement Act) that have been packaged together with health care reform. These bills add 398 pages to the bill.
Q: Why were the sections regarding tribes added to this bill?
Over the last few months I have heard from the eight tribes in my district that they cannot wait any longer for health care reform in Indian Country. Our country desperately needs health insurance reform – but our pursuit of reform cannot leave Native Americans behind.
The last time the Indian Health Care Improvement Act (IHCIA), which governs the Indian Health Care System, was modernized was 1992 – and that reauthorization expired eight years ago. These provisions reauthorize the IHCIA through 2025 and make urgent reforms to the program including enhancing and expanding care and modernizing the Indian Health Care System -- including the development of Indian epidemiology centers, long term home and community-based health serves, and assisted living services to Indian people.
Q: Why is page 1792 in this bill?
Section 303, the “Buy Indian Act” gives preference to Indian businesses for projects related to Indian Health Care services. Specifically, when the Indian Health Service (HIS) or the Bureau of Indian Affairs (BIA) engage in projects on Tribal territory, firms owned by enrolled Tribal members will be given preference.
Q: Is this bill going to force me to talk to doctors every five years about how I want to die? Does this bill mean forced euthanasia for seniors?
Absolutely not. The House bill says that if the patient wants to speak to his or her doctor about their wishes and values regarding end of life care, Medicare is allowed to pay for it. This would be entirely voluntary, and patients would not need to have this consultation with their doctor if they do not want to.
This provision in the bill (page 641, Sec. 1233) is about giving patients the power to communicate with their doctors regarding their wishes on these difficult issues – it’s about increasing communication between medical providers, patients and families about what kinds of measures they want and don’t want.
Specifically, page 641 of the bill, Sec 1233, would allow seniors, if they choose, to have an advanced care consultation with their doctor be paid for by Medicare once every five years, or more frequently if the patient has a life threatening disease. These consultations include “an explanation by the practitioner of the continuum of end-of-life services and services available, including palliative care and hospice, and benefits for such services that are available under this title.
Q: Does this bill mandate government funding of abortion? Will my taxpayer dollars be paying for abortions?
The bill does not mandate government funding of abortion. In fact, the bill was amended to specifically ensure that no federal funds go towards abortion services (Rep. Capps amendment, agreed to by a 30-28 vote on Thursday, June 30 during the Energy and Commerce Committee markup). The bill prohibits federal funds from being used to pay for abortion (except in cases of rape, incest, and to save the life of the woman). No health insurance plan – public or private – in the Exchange would be required to cover abortion services. If a health insurance plan does cover abortion services, funds for this purpose must be segregated from other funds, including affordability credits. Only private premium dollars can be used to provide abortion coverage.
Q: Will illegal aliens get government-funded health care?
No. The House health care reform bill specifically prevents illegal aliens from receiving government-funded health care. Page 267, Sec. 347 of the bill says: “No Federal Payment for Undocumented Aliens. Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” Sec. 341 of the bill establishes a citizenship verification mechanism that will require verification of legal citizenship in order to receive affordability credits.
Q: Isn’t it unconstitutional to require citizens to have health insurance? Where in the Constitution does say that people must have health insurance?
There is no explicit clause within the Constitution that states health care is a fundamental right, or that states that citizens must have health coverage.
However, Congress has historically provided funding to pay for the health services provided under law (Medicare, Medicaid, CHIP). Most of these statutes have been enacted pursuant to Congress's authority to "make all Laws which shall be necessary and proper" to carry out its mandate "to … provide for the … general Welfare." The power to spend for the general welfare is one of the broadest grants of authority to Congress in the U.S. Constitution. The Supreme Court allows considerable latitude to a legislative decision by Congress that a particular health care spending program provides for the general welfare.
Specifically, the Necessary and Proper Clause (commonly referred to as the Elastic Clause) grants the federal government of the United States the flexibility to create laws or otherwise to act where the Constitution does not give it the explicit authority to act. The Taxing and Spending Clause (commonly referred to as the General Welfare clause) grants the federal government of the United States its power of taxation. This is open to interpretation, but the broader view of Alexander Hamilton that spending is an enumerated power that Congress may exercise independently to benefit the general welfare, such as to assist national needs in agriculture or education, provided that the spending is general in nature and does not favor any specific section of the country over any other.
Q: Is health care reform going to lead to socialized medicine?
None of the health care reform proposals in Congress will socialize our health care system. To me, socializing health care means making our health care system more like Great Britain, where the government owns hospitals and employs physicians; or like Canada, where the government pays for every citizen’s health care. To be clear, President Obama and Congress are not proposing anything like this. Under the House health care reform bill, if you like your doctor, you will be able to keep your doctor. If you like the health care coverage you have, you will be able to keep it.
I share some of your concerns about the role of the federal government. I’m a strong believer in free market economy, and I believe that the government should step in to pass rules and regulations or legislation only when it’s needed, and particularly when doing so levels the playing field for consumers.
I believe that reforming health care is a critical priority. Today, our health care system is broken, and is needs to be fixed. The status quo is unacceptable. Families and business are faced with skyrocketing costs. Since 2001, health care premiums have grown four times faster than wages. Health care costs are breaking the bank for families, for small businesses and governments.
Reforming health care will mean no discrimination for pre-existing conditions. No dropping your coverage because you get sick. No more job or life decisions made based on loss of coverage. No need to change doctors or plans. No co-pays for preventive care. No excessive out-of-pocket expenses, deductibles, or co-pays. No yearly or lifetime cost caps on what insurance companies cover.
