CLAIM: Health Care Bill “Forces You To Enroll” In A Health Plan “Whether You Can Afford It Or Not”

McCaughey: The Law “Forces” People Into Health Care Plans “Whether You Can Afford It Or Not.” In her February 12 CPAC speech, McCaughey falsely claimed that the health care law “forces you to enroll in a one-size-fits-all health plan whether you like it or not; whether you can afford it or not.” [CPAC, 2/12/11]

FACT: Mandate Language Provides Exemptions For Those Who Cannot Afford A Qualifying Health Plan

KFF: The Law Provides Automatic Exemptions For People Who Cannot Afford A Plan. As the Kaiser Family Foundation (KFF) has noted, automatic exemptions are provided from the individual mandate for “those for whom the lowest cost plan option exceeds 8% of an individual's income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples).” [Kaiser Family Foundation, 3/26/10]

CLAIM: Section 1311 Of The Health Care Law “Empowers The Federal Government To Dictate How Doctors Treat Privately Insured Patients”

McCaughey: “Even If You're In Aetna, Or Cigna, Or Some Other Plan, The Government Is Still In Charge Of Your Care.” In her CPAC speech, McCaughey also falsely claimed that “this law empowers the federal government to dictate how doctors treat privately insured patients,” citing Section 1311 of the bill as evidence. From her speech at CPAC:

McCAUGHEY: Even worse, for the first time in history, this law empowers the federal government to dictate how doctors treat privately insured patients. So even if you're in Aetna, or Cigna, or some other plan, the government is still in charge of your care. Section 1311, right here on page 62, says that insurance companies can pay only those doctors who follow whatever dictates the Secretary of Health and Human Services imposes in the name of “quality.” Well, that can cover anything in medicine, whether your OB/GYN does a Caesarian section or whether your cardiologist opts for bypass surgery instead of using a stent....ultimately, your doctor will be forced to choose between what is best for you, and staying in the government's good graces. [CPAC, 2/12/11]

FACT: Section 1311 Sets Minimum Requirements For An Insurance Plan To Operate In The Exchange

Legislation Requires HHS Secretary To Establish Minimum Guidelines For Health Insurance Plans In The Exchange. According to the Democratic Policy Committee's summary of the Patient Protection and Affordable Care Act of 2010, the legislation requires the secretary to "[e]stablish certification criteria for qualified health plans, requiring such plans to meet marketing requirements, ensure a sufficient choice of providers, include essential community providers in their networks, be accredited on quality, implement a quality improvement strategy, use a uniform enrollment form, present plan information in a standard format, and provide data on quality measures." [Democratic Policy Committee, accessed 2/14/11]

CRS: Section 1311 Establishes “Consumer Choices And Insurance Competition Through Health Benefit Exchanges.” From the Congressional Research Service's (CRS) summary of Section 1311 of the Patient Protection and Affordable Care Act:

Part II: Consumer Choices and Insurance Competition Through Health Benefit Exchanges - (Sec. 1311, as modified by Sec. 10104) Requires states to establish an American Health Benefit Exchange that: (1) facilitates the purchase of qualified health plans; and (2) provides for the establishment of a Small Business Health Options Program (SHOP Exchange) that is designed to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the state.

Requires the Secretary to establish criteria for the certification of health plans as qualified health plans, including requirements for: (1) meeting market requirements; and (2) ensuring a sufficient choice of providers.

Sets forth the requirements for an Exchange, including that an Exchange: (1) must be a governmental agency or nonprofit entity that is established by a state; (2) may not make available any health plan that is not a qualified health plan; (3) must implement procedures for certification of health plans as qualified health plans; and (4) must require health plans seeking certification to submit a justification of any premium increase prior to implementation of such increase.

Permits states to require qualified health plans to offer additional benefits. Requires states to pay for the cost of such additional benefits.

Allows a state to establish one or more subsidiary Exchanges for geographically distinct areas of a certain size.

Applies mental health parity provisions to qualified health plans. [Congressional Research Service, 2/23/10]

KFF: Plans “Will Be Required To Offer Benefits That Meet A Minimum Set Of Standards.” According to a summary of the bill by the Kaiser Family Foundation, “Plans in the Exchanges will be required to offer benefits that meet a minimum set of standards. Insurers will offer four levels of coverage that vary based on premiums, out-of-pocket costs, and benefits beyond the minimum required plus a catastrophic coverage plan.” [Kaiser Family Foundation, 4/28/10]

CLAIM: Obama Administration Is Granting Waivers To “The Very Interests Who Supported This Law”

McCaughey: “If The Government Has The Power To Grant Waivers, They Have The Power To Deny Them. And Destroy A Business.” In her CPAC speech, McCaughey suggested that the Obama administration is granting waivers from the health care bill to “the very interests who supported this law and helped ram it through congress. From CPAC:

McCAUGHEY: The very interests who supported this law and helped ram it through Congress are now applying for waivers. And the Obama administration has granted 950 waivers already to unions and corporations allowing them to be exempt from the law the rest of us are forced to obey. Well, that is more dangerous than anything in this law because if government has the power to grant waivers, they have the power to deny them. And destroy a business. Americans should never have to slink and slither to the White House for exemptions like supplicants. [CPAC, 2/12/11]

FACT: Waivers Are Temporary, And Companies In Industries That Opposed Law Have Received Them

FactCheck: Companies From Industries That Opposed Health Care Reform Have Been Granted Waivers. Responding to a question from a reader regarding “the White House approving opt-out waivers,” FactCheck.org wrote:

[A]s of Dec. 3, the federal government had approved a total of 222 one-year waivers that allow the insurance plans at companies like McDonald's, Jack in the Box and Ruby Tuesday, and unions, to ignore the requirement on annual limits. Far from being “Obama's buddies,” as the Internet post claimed, the restaurant industry, through the National Restaurant Association, opposed the legislation. [FactCheck.org, 12/7/10]

FactCheck: Waivers “Merely Give Companies A Temporary Delay Before Being Required To Improve The Coverage Of Cheap, Bare-Bones Plans They Currently Offer.” From FactCheck:

We've received several questions about whether businesses have been able to opt out of the new health care law. The companies haven't been granted permission to ignore the entire law, as the Facebook post quoted by our reader might suggest -- but many have been given one-year waivers to delay compliance with a key insurance mandate that was put into place this fall. The White House says it instituted the waiver process to enable those companies to continue to provide limited-benefits plans -- cheap, bare-bones policies called mini-med plans -- until the law is fully implemented in 2014.

[...]

The new health care law aims to eliminate low annual coverage caps like those over time, and this is where the waiver issue has come in. The law says that annual coverage limits can't be set lower than $750,000 for new policy years starting between Sept. 23, 2010 and Sept. 23, 2011. That cap will be raised each year until 2014, when the law will require companies to have no annual spending limits on most benefits in health care plans.

[...]

The companies that have been approved for the waivers must reapply for them next year. Waivers are available until 2014. [FactCheck.org, 12/7/10]

Obama Official: "[W]aivers Only Apply To One Provision Of The Law," And “Companies And Employers That Receive Waivers Must Comply With All Other Parts” Of The Law. In a blog post on the White House website titled, “The Truth About Health Care Waivers,” Obama administration official Stephanie Cutter wrote:

To ensure that we protect the coverage that these workers have today until better options are available for them in 2014, the law allows HHS, in extreme cases, to issue temporary waivers from the phase out of annual limits. There are some important facts to remember about these temporary waivers:

• The waivers only apply to one provision of the law - the provisions phasing out annual limits. Insurance companies and employers that receive waivers must comply with all other parts of the Affordable Care Act.
• The waivers last one year. Insurance companies must reapply for the waivers each year between now and 2014 when annual limits on coverage will be completely prohibited and individuals will have more affordable and better private insurance choices in the competitive Exchange markets.
• All employers and insurers that offer mini-med plans may apply for a waiver if they demonstrate that there will be large increases in premiums or a significant decrease in access to coverage without a waiver. You can read a list of employers and insurers that have received waivers here. [The White House Blog, 12/10/10]

HHS: Waiver Applicants Must Certify That Waiver Is Necessary To Prevent Reduced Access To Coverage Or Large Premium Increases. From the Department of Health and Human Services website:

The Affordable Care Act is designed to provide Americans with affordable, high-quality coverage options -- while ensuring that those who like their current coverage can keep it. Unfortunately, today, limited benefit plans, or “mini-med” plans are often the only type of insurance offered to some workers. In 2014, the Affordable Care Act will end mini-med plans when Americans will have better access to affordable, comprehensive health insurance plans that cannot use high deductibles or annual limits to limit benefits. In the meantime, the law requires insurers to phase out the use of annual dollar limits on benefits. In 2011, most plans can impose an annual limit of no less than $750,000.

Mini-med plans have lower limits than allowed under the Affordable Care Act. While mini-med plans do not provide security in the event of serious illness or accident, they are unfortunately the only option that some employers offer. In order to protect coverage for these workers, the Affordable Care Act allows these plans to apply for temporary waivers from rules restricting the size of annual limits to some group health plans and health insurance issuers.

Waivers only last for one year and are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage. In addition, enrollees must be informed that their plan does not meet the requirements of the Affordable Care Act. No other provision of the Affordable Care Act is affected by these waivers: they only apply to the annual limit policy. [HHS.gov, accessed 2/14/11]