Concerns About the HR3200 Healthcare Reform Bill

A fellow named Fred wrote this to me: “Don’t you have your own ideas, Doc? How would you propose to fix the system? Evidently it is by sitting on your butt and watching FoxNews, carefully copying and reposting their slanted stories, and pretending there is no problem. Who paid you to post all this negative information about attempts to reform our broken healthcare system?” Here’s my response.

More Information:Dear Fred,

I join you in supporting healthcare reform that improves healthcare. However, not all “reform” legislation would actually improve health care.

Now that the complete text of the 158,000-word House Bill 3200 ( “America’s Affordable Health Choices Act of 2009”) is finally available, I can offer an initial perspective on this healthcare “reform” bill. You can read the entire bill here. You can also find the sections I refer to below.

First of all, here are some of the the general principles that I, and my 16,000 colleagues at the Christian Medical Association, use to evaluate any healthcare reform proposal:

  • Access for all
  • High standards of quality
  • Affordability and sustainability
  • Emphasis on prevention
  • Justice for all, from conception until natural death
  • Personal responsibility and decision-making
  • Protection of ethical standards (e.g., each life is sacred)
  • Right of conscience for patients and healthcare professionals.

Unfortunately, Fred, the main bill the U.S. House of Representatives is considering, HR 3200, does not conform to virtually any the above principles.

My review (and the review of my CMA colleagues, Gene Rudd, MD and Jon Imbody) of HR 3200 leads me to a number of serious concerns. By the way, have you even read the bill you so vociferously support? I doubt it!

Nevertheless, here are just some of our concerns:

1) The government will likely mandate abortion coverage.

The lawmakers pushing HR 3200 have so far refused to explicitly exclude abortion from services that will be mandated under this legislative plan. That is why you will not find abortion ever mentioned in the bill. That is not good.

Court and agency decisions in the past demonstrate that without specific restrictions on abortion coverage, it will be mandated. Beginning in 1973, federal taxpayers were being forced to fund 300,000 Medicaid-paid abortions per year.

The Sixth Circuit Court of Appeals has noted, “Because abortion fits within many of the mandatory care categories, including ‘family planning,’ ‘outpatient services,’ ‘inpatient services’ and ‘physicians’ services,’ Medicaid covered medically necessary abortions between 1973 and 1976.” [Planned Parenthood Affiliates of Michigan v. Engler, 73 F.3d 634,636 (6th Cir. 1996)].

That is why the Congress had to pass the federal Hyde Amendment in 1976, specifically prohibiting coverage of abortion. (For more on this, go here.)

Since the legislation empowers the government to issue an “essential benefit package requirement,” insurance plans will not be able to ethically exclude abortion:

“A qualified health benefits plan may not impose any restriction (other than cost – sharing) unrelated to clinical appropriateness on the coverage of the health items and services.” (See Section 121c, “SEC. 121. “Coverage of Essential Benefits Package.”)

Under section 124(b)(1), “Not later than 18 months after the date of the enactment of this Act, the Secretary [of Health and Human Services, Kathleen Sebelius] shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards.”

HR 3200 bill authorizes the HHS Secretary (in non-binding consultation with a panel of experts, the majority of whom are appointed by the President) to determine what services must be covered by all plans, both public and private.

“The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services … and periodic updates to such standards” (Sec. 123(b)(1)).

“In the case that the Commissioner determines that a Qualified Health Benefit Plan offering entity violates a requirement of this title,” the federal government will enforce its healthcare ideology by exacting penalties including “civil money penalties,” “suspension of enrollment of individuals ,” “suspension of payment” and termination (Sec. 142(d)(1)and (2)).

The voting records and comments of the President, the Secretary of HHS, and the Speaker of the House are unambiguous regarding their view that abortion coverage is, as President Obama termed it, “absolutely vital” … “at the center, the heart of the plan that I propose.”

At the time of this writing, the House Energy and Commerce Committee had passed an amendment by Representative Capps that purports to address abortion mandates. Pro-life legislative analysts on Capitol Hill point out that the craftily structured amendment would actually explicitly permit the HHS Secretary to include abortion in the services offered by public plan requiring abortion mandates and also require taxpayer subsidies to flow to plans that include abortion.

I simply believe it is wrong to mandate that the over 50% of Americans, who believe abortion is morally wrong, be required to pay for the willful murder of a single unborn child – much less the 1.2 million unborn children whose lives are prematurely snuffed out each year.

I hope you’ll take some time to read some of my blogs on abortion:

2) Healthcare Professionals may be forced to refer for and/or participate in abortion.

The original version of House Bill 3200 did not include conscience protections for healthcare professionals who decline to perform or refer for abortions. Coupled with President Obama’s stated plan to erase the only federal conscience protection regulation, this gap imperiled faith-based physicians and others who will not bow to abortion-on-demand ideology.

Attempts to bridge that gap have met with mixed success.

A bipartisan amendment offered in committee markup by Representatives. Bart Stupak (D-Mich. 1) and Joe Pitts (R-Pa. 16) successfully added language from the Hyde-Weldon amendment, which provides strong conscience protections, but only under certain circumstances involving federal funding.

When marking up healthcare reform legislation in the Senate, pro-life committee members introduced clear conscience protection amendments. Partisan committee votes killed those amendments, however, and substituted a pseudo-protection amendment that would allow classifying virtually any abortion as an “emergency” that could compel physician participation. (For more on this amendment, see CMA’s analysis of the Kennedy amendment #205 here.)

I hope you’ll take some time to read some of my blogs on conscience:

3) Rationing will marginalize the neediest patients.

Section 114(a) states, “A qualified health benefits plan shall comply with standards established by the [Health Choices] Commissioner to prohibit discrimination in health benefits or benefit structures for qualifying health benefits plans …”

The enforcement of such provisions will invariably lead to fewer options for patients and doctors. Washington is not able to individualize; it can only standardize. Patients and doctors will be at the mercy of standardized protocols. In order to meet increasing economic challenges, less coverage is inevitable.

Of particular concern, the principles and values of those making these decisions will trump the principles and values of those who must live with the consequences.

To meet the cost pressures of this massive government-funded program, we can expect assisted suicide to be presented as a major economic solution. This process begins subtly under HR 3200:

“An eligible provider participating in the program shall routinely schedule Medicare beneficiaries for a counseling visit after the viewing of such a patient decision aid to answer any questions the beneficiary may have with respect to the medical care of the condition involved and to assist the beneficiary in thinking through how their preferences and concerns relate to their medical care.” –Sec. 1236(c)(1)

We can expect such standardized counseling to be influenced by high costs of end-of-life care.

As Dr. Ezekiel Emanuel, an appointed member of Federal Council on Comparative Effectiveness Research, put it, medical care should not be given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (for more on this, see “Deadly Doctors – Obama Advisors Want to Ration Care,” New York Post.)

4) Government will further invade the patient-doctor relationship.

HR 3200 provides for the government to determine what is covered or not covered, define best practices, and determine suitable outcomes.

The medical literature and my own experience reveals how much time doctors already spend dealing with healthcare bureaucracy on behalf of my patients. Now, insert the government into the equation, as economic rationing forces policy-makers to say “no” more often and ratchets up the pressure to cross traditional ethical boundaries.

HR 3200 would nail shut the coffin of covenant-based healthcare.

Well, Fred, I’ve not even covered the euthanasia and eugenics concerns some have with this proposed bill, nor the cost issues, nor the fact that a large majority of Americans don’t want it . . .

And, it does not rehash my blogs on Health Myths:

But, to address your comment, “Don’t you have your own ideas, Doc? How would you propose to fix the system? Evidently it is by sitting on your butt and watching FoxNews, carefully copying and reposting their slanted stories, and pretending there is no problem. Who paid you to post all this negative information about attempts to reform our broken healthcare system?” let me tell you what I do support.

Legislative language that is closer to my and the CMA’s values can be found in this legislative proposal by Rep. Tom Price. Here are some of his proposals that I think are super:

SEC. 105. LIMITATION ON ABORTION FUNDING

No funds authorized under this Act (or any amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of forcible rape or incest.

SEC. 106. NON-DISCRIMINATION ON ABORTION AND RESPECT FOR RIGHTS OF CONSCIENCE

(a) NON-DISCRIMINATION.—A Federal agency or program, and any State or local government that receives Federal financial assistance, may not subject any individual or institutional health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.

(b) DEFINITION.—In this section, the term “healthcare entity” includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan

(c) ADMINISTRATION.—The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this section, and coordinate the investigation of such complaints

(d) CONSCIENTIOUS OBJECTION.—Nothing in this Act shall be construed as forbidding a health plan or health insurance issuer to accommodate the conscientious objection of a purchaser or an individual or institutional health care provider when a procedure is contrary to the religious beliefs or moral convictions of such purchaser or provider.

Caveat: While I personally do not agree with abortions for rape and incest, such exceptions historically have enabled otherwise strongly pro-life measures to garner broad enough support to be adopted.

Fred, I hope this answers your challenge and questions. I hope you’ll consider my response and I look forward to your future comments – although I hope they will be a bit more civil.

Dr. Walt

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So, what can you do if you agree with me?

It is time to talk action. We can all have tremendous influence on our Senators and Representative. A great choice is to visit with them while they are home during the August recess. Click here to learn more.

If you can not do that, write a personal note. This link will take you to contact information. Let them know:

  • You are a constituent (and, if you are a medical professional, let them know that also).
  • Ask that the legislator OPPOSE the abortion coverage and abortion participation mandates of HR 3200.
  • Ask that the legislator SUPPORT a reform plan that provides access for all while respecting conscience and traditional ethical standards.

My colleagues at the Christian Medical Association and I  will continue to monitor legislative developments and keep you updated. Pray that God will equip us to be salt and light and influence our nation’s policies, and that He would grant our leaders wisdom and grace and a new desire to protect the “least of these.”