The proposed America's Affordable Health Choices Act of 2009 () was an unsuccessful bill introduced in the U.S. House of Representatives on July 14, 2009. The bill was introduced during the first session of the
111th Congress
The 111th United States Congress was a meeting of the legislative branch of the United States federal government from January 3, 2009, until January 3, 2011. It began during the last weeks of the George W. Bush administration, with th ...
as part of an effort of the Democratic Party leadership to enact health care reform. The bill was not approved by the House, but was superseded by a similar bill, the proposed Affordable Health Care for America Act (HR 3962), which was passed by the House in November 2009, by a margin of 220-215 votes but later abandoned.
A similar bill to HR 3200, called the "Affordable Health Choices Act" (HR 1679), was introduced in the Senate on September 17, 2009. It too was unsuccessful as the Senate approved instead another proposal called the " Patient Protection and Affordable Care Act".
According to the
Congressional Budget Office
The Congressional Budget Office (CBO) is a List of United States federal agencies, federal agency within the United States Congress, legislative branch of the United States government that provides budget and economic information to Congress.
Ins ...
, HR 3200 included tax increases and spending cuts that reduce the net increase in the federal deficit to 1% of 2008 tax revenues. The CBO director subsequently noted that, in terms of total National Health Expenditure, non-governmental spending will increase as coverage expands.
The bill was originally sponsored by Representatives
John Dingell
John David Dingell Jr. (July 8, 1926 – February 7, 2019) was an American politician who served as a member of the United States House of Representatives from 1955 until 2015. A member of the Democratic Party, he holds the record for longes ...
,
Charles Rangel
Charles Bernard Rangel (, ; born June 11, 1930) is an American politician who was a U.S. representative for districts in New York from 1971 to 2017. A member of the Democratic Party, he was the second-longest serving incumbent member of the Ho ...
,
Henry Waxman
Henry Arnold Waxman (born September 12, 1939) is an American politician who served as a U.S. representative from California from 1975 to 2015. He is a member of the Democratic Party.
His district included much of the western part of the city of ...
Frank Pallone
Frank Joseph Pallone Jr. (; born October 30, 1951) is an American lawyer and politician serving as the U.S. representative for , serving since 1988. He is a member of the Democratic Party. The district, numbered as the 3rd district from 1988 to ...
, and Robert Andrews. The 1017 page PDF version of the bill is the first of three health care reform-related legislative proposals expected from the Democratic congressional leadership.Marianne Kolbasuk McGe Health Care Overhaul Bill Calls For Online Enrollment InformationWeek June 10, 2009 Votes in the U.S. House of Representatives on this bill and on the
Medicare for All Act
The Medicare for All Act, aka the Expanded and Improved Medicare for All Act or United States National Health Care Act, is a bill first introduced in the United States House of Representatives by Representative John Conyers (D-MI) in 2003, with ...
, an alternative that would establish a national, universal single-payer health insurance, were previously expected in September 2009 and again in October 2009, before the actual November 2009 vote took place.
Elements of the bill
The summary of the bill includes the following elements, among others:
#Establishes a mandate to purchase private insurance for most individuals with an income above poverty level.
#Creates a mechanism to enforce the mandate in a
sliding scale
Sliding scale fees are variable prices for products, services, or taxes based on a customer's ability to pay. Such fees are thereby reduced for those who have lower incomes, or alternatively, less money to spare after their personal expenses, regar ...
tax on those who do not purchase health insurance for most legal United States residents with an income above poverty level.
# Prohibits
pre-existing condition
In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a person's health insurance went into effect. Before 2014, some insurance policies would not cover expenses due to pre-existi ...
exclusions.
#Requires adjusted community rating, guaranteed issue, and guaranteed renewal of individual and small group health insurance that: ''limits'' age rating variation of premiums to 2:1 (200 percent), ''prohibits'' gender and health status rating variation of premiums, ''allows'' variation of premiums by geographic area and family (vs. individual) enrollment.
#Prohibits cancellation of coverage except for evidence of fraud.
#Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
#Requires Health and Human Services to create a non-subsidized public health insurance plan with pricing based on private industry averages. Three optional levels of coverage are to be offered by the plan which must set premiums at a level sufficient to fully finance the costs of the health benefits the administrative costs related to operating the plan.
#Establishes a Health Insurance Exchange (HIE) within a proposed Health Choices Administration, to provide a market place for insurers to sell qualifying plans on a public web site.s:H.R. 3200/Division A/Title II/Subtitle A
#Requires the creation of a
risk equalization Risk equalization is a way of equalizing the risk profiles of insurance members to avoid loading premiums on the insured to some predetermined extent.
In health insurance, it enables private health insurance to operate in some countries to be offer ...
pool that will allow qualifying plans to minimize the impact of
adverse selection
In economics, insurance, and risk management, adverse selection is a market situation where buyers and sellers have different information. The result is that participants with key information might participate selectively in trades at the expe ...
of enrollees among the plans.
#Provides a
tax credit
A tax credit is a tax incentive which allows certain taxpayers to subtract the amount of the credit they have accrued from the total they owe the state. It may also be a credit granted in recognition of taxes already paid or a form of state "dis ...
for
low-income
Poverty is the state of having few material possessions or little
individuals and families to help pay insurance premiums.
#Requires employers with payroll costs over $500,000 to provide health insurance that meets the minimum standard of coverage allowed in the HIE.
# Provides for a tax on employers that do not provide the required health insurance.
# Provides for a tax on couples with adjusted joint gross income exceeding $350,000 (80% of this figure for single people)
#Reduces Medicare payments to hospitals with excessive re-admissions.
#Further expands Medicaid eligibility and scope of covered preventive services, for lower-income individuals and families.
#Increases Medicaid payments to physicians for primary care.
# Provides for a phased-in elimination of the
Medicare Part D
Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. Part D was enacted as part of the Medi ...
coverage gap and requires drug manufactures to discount and/or rebate additional qualifying drugs originally excluded from the plan.
#Requires the Secretary of
Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
(HHS) to develop quality measures for the delivery of health care services in the United States.
# Establishes the Health Benefits Advisory Committee chaired by the Surgeon General of the United States.
# Prioritizes any eventual implementation of best practices in the delivery of health care.
# Establishes a National Prevention and Wellness Strategy along with appropriations for its trust fund.
#
Outlines
Outline or outlining may refer to:
* Outline (list), a document summary, in hierarchical list format
* Code folding, a method of hiding or collapsing code or text to see content in outline form
* Outline drawing, a sketch depicting the outer edg ...
Administrative standards that reduces costs and improves service, including the ability for Administrators to determine an accurate total financial estimate at the point of service as well as enabling real time electronic transfer of funds to take place if possible (mirror currently existing laws .
House Committees' mark-ups
America's Affordable Health Choices Act of 2009 has been amended in the nature of substitute during mark-up proceedings since its original introduction recorded in the Congressional Record on July 14, 2009. These amendments have only been voted on by each Committee involved in order to pass out of the Committee phase but have not been voted on by the full House membership, which is needed before the originally introduced legislation can be changed to reflect any amendments recommended by the Committees and passed by a full House vote.
states rights
In American political discourse, states' rights are political powers held for the state governments rather than the federal government according to the United States Constitution, reflecting especially the enumerated powers of Congress and the ...
to
single payer
Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer").
Single-payer systems may contract for healthcare services from ...
health care at the state level. This is how
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
adopted single payer, with
Saskatchewan
Saskatchewan ( ; ) is a province in western Canada, bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, to the northeast by Nunavut, and on the south by the U.S. states of Montana and North Dak ...
passing it first. In July 2009, the House Education and Labor Committee approved the Kucinich Amendment by a vote of 27–19, with 14 Democrats and 13 Republicans voting for it.
:* See external link t Mark-Up Summary
Comparison with Senate versions
''
The Washington Post
''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large nati ...
'' published comparison tables of the main House version with the two main Senate versions, which themselves may be summarized as:
CBO analysis of the bill
The U.S.
Congressional Budget Office
The Congressional Budget Office (CBO) is a List of United States federal agencies, federal agency within the United States Congress, legislative branch of the United States government that provides budget and economic information to Congress.
Ins ...
is a non-partisan organization that analyzes the effect on the federal budget of proposed and existing legislation on behalf of the Congress. CBO analyzed the bill as of July 14, 2009 and reported the following:
In terms of what would happen for consumers, the CBO's methodology in a report in late July used a public plan with premiums about 10% lower than private plans.
Health exchange details
Businesses with ten or fewer employees can use the exchange in the first year after the act begins. The cutoff changes to twenty or fewer employees the next year. On the third year, the 'Health Choices Commissioner' has the authority to phase in businesses with more employees. The legislation does not specify any further phases, leaving that up to the officer to decide.Weiner mangles details of health care reform PolitiFact. Retrieved August 30, 2009.
The act creates new standards, intended by lawmakers as methods of consumer protection, for what would be considered a minimally acceptable insurance plan. Employers that currently offer insurance have a five-year grace period after the act begins before they would be subject to the standards. Individuals would be free to purchase their own private insurance, or work with the public option, in this period and afterward.
President of the United States
The president of the United States (POTUS) is the head of state and head of government of the United States of America. The president directs the executive branch of the federal government and is the commander-in-chief of the United States ...
. It will also consist of 9 members who are appointed by the
Comptroller General of the United States
The Comptroller General of the United States is the director of the Government Accountability Office (GAO, formerly known as the General Accounting Office), a legislative-branch agency established by Congress in 1921 to ensure the fiscal and man ...
. Also, up to eight more members will be appointed in even numbers by the
President of the United States
The president of the United States (POTUS) is the head of state and head of government of the United States of America. The president directs the executive branch of the federal government and is the commander-in-chief of the United States ...
who are federal employees and officers. Each member of the committee will serve three year terms. The Health Benefits Advisory Committee will recommend to the
United States Secretary of Health and Human Services
The United States secretary of health and human services is the head of the United States Department of Health and Human Services, and serves as the principal advisor to the president of the United States on all health matters. The secretary is ...
benefit standards and periodic updates to such standards.
Debate and controversies
Reimbursement for counseling about living wills
One often-cited provision of the un-passed bill would have authorized Medicare reimbursement for physicians who provide voluntary counseling about such subjects as living wills. The provision is based on a separate bill that was cosponsored by
Republican
Republican can refer to:
Political ideology
* An advocate of a republic, a type of government that is not a monarchy or dictatorship, and is usually associated with the rule of law.
** Republicanism, the ideology in support of republics or agains ...
Charles Boustany
Charles William Boustany Jr. (; born February 21, 1956) is an American politician, physician, and former congressman from Lafayette, Louisiana, who served as the U.S. representative from Louisiana's 3rd congressional district from 2005 to 2017 (nu ...
of
Louisiana
Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is borde ...
, a surgeon, and is similar to end-of-life counseling signed by President
George W. Bush
George Walker Bush (born July 6, 1946) is an American politician who served as the 43rd president of the United States from 2001 to 2009. A member of the Republican Party, Bush family, and son of the 41st president George H. W. Bush, he ...
conservatives
Conservatism is a cultural, social, and political philosophy that seeks to promote and to preserve traditional institutions, practices, and values. The central tenets of conservatism may vary in relation to the culture and civilization in ...
such as
Betsy McCaughey
Elizabeth Helen McCaughey (; née Peterken; born October 20, 1948), formerly known as Betsy McCaughey Ross, is an American politician who was the Lieutenant Governor of New York from 1995 to 1998, during the first term of Governor George Pataki ...
, a
lobbyist
In politics, lobbying, persuasion or interest representation is the act of lawfully attempting to influence the actions, policies, or decisions of government officials, most often legislators or members of regulatory agencies. Lobbying, which ...
for the
healthcare industry
The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, ...
who also helped to defeat the
Clinton health care plan of 1993
The Clinton health care plan was a 1993 healthcare reform package proposed by the administration of President Bill Clinton and closely associated with the chair of the task force devising the plan, First Lady of the United States Hillary Clinto ...
. These critics allege that it includes mandatory language aimed at pressing elderly and disabled patients toward euthanasia. Their interpretation was the basis for the charge about this section by prominent Republican 2008 Vice Presidential candidate Sarah Palin.
However, the "level of productivity in society" or panels claim is not mentioned in the actual legislation, which is structured primarily to amenda specific clause in the Social Security Act, Section 1861 of definitions that are used in sections regarding reimbursements for end-of-life counseling, including the use of
Advance Directive
An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no ...
Earl Blumenauer
Earl Francis Blumenauer ( ; born August 16, 1948) is an American lawyer, author, and politician serving as the U.S. representative for since 1996. The district includes most of Portland east of the Willamette River.
A member of the Democrat ...
of Oregon, has called this attack on the bill "an all-time low".
Blumenauer said the measure would block funds for counseling that presents suicide or assisted suicide as an option, and called references to death panels or euthanasia "mind-numbing". He said that "the majority of Congressional Republicans supported the similar provisions for terminally ill elderly patients that were part of the 2003 prescription drug bill" and that, out of the dozens of Republican proposals for revising the bill, "not a single word" was said against end-of-life counseling. He said that
Rush Limbaugh
Rush Hudson Limbaugh III ( ; January 12, 1951 – February 17, 2021) was an American conservative political commentator who was the host of '' The Rush Limbaugh Show'', which first aired in 1984 and was nationally syndicated on AM and FM r ...
,
Virginia Foxx
Virginia Ann Foxx ( Palmieri;Foxx, Virginia Ann . ''Biographical Directory of ...
, Newt Gingrich, Charles Grassley and other Republicans defended the death panel story only after Betsy McCaughey's editorials, and that some people at town hall meetings even wanted to "keep government out of their Medicare," a government run program. Blumenauer said that as recently as April 2008 then-governor Palin supported end-of-life counseling as part of Health Care Decisions Day. Palin's office called this comparison "hysterically funny" and "desperate".Eric Adams, September 14, 2009, MSNBC Blumenauer's end-of-life counseling once favored by Palin Republican Senator
Johnny Isakson
John Hardy Isakson (December 28, 1944 – December 19, 2021) was an American businessman and politician who served as a United States senator from Georgia from 2005 to 2019 as a member of the Republican Party. He represented in the United States ...
, who co-sponsored a 2007 end-of-life counseling provision, called the euthanasia claim "nuts". Analysts who examined the end-of-life provision Palin cited agreed that it merely authorized Medicare reimbursement for physicians who provide voluntary counseling for advance health care directives (including living wills).PolitiFact, August 7, 2009 Sarah Palin falsely claims Barack Obama runs a 'death panel' /ref> According to TIME and ABC, Palin and McCaughey made false euthanasia claims.ABC News, Jake Tapper, August 7, 2009 Palin Paints Picture of 'Obama Death Panel' Giving Thumbs Down to Trig
The page 425 legislation began as a separate bill that was co-sponsored by Republicans
Charles Boustany
Charles William Boustany Jr. (; born February 21, 1956) is an American politician, physician, and former congressman from Lafayette, Louisiana, who served as the U.S. representative from Louisiana's 3rd congressional district from 2005 to 2017 (nu ...
,
Patrick Tiberi
Patrick Joseph Tiberi (; born October 21, 1962) is an American lobbyist and politician who served as the U.S. representative for from 2001 to 2018. His district included communities north and east of Columbus. He is a member of the Republican ...
and
Geoff Davis
Geoffrey Clark Davis (born October 26, 1958) is an American businessman, politician and former U.S. Representative for , serving from 2005 to 2012. He is a member of the Republican Party. The district includes 24 counties in the northeastern p ...
. Boustany, a heart surgeon, said the end-of-life legislation was a "good medical practice". 204 GOP House members and 42 GOP Senators voted for a 2003 Medicare prescription drug bill that included end-of-life counseling. The 2003 legislation only covered end-of-life counseling for terminally ill patients, which the Republican Charles Grassley supported. Grassley said that the 2009 end-of-life counseling would " pull the plug on grandma" and that "You shouldn't have counseling at the end of life, you should have done that 20 years before," which is what the 2009 legislation would allow. Republican Newt Gingrich defended the death panel claim, but previously praised the Gundersen Lutheran Health System for encouraging the widespread use of Advance Directives.
The federal requirement that hospitals help patients with things like living wills began when Republican George H. W. Bush was president.Ricardo Alonso-Zaldivar, August 15, 2009, AP Palin is wrong: There's no 'death panel' in health care bill Section 1233 merely allows doctors to be paid for their time. However, between 30 percent and 45 percent of Americans believed in the death panel story. According to PolitiFact, private health insurance companies already ration health care by income, by denying health insurance to those with pre-existing conditions and by caps on health insurance payments.
Rationing
Rationing is the controlled distribution of scarce resources, goods, services, or an artificial restriction of demand. Rationing controls the size of the ration, which is one's allowed portion of the resources being distributed on a particular ...
Investor's Business Daily
''Investor's Business Daily'' (''IBD'') is an American newspaper and website covering the stock market, international business, finance and economics. Founded in 1984 by William O'Neil as a print news publication, it is owned by News Corp and is ...
'', which analogized the bill to the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS) in the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...
and editorialized: "People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless." The Investor's Business Daily editorialists had to beat a retreat and quickly retracted its claim after it was pointed out that Hawking was in fact British, and had lived his entire life in the United Kingdom with treatment from the NHS. Stephen Hawking responded, "I wouldn't be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived."
On a separate issue, physician and conservative commentator
Charles Krauthammer
Charles Krauthammer (; March 13, 1950 – June 21, 2018) was an American political columnist. A moderate liberal who turned independent conservative as a political pundit, Krauthammer won the Pulitzer Prize for his columns in ''The Washingt ...
has criticized what he sees as a naive focus on living wills by the policymakers over other types of medical advice. He has written:
Competition
A
CNN
CNN (Cable News Network) is a multinational cable news channel headquartered in Atlanta, Georgia, U.S. Founded in 1980 by American media proprietor Ted Turner and Reese Schonfeld as a 24-hour cable news channel, and presently owned by ...
report has stated that the proposed public option is a '
lightning rod
A lightning rod or lightning conductor (British English) is a metal rod mounted on a structure and intended to protect the structure from a lightning strike. If lightning hits the structure, it will preferentially strike the rod and be conducte ...
' in American public opinion about healthcare reform. Republicans, people with the insurance industry, and employer groups have discussed the concern that the availability of a public plan would make it difficult for private insurers to compete. This may then lead to a situation where most people end up being covered by the public insurance option.
The
Congressional Budget Office
The Congressional Budget Office (CBO) is a List of United States federal agencies, federal agency within the United States Congress, legislative branch of the United States government that provides budget and economic information to Congress.
Ins ...
's analysis in late July stated that this would not be the case for the " public option" included in H.R. 3200, projecting that only about 11 to 12 million people would enroll in the public option. The
Lewin Group
UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest c ...
, a research firm that is part of a subsidiary of
UnitedHealth Group
UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest ...
but is run independently, has estimated that over 100 million people would join the public plan if it were structured like Medicare, which would then make it the dominant insurer.
A model similar to one proposed by the late Senator
Ted Kennedy
Edward Moore Kennedy (February 22, 1932 – August 25, 2009) was an American lawyer and politician who served as a United States senator from Massachusetts for almost 47 years, from 1962 until his death in 2009. A member of the Democratic ...
would bring in between 21.5 million and 67.5 million according to the group. A 2008 report by the
Urban Institute
The Urban Institute is a Washington, D.C.–based think tank that carries out economic and social policy research to "open minds, shape decisions, and offer solutions". The institute receives funding from government contracts, foundations and pr ...
stated the public option would probably settle into a '
niche
Niche may refer to:
Science
*Developmental niche, a concept for understanding the cultural context of child development
*Ecological niche, a term describing the relational position of an organism's species
*Niche differentiation, in ecology, the ...
' in the insurance market with other firms still able to compete.
The bill bases the publicly authorized insurance plan fees on industry averages, so there is no clear economic competitive advantage versus existing private insurance. The health insurance subsidy is available to anyone with a qualifying level of income buying insurance from the exchange regardless of whether they choose a public or private plan. A poll done by ''Penn, Schoen and Berland Associates'' for the AARP stated that only 37% of Americans correctly identified the definition of the 'public option' being proposed, numbers very close to respondents guessing randomly among answers.
In a June 2009
NBC News
NBC News is the news division of the American broadcast television network NBC. The division operates under NBCUniversal Television and Streaming, a division of NBCUniversal, which is, in turn, a subsidiary of Comcast. The news division's var ...
/
The Wall Street Journal
''The Wall Street Journal'' is an American business-focused, international daily newspaper based in New York City, with international editions also available in Chinese and Japanese. The ''Journal'', along with its Asian editions, is published ...
survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." A July survey by
Rasmussen Reports
Rasmussen Reports is an American polling company founded in 2003. The company engages in political commentary and the collection, publication, and distribution of public opinion polling information. Rasmussen Reports conducts nightly tracking, ...
found 50% of Americans opposed the idea of a public option and 35% expressed support. An August 2009 NBC News/Wall Street Journal poll found 47% of Americans opposed and 43% expressing support.
CNN
CNN (Cable News Network) is a multinational cable news channel headquartered in Atlanta, Georgia, U.S. Founded in 1980 by American media proprietor Ted Turner and Reese Schonfeld as a 24-hour cable news channel, and presently owned by ...
Polling Director Keating Holland has stated that partisan affiliations drive people's opinions on the issue.Poll: Americans split on public option By Paul Steinhauser.
CNN
CNN (Cable News Network) is a multinational cable news channel headquartered in Atlanta, Georgia, U.S. Founded in 1980 by American media proprietor Ted Turner and Reese Schonfeld as a 24-hour cable news channel, and presently owned by ...
. Posted August 18, 2009. Retrieved September 1, 2009.
Town halls
A number of
town hall meeting
Town hall meetings, also referred to as town halls or town hall forums, are a way for local and national politicians to meet with their constituents either to hear from them on topics of interest or to discuss specific upcoming legislation or ...
s held by members of Congress during the August 2009 congressional recess were the site of protests and disruptions by opponents of this health care reform legislation.
Steven Pearlstein
Steven Pearlstein is an American columnist who wrote on business and the economy in a column published twice weekly in ''The Washington Post''. His tenure at the WaPo ended on March 3, 2021. Pearlstein received the 2008 Pulitzer Prize for Commentar ...
of ''
The Washington Post
''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large nati ...
'' wrote that the concerns raised in most of these town hall disruptions are factually incorrect claims made by some conservative members of Congress and some in the right-wing media in opposition of the reform bill. Wendell Potter, who has been an executive of Cigna, a for-profit health insurer, stated that health insurance companies "are very much behind the town hall disruptions that you see and a lot of the deception that's going on in terms of disinformation that many Americans, apparently, are believing."
Many proponents of the reform bill have accused organizations such as
FreedomWorks
FreedomWorks is a conservative and libertarian advocacy group based in Washington, D.C. FreedomWorks trains volunteers, assists in campaigns, and encourages them to mobilize, interacting with both fellow citizens and their political representat ...
, a corporate and individual funded activist group, of organizing these protests to look like grassroots opposition. FreedomWorks representatives have stated that they represent grassroots dissatisfaction and disputed the allegations. The chairman of FreedomWorks is former Republican
House Majority Leader
Party leaders of the United States House of Representatives, also known as floor leaders, are congresspeople who coordinate legislative initiatives and serve as the chief spokespersons for their parties on the House floor. These leaders are ele ...
Dick Armey
Richard Keith Armey (; born July 7, 1940) is an American economist and politician. He was a U.S. Representative from Texas's (1985–2003) and House Majority Leader (1995–2003). He was one of the engineers of the "Republican Revolution" of t ...
. Health Care for America Now (HCAN), a union and individual-funded liberal activist group, organized and co-ordinated health care reform proponents in the town hall meetings. FreedomWorks has accused them of astroturfing, which HCAN disputes. The
Service Employees International Union
Service Employees International Union (SEIU) is a labor union representing almost 1.9 million workers in over 100 occupations in the United States and Canada. SEIU is focused on organizing workers in three sectors: healthcare (over half of members ...
(SEIU), a labor union, has been accused by opponents of the reform bill of busing paid operatives into town halls to demonstrate in support of the measure. The group denies the accusation.
Rasmussen Reports
Rasmussen Reports is an American polling company founded in 2003. The company engages in political commentary and the collection, publication, and distribution of public opinion polling information. Rasmussen Reports conducts nightly tracking, ...
found in a late-August survey that a 49% plurality of Americans believe that protesters genuinely express their own views while 37% consider them to be a creation of special interest groups and lobbyists. An early-August survey stated that 35% viewed the protests unfavorably and 41% viewed them favorably. Both polls showed highly partisan differences in people's view of the town halls.
Medicare issues
Ezra Klein
Ezra Klein (born May 10, 1984) is an American journalist, political analyst, ''New York Times'' columnist, and the host of ''The Ezra Klein Show'' podcast. He is a co-founder of '' Vox'' and formerly served as the website's editor-at-large. He h ...
has written in ''
The Washington Post
''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large nati ...
' in late August that, in his opinion, polls now indicate that senior citizens are becoming fearful of healthcare reform, due to concerns that funding subsidies for the uninsured would require cuts to the popular Medicare program. He said that the specific changes "don't involve anything of the kind (most of the savings would come from reducing overpayments to the private insurers that participate in the Medicare Advantage program)". He argued that, as a result, an odd but potent political alliance has emerged with Republicans arguing to protect the existing Medicare program despite its position historically which has been to oppose Medicare as an entitlement.
Peter R. Orszag
Peter Richard Orszag (born December 16, 1968) is the CEO of Financial Advisory at Lazard. Before June 2019, he was the firm's Head of North American M&A and Global Co-Head of Healthcare.
Orszag previously served as a Vice Chairman of Corporate ...
, the then director of the CBO, argued in June 2008 that the Medicare program as currently structured is unsustainable without significant reform, as tax revenues dedicated to the program are not sufficient to cover its rapidly increasing expenditures. According to the CBO, spending on Medicare will grow from $485 billion during 2009 to $879 billion by 2018. President Obama said at a White House news conference on July 22 that, without changes, the system is guaranteed "to basically break the federal budget". He argued that it is necessary to cut wasteful spending which is known to exist (over-testing, no IT, lack of co-ordination, hospital re-admissions) in order to cut costs in order to protect Medicare in the future and cut the projected national deficit.
The act, as currently structured, does not cut present Medicare benefits. It reduces projected future increases in Medicare spending such as inpatient hospital service payments and ambulatory care payments that would otherwise undergo annual re-adjustments. These changes would save $196 billion from Medicare over 10 years and removing wasteful subsidies to insurers for Medicare Advantage plan would save a further $156 billion according to the CBO. Gail Wilensky, a deputy assistant to President Bush Snr advising him on health and welfare issues from 1992 to 1993 and previously a director of Medicare and Medicaid has expressed concern that this might affect seniors access to health care if the changes are made too quickly, while other activists such as Stuart Guterman of the
Commonwealth Fund
The Commonwealth Fund is a private foundation (United States), private U.S. foundation whose stated purpose is to "promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly fo ...
argue that Medicare Advantage plans cost the taxpayer $1,000 per policyholder more than if the person had been insured through traditional fee for services.
Illegal immigrants
HR 3200 states that illegal immigrants are not eligible for the proposed taxpayer-funded affordable premium credits. Republicans have stated that there is nothing in the bill to enforce this. A group of 21 House Democrats, led by Rep. Michael M. Honda, are trying to change those requirements. He has argued that the restriction "will only add to uncompensated care costs and costly emergency room visits. Costs due to such visits will be shifted and distributed among all those who have been mandated to carry insurance. With skyrocketing health care costs, legislators should do all that we can to contain costs for working American families".http://www.house.gov/apps/list/press/ca15_honda/Health_090923.html Text of letters from Rep. Honda and leaders within the Congressional Tri-Caucus, the Congressional Progressive Caucus (CPC), and other Members of Congress to key players in the reform debate in the House of Representatives and the Senate. The
Center for Immigration Studies
The Center for Immigration Studies (CIS) is an anti-immigration think tank and a SPLC designated hate group. It favors far lower immigration numbers, and produces analyses to further those views. The CIS was founded by historian Otis L. Grah ...
has also commented on the issue.
Abortion funding
The
Hyde Amendment
In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion, except to save the life of the woman, or if the pregnancy arises from incest or rape. Before the Hyde Amendment took effect in ...
prohibits federal funding for abortions in government related health programs unless they are performed in cases of rape, incest, or to save the life of the mother. A political controversy has broken out about whether or not the 'public plan' in HR 3200 will cover abortions, which, if done, would be funded by premiums paid by individuals to that agency and not by outside payments. After rejecting Democratic Rep.
Lois Capps
Lois Ragnhild Capps (née Grimsrud; January 10, 1938) is an American politician who served as the U.S. representative for from 1998 to 2017. She is a member of the Democratic Party. The district, numbered as the 22nd District from 1998 to 2003 ...
's amendment to segregate abortion funding, the House or Representatives voted for tighter restrictions on federal funding for elective abortions via the Stupak Amendment.
Ad campaign funding
"America's Health Insurance Plans", a lobbyist group, opposed the bill.
'Americans for Stable Quality Care' is an activist group that has devised television ads in support of this type of healthcare reform. Although the group gets funding from the drug lobby
PhRMA
Pharmaceutical Research and Manufacturers of America (PhRMA, pronounced ), formerly known as the Pharmaceutical Manufacturers Association, is a trade group representing companies in the pharmaceutical industry in the United States. Founded in 195 ...
as well as from the
Service Employees International Union
Service Employees International Union (SEIU) is a labor union representing almost 1.9 million workers in over 100 occupations in the United States and Canada. SEIU is focused on organizing workers in three sectors: healthcare (over half of members ...
, it does not disclose this fact in the ads themselves. The head of the
Public Relations Society of America
The Public Relations Society of America (PRSA) is a nonprofit trade association for public relations professionals. It was founded in 1947 by combining the American Council on Public Relations and the National Association of Public Relations Cou ...
, Michael Cherenson, has accused the group of dishonest ' front group' manipulations (his group does not use the exact term ' astroturfing' since it respects the trademark). The vice chairperson of
PhRMA
Pharmaceutical Research and Manufacturers of America (PhRMA, pronounced ), formerly known as the Pharmaceutical Manufacturers Association, is a trade group representing companies in the pharmaceutical industry in the United States. Founded in 195 ...
has disputed the allegation and referred to the campaign as completely "transparent".
See also
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Public opinion on health care reform in the United States
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Afforda ...
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111th United States Congress
The 111th United States Congress was a meeting of the legislative branch of the United States federal government from January 3, 2009, until January 3, 2011. It began during the last weeks of the George W. Bush administration, with th ...
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Medicare for All Act
The Medicare for All Act, aka the Expanded and Improved Medicare for All Act or United States National Health Care Act, is a bill first introduced in the United States House of Representatives by Representative John Conyers (D-MI) in 2003, with ...
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Wyden-Bennett Act
The Healthy Americans Act (HAA), also known as the Wyden-Bennett Act, is a Senate bill that had proposed to improve health care in the United States, with changes that included the establishment of universal health care. It would transition a ...
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America's Healthy Future Act
The America's Healthy Future Act () was a bill proposed by Democratic Senator Max Baucus of Montana, who chaired the Senate Finance Committee, on September 16, 2009. It is also colloquially known as the Baucus Health Bill, the Baucus Health P ...