John Roberts did not challenge Betsy McCaughey's assertion that the Affordable Health Choices Act "basically" "pushes everyone into an HMO-style plan."
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On June 24, CNN's American Morning co-host John Roberts did not challenge former New York Lt. Gov. Betsy McCaughey's assertions that the Affordable Health Choices Act "basically" "pushes everyone into an HMO-style plan" and that most Americans will have to "go through what they call a 'medical home,' which is this decade's term for an HMO gatekeeper." However, under the proposed legislation, individuals already enrolled in a health care plan or receiving health insurance coverage are able to keep their coverage and are not "pushed" into "an HMO-style plan."
McCaughey later stated that "most Americans will have no options. When they file their taxes, they're going to have to staple a proof, like a W-2, that they've enrolled in one of these qualified health plans, with the limits of choice: limits of choices of doctors, limits of choices of when you can see a specialist, when you can have a diagnostic test." In fact, individuals do not have to enroll in "qualified health plans." Indeed, the legislation contains a provision explicitly stating that "[n]o individual shall be compelled to enroll in a qualified health plan or to participate in a Gateway." In the bill, "qualified health plans" are plans that must meet certain criteria in order to be offered under a "Gateway." A gateway is defined as a state-run mechanism that "facilitates the purchase of health insurance coverage and related insurance products through the Gateway at an affordable price by qualified individuals and qualified employer groups."
From the bill:
''(1) VOLUNTARY NATURE OF GATEWAY. --
''(A) CHOICE TO ENROLL OR NOT TO ENROLL. -- A qualified individual shall have the choice to enroll or not to enroll in a qualified health plan or to participate in a Gateway.
''(B) PROHIBITION ON COMPELLED ENROLLMENT. -- No individual shall be compelled to enroll in a qualified health plan or to participate in a Gateway.
While the bill says that those who are not enrolled in "qualifying coverage" "for any month during the taxable year" may be fined as mandated by Subtitle D, the "Shared Responsibility for Health Care," the definition of "qualifying coverage" does not say that the plan a consumer is enrolled in must be a "qualified plan" -- it simply includes that as an option -- and the definition does not say it must be an HMO or have a "medical home." "Qualifying coverage" can be one's existing coverage. The office of Senate HELP Committee chairman Edward M. Kennedy has said that an "important foundation" of the bill is the principle that "[i]f you like the coverage you have now, you keep it. But if you don't have health insurance or don't like the insurance you have, our bill will give you new, more affordable options."
According to the bill:
(6) QUALIFYING COVERAGE. -- The term 'qualifying coverage' means --
(A) a group health plan or health insurance coverage --
(i) that an individual is enrolled in on the date of enactment of this title; or
(ii) that is described in clause (i) and that is renewed by an enrollee;
(B) a group health plan or health insurance coverage that --
(i) is not described in subparagraph (A); and
(ii) meets or exceeds the criteria for minimum qualifying coverage (as defined in subsection (d));
(C) Medicare coverage under parts A and B of title XVIII of the Social Security Act or under part C of such title;
(D) Medicaid coverage under a State plan under title XIX of the Social Security Act (or under a waiver under section 1115 of such Act), other than coverage consisting solely of benefits under section 1928 of such Act;
(E) coverage under title XXI of the Social Security Act;
(F) coverage under the TRICARE program under chapter 55 of title 10, United States Code;
(G) coverage under the veteran's health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary to be not less than the coverage provided under a qualified health plan, based on the individual's priority for services as provided under section 1705(a) of such title;
(H) coverage under the Federal employees health benefits program under chapter 89 of title 5, United States Code; (I) a State health benefits high risk pool;
(I) a State health benefits high risk pool;
(J) a health benefit plan under section 2504(e) of title 22, United States Code; or
(K) coverage under a qualified health plan.
From the June 24 edition of CNN's American Morning:
ROBERTS: Meantime, to another one of the president's priorities: health care. So, what's another trillion dollars? President Obama standing firm on the public option for health care, in spite of that possible price tag, which is a staggering one, but private health insurance groups say they do not like the idea of competing with the government.
Former New York Lieutenant Governor Betsy McCaughey is a long-time expert in public health and is currently the chairwoman of an advocacy group for patients' safety. And she joins us this morning. Good morning to you. How are you?
McCAUGHEY: Good to be with you.
ROBERTS: So, we should point out that you were opposed to the Clinton health care plan back in 1993. You are opposed to a public option this time around. Are you just opposed to the government getting involved in providing health insurance for people?
McCAUGHEY: No, I've read the Kennedy bill through three times, and I'm worried because I'm a patient advocate -- I spend the first 80 hours of the week preventing hospital infections -- and this bill will mean fewer choices for patients. Basically, the bill pushes everyone into an HMO-style plan, with restrictions on your access to specialists and diagnostic tests. You'll have to go through what they call a "medical home," which is this decade's term for an HMO gatekeeper.
Doctors will be paid based on incentives to reduce care and save money, rather than being paid every time you get a service or you visit the doctor. The one outrage of this bill, more than any other, is that members of Congress exempt themselves from this limit on choices. They're members of a federal health plan, with many, many choices: fee-for-service plans, high-deductible plans, as well as HMOs, and plans with many more choices of doctors.
ROBERTS: There is a clause in there that says that federal employees are not eligible. I've got it right here. But they are just one of a number of groups that aren't eligible, and --
McCAUGHEY: Not eligible -- they're not being pushed into this. Otherwise, most Americans will be -- will have no option --
ROBERTS: It says here: "not eligible for coverage" --
McCAUGHEY: That's right -- page 114. But most Americans will have no options. When they file their taxes, they're going to have to staple a proof, like a W-2, that they've enrolled in one of these qualified health plans, with the limits of choice: limits of choices of doctors, limits of choices of when you can see a specialist, when you can have a diagnostic test.
And for seriously ill people, this just isn't good enough. If it were good enough, members of Congress would agree to it as well.
ROBERTS: Well, as I said, the bill is written here. It just says that these people are not eligible, as opposed to saying, "Hey, we're going to give you access." It would suggest you've already got -- you've --
McCAUGHEY: This isn't a question of choice.
ROBERTS: You've already got --
McCAUGHEY: You have to do it. If you don't do it, on page 104, there is a hefty penalty.
ROBERTS: But this would suggest that federal employees already have health care; they don't need this system.
McCAUGHEY: But other Americans who already have health care still have to do this. Let me make that clear: This is not optional. It's also a serious problem for people who are seriously ill, because the government has said they're going to slow the flow of dollars into the health care system. That's going to mean cuts in hospital budgets, fewer nurses spread even thinner, fewer diagnostic tests, so it means longer waits for treatment.
ROBERTS: Do you think that a health care plan is even going to see the light of day? There seems to have been a strategic blunder made in sending out this bill to the Congressional Budget Office for scoring -- it came back a trillion dollars over 10 years. Senator Dianne Feinstein [D-CA] said we don't know if we've got the votes to pass this.