Healthcare Q&A

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With lawmakers home for their August recess, a fierce battle has broken out over what precisely is in the mammoth healthcare bills being pushed by congressional Democrats in Washington.

There has been no shortage of misinformation, much of it advanced by critics who have made sometimes outlandish claims about the legislation.

Below are some brief questions and answers about a few of the most contentious parts of the legislation.

Q - Does the legislation include provisions to encourage senior citizens to commit suicide?

No.

This has become one of the most misleading, inflammatory claims made in the healthcare debate, advanced repeatedly by conservative commentators such as Rush Limbaugh and Sean Hannity and Republican lawmakers working to stoke fears among senior citizens.

Rep. Virginia Foxx (R- N.C.) recently went to the floor of the House to suggest that the Democratic healthcare bill would "put seniors in a position of being put to death by their government."

There is no such provision.

The House bill would give seniors on Medicare the option to sit down with a doctor for an "Advance CQ Care Planning Consultation" every five years to discuss options for care should they become seriously ill or unable to make medical decisions. Topics could include the development of a living will and directives for care.

"These are important discussions everyone should have so they are fully informed and can make their wishes known," said Dr. J. James Rohack, president of the American Medical Association in a statement. "That's not controversial, it's plain, old-fashioned patient-centered care."

The provision also is endorsed by the AARP.

Q - Will the government start paying for abortions?

That's still unclear.

Neither the House or Senate versions of the healthcare legislation contains any requirement that federal funding be made available for abortions. Claims that tax dollars will be used for abortions, as a television ad from the Family Research Council contends, are premature and somewhat misleading.

But the legislation is still short on many details. Depending on how future regulations are written, it is possible that some women who get federally subsidized insurance could buy plans that cover abortions.

Under the most popular Democratic healthcare proposals, millions of Americans would buy their insurance in a new, highly regulated marketplace in which private insurers and the government would offer a choice of health plans.

Many of those people would qualify for federal aid to defray the costs of at least part of their premiums.

It appears unlikely that the federal government would require the plans in this new marketplace to cover abortions. In fact, one version of the legislation explicitly prohibits such a requirement.

But some private insurers in the exchange may well cover abortion services.

If a woman who receives public subsidies for her coverage selects one of those plans, it could be argued that the government is helping to fund abortions.

Q - Will illegal immigrants get free healthcare benefits?

Not legally.

Provisions in the House and Senate bills explicitly prohibit people who are "not lawfully present in the United States" from getting federal aid to help them buy health insurance in the new insurance exchanges.

Congressional Democrats have resisted Republican efforts to put even tougher documentation requirements on those applying for aid, however, arguing that that could discourage many poor people from signing up for health insurance.

No matter what happens with the legislation, undocumented immigrants will almost certainly still be able to get care in emergency rooms, a major burden in some parts of the country.

Q - Will the government ration care?

This is almost impossible to say, although if the legislation passes there may be less "rationing" than there is now.

Under the nation's current healthcare system, private insurers and the federal government already put a variety of limits on what kinds of medical procedures, imaging and drugs that they will pay for.

Millions of people with pre-existing medical conditions face even more limits, as private insurers refuse to sell them policies.

A cornerstone of the Democratic push for a healthcare overhaul is a larger role for the federal government in introducing more standards to the system through a series of new initiatives to regulate coverage and expand information about the most effective treatments.

Both House and Senate bills would prohibit insurers from denying coverage to anyone with a pre-existing medical condition, thus eliminating one form of rationing in the current system.

The legislation would also give the federal government the authority to set a minimum set of benefits that insurers would have to offer in order to sell policies in the new insurance exchanges. That could mean more coverage for millions of individuals and many small businesses who currently are shut out of the healthcare system.

Most controversially, the bills would fund more research into the comparative effectiveness of various drugs and medical procedures.

The legislation does not dictate that the research be used to limit coverage of any medical procedures. And many doctors and other healthcare experts see this kind of research as critical to improving the quality of care.

Nonetheless, some critics of the bill say the provisions could someday allow the government to use this research to limit what Medicare or other government insurance programs would cover.

Noam.levey@latimes.com

Copyright © 2014, Los Angeles Times
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