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Health Insurance Reform - DAILY MYTHBUSTER: House Republican Leader John Boehner Column in USA TODAY

Republican Leader John Boehner's guest opinion column in today's USA Today peddles the same old myths and scare tactics employed by too many opponents of health insurance reform. While Democrats are talking to constituents about health insurance reform in events across the country, the Republican leader is just spreading already debunked myths.

Myth:  The White House [representatives] “… simply don't know how many employers will drop their coverage altogether if their plan goes into effect. Experts at the Lewin Group estimate the number could be more than 100 million Americans.” - Leader Boehner Op-Ed


Fact: While news reports have discredited the Lewin Group as a wholly-owned subsidiary of the insurance industry, the non-partisan Congressional Budget Office (CBO) confirmed the provisions in America's Affordable Health Choices Act would increase, not cut, the number of Americans receiving employer-provided health insurance.

Specifically, the CBO says that the bill would:

  • Lead to an increase in employer sponsored insurance coverage: “We estimate that about 12 million people who would not be enrolled in an employment-based plan under current law would be covered by one in 2016...”
  • Result in the vast majority of Americans remaining in private, employer-provided care - with private insurance companies remaining dominant in the marketplace.
  • Result in only 10 to 11 million individuals - or about 3 percent of Americans -- in the public option by 2019.  “For several reasons, we anticipate that our estimate of the number of enrollees in the public plan would be substantially smaller than the Lewin Group's, even if we assumed all employers would have that option.”
  • Several of the bill's measures could lead to decreased costs for the average consumer (e.g. encouraging healthy consumers to purchase insurance, reducing the “cost shift” of the uninsured, and reforms to Medicare). [For More Information on CBO Analysis]

Far from “independent,” the Lewin Group has been widely discredited:.

  • The Washington Post reported the group is a “wholly owned by UnitedHealth Group, one of the nation's largest insurers,” that is “part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association of helping insurers shift medical expenses to consumers by distributing skewed data... In January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.”

Myth:  “… the House Democrats' bill would raise costs and the deficit by $239 billion over 10 years.” - Leader Boehner Op-Ed

Fact: On July 17, the Congressional Budget Office (CBO) confirmed that the health insurance reform policies of the America's Affordable Health Choices Act will be fully paid for. CBO estimated that the cost of the bill's reforms was $1.042 trillion over 10 years, while the bill's cost savings and revenues totaled $1.048 trillion. The reforms will be fully paid for through a combination of almost $500 billion in net Medicare and Medicaid savings, included in the bill, and over $500 billion in revenue raised through a tax surcharge on the wealthiest 1.2 percent of Americans. These reforms will provide affordable coverage to 97 percent of Americans two years after the bill takes effect.

CBO also estimated that additional provisions to maintain current Medicare physician payment rates, included in this bill, carry a net cost of $239 billion over ten years. These provisions have had bipartisan support.  If these provisions are not enacted, there will be a 21 percent cut in Medicare physician payment rates on January 1, 2010, with further deep cuts in each succeeding year.  These types of draconian cuts could result in millions of seniors losing access to their doctors and undermine the quality of care.  Because this is an existing policy, and not technically new spending, the House voted to exempt these Medicare physician payment provisions from PAYGO rules earlier this year. Also, under PAYGO legislation adopted by the House in July, these provisions would be exempted.

The principle of PAYGO is requiring new policies reducing revenues or expanding entitlement spending be fully offset. Since the Medicare physician payment provisions maintain current policy, it is logical they be exempted. 

Myth:  “… the plan would cut Medicare to the tune of $361.9 billion over 10 years. That means fewer choices and lower quality care…” - Boehner Op-Ed

Fact: The cost savings in Medicare in the bill are all targeted at achieving new efficiencies; expanding authority to fight waste, fraud and abuse; and eliminating wasteful subsidies to private insurance companies.  None of the cost savings would reduce Medicare benefits (rather, the bill increases benefits; see below).  Following are the three key areas of cost savings in Medicare in the bill:

  • $156 billion in savings over 10 years by eliminating wasteful overpayments to private Medicare Advantage plans. (Private Medicare Advantage plans are currently paid, on average, 14 percent more than traditional Medicare providers.)
  • $102 billion in savings over 10 years by incorporating productivity adjustments into Medicare payment updates for hospitals.  This adjustment will encourage greater efficiency in health care provision, while more accurately aligning Medicare payments with hospital costs.
  • $30 billion in savings over 10 years by providing that Medicare Part D beneficiaries will get a 50 percent reduction in price on any brand-name drugs they need while in the so-called “donut hole,” where drug costs are not reimbursed at certain levels. 

The bill also includes numerous provisions that IMPROVE Medicare benefits and health care for seniors, including the following:

  • Reduces the size of the “donut” hole in the Medicare Part D prescription drug benefit by $500 in 2011 and then completely eliminates the “donut” hole over a period of years.
  • Enhances preventive coverage, by eliminating copayments for preventive services in Medicare.
  • Improves low-income subsidy programs to help ensure Medicare is affordable for those with low and modest incomes.
  • Computerizes medical records so seniors won't have to take the same test over and over or relay their entire medical history every time they see a new provider.
  • Extends solvency of Medicare by five years or more.

Myth:  “The President claimed the plan will not lead to rationing.  But the 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, and what kind of cost sharing will occur.” - Boehner Op-Ed

Fact: There is no rationing of care under this bill.  The House bill will put patients and doctors where they belong - in the driver's seat. Insurance company bureaucrats will never again stand between Americans, their doctors, and the care they need. 

The Health Benefits Advisory Committee does NOT have any role in determining what treatments individuals are entitled to; its primary role is simply to recommend the minimum benefit package insurers must offer under the bill.

  • Nothing in the role of the Health Benefits Advisory Committee infringes on the ability of an individual and the individual's doctor to make medical decisions.
  • The primary role of the Health Benefits Advisory Committee is to make recommendations about the minimum covered benefits that all insurance companies have to offer - in order to ensure that everyone has a health plan that provides them with adequate coverage.  (It will also make recommendations on covered benefits for the “enhanced” and “premium” insurance plans that insurance companies may also wish to offer under the bill.)
  • In addition, Republicans attempt to claim that the Health Benefits Advisory Committee is an attempt by the government to “ration” care, but this is not a “government” committee.  It will be made up of mostly of providers, consumer representatives, employers, labor, health insurance issuers, and independent experts.

For more health insurance reform myth busting, please click here.

For more information on America's Affordable Health Choices Act, please click here.