USA Today published an op-ed by House Minority Leader John Boehner in which he claimed that a Democratic health care reform bill "would create a 'Health Benefits Advisory Committee' that would make determinations about what kinds of treatments, items and services can be covered within certain benefit classes" [emphasis added]. In fact, the provision Boehner cited sets minimum requirements for what "treatments, items and services" must be covered; moreover, Boehner's suggestion that the bill would create rationing ignores the fact that private insurers currently ration health care.
Boehner claimed health advisory committee determines what "can be covered"
From Boehner's August 13 USA Today op-ed:
And instead of using the power of the bully pulpit to rein in the speaker and her allies, the president has attempted to use it to spin the American people about the hopelessly flawed bill the speaker is seeking to pass in September.
Finally, the president claimed the plan will not lead to rationing. But the bill, on page 30, section 123, would create a "Health Benefits Advisory Committee" that would make determinations about what kinds of treatments, items and services can be covered within certain benefit classes, and what kind of cost sharing will occur.
But health advisory committee sets coverage floor, not ceiling
Bill description makes clear Health Benefits Advisory Committee recommends "benefits required to be included" in qualified plans. According to a section-by-section description of the Affordable Health Choices Act by committees on Energy and Commerce, Ways and Means, and Education and Labor, section 123 establishes an advisory committee that will make recommendations "regarding the details of covered health benefits as outlined in Sec. 122," which "[o]utlines the broad categories of benefits required to be included in the essential benefits package" [emphasis added]. Section 123 does not state that the advisory committee will establish a cap on the types of health care services that can be covered. From the report:
SUBTITLE C - STANDARDS GUARANTEEING ACCESS TO ESSENTIAL BENEFITS
Sec. 121. Coverage of essential benefits package. Requires qualified plans to meet the benefit standards recommended by the Benefits Advisory Committee and adopted by the Secretary of HHS. Plans outside the Exchange must offer at least the essential benefits and others as they choose. Plans within the Exchange must meet the specified benefit packages, which includes a tier with offerings of additional benefits. Allows for the continued offering of separate excepted benefits packages as in current law outside of the Exchange.
Sec. 122. Essential benefits package defined. Outlines the broad categories of benefits required to be included in the essential benefits package, prohibits any cost-sharing for preventive benefits (including well child and well baby care), and limits annual out-of-pocket spending in the essential benefits package to $5,000 for an individual and $10,000 (indexed to CPI) for a family. Defines the initial essential benefit package as being actuarially equivalent to 70% of the package if there were no cost-sharing imposed.
Sec. 123. Health Benefits Advisory Committee. Establishes a Health Benefits Advisory Committee, chaired by the Surgeon General, with private members appointed by the President, the Comptroller General, and representatives of relevant federal agencies. The Advisory Committee will make recommendations to the Secretary of HHS regarding the details of covered health benefits as outlined in Sec. 122, including the establishment of the three tiers of coverage: basic, enhanced and premium.
Sec. 124. Process for adoption of recommendations; adoption of benefit standards. Establishes the timeline for the initial adoption of benefits by the Secretary of HHS and the period updating of standards in the future. [Report prepared by Committees on Energy and Commerce, Ways and Means, and Education and Labor, 7/14/09]
Section 121 requires qualified plans to "at least" meet benefit standards recommended by the advisory committee. From section 121:
IN GENERAL.-A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the essential benefits package described in section 122 for the plan year involved. [Affordable Health Choices Act]
Section 122 outlines the benefits required to be included in qualified packages. From section 122:
Minimum Services To Be Covered- The items and services described in this subsection are the following:
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age. [Affordable Health Choices Act]
Section 123 establishes an advisory committee that recommends benefit standards for qualified packages. From section 123:
(a) Establishment --
(1) IN GENERAL -- There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
(b) Duties --
(1) RECOMMENDATIONS ON BENEFIT STANDARDS- The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the 'Secretary') benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
(2) DEADLINE- The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.
(3) PUBLIC INPUT- The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(4) BENEFIT STANDARDS DEFINED- In this subtitle, the term 'benefit standards' means standards respecting --
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5). [Affordable Health Choices Act]
Boehner's suggestion that bill would create rationing ignores reality: Insurance companies already ration care
Sebelius saw rationing by "private insurers" on "a regular basis" while serving as Kansas insurance commissioner. During her confirmation hearings, Health and Human Services Secretary Kathleen Sebelius stated, "I, frankly, as insurance commissioner, where I served for eight years, saw [rationing] on a regular basis by private insurers, who often made decisions overruling suggestions that doctors would make for their patients, that they weren't going to be covered. And a lot of what we did in the office of the Kansas Insurance Department was go to bat on behalf of those patients to make sure that the benefits that they had actually paid for were, in fact, ones that were delivered." [Senate confirmation hearing, 3/31/09]
Sebelius: "Health care providers," not "private insurers" should make coverage decisions. In Sebelius' words:
It's private insurers who often are telling their clients that, "No, you can't get this recommended treatment that the doctor has made"; "No, you can't get this drug"; "No, you're not going to be able to stay in the hospital an extra day"; "No, you're not going to get this because we're concerned about costs." So, people who say that, "Oh, this is a terrible idea; this could happen someday in the future," it's happening every day. But it's really private insurance plans that are making those decisions. What we're hoping to do is change that situation. Private insurance companies should no longer be able to decide who gets health coverage and who doesn't, what kinds of benefits are available. And we want to make sure that it's really health care providers that make those choices in the future. [MSNBC's Hardball, 6/15/09]