Facts, fallacies on what is buried on legislation’s pages

By Noam N. Levey
Los Angeles Times / August 12, 2009

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WASHINGTON - With lawmakers home for August recess, a fierce battle has broken out over what precisely is in the mammoth healthcare bills being pushed by congressional Democrats. There has been no shortage of misinformation. Here is a look at a few of the most contentious parts of the legislation.

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

There is no such provision. The House bill would give seniors on Medicare the option to sit down with a doctor for an “advance care planning consultation’’ every five years to discuss options should they become seriously ill or unable to make medical decisions. Topics could include the development of a living will and directives for care.

The provision is endorsed by the AARP.

Will the government start paying for abortions?

That is unclear. Neither House nor Senate versions of the healthcare legislation contains any requirement that federal funding be made available for abortions. Assertions 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 short on many details. Depending on how future regulations are written, it is possible that some women who receive federally subsidized insurance could buy plans that cover abortions.

Under the most popular Democratic 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 government would require the plans in this marketplace to cover abortions. In fact, one version of the legislation explicitly prohibits such a requirement. But some private insurers in the exchange may cover abortion services.

Will illegal immigrants receive free healthcare benefits?

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

Congressional Democrats have resisted Republican efforts to put tougher documentation requirements on those applying for aid, 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 obtain care in emergency rooms, a major burden in some parts of the country.

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 system, private insurers and the federal government put a variety of limits on what kinds of medical procedures and drugs they will pay for.

Both House and Senate bills would prohibit insurers from denying coverage to anyone with a preexisting condition, thus eliminating one form of rationing in the current 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 procedures. And many doctors and other healthcare specialists see this kind of research as critical to improving the quality of care.

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

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