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2 FACTS: Abortion Coverage Allowed; End-of-Life Rationing Incentivized
Update of November 20, 2009:
The analysis of the House bill below remains relevant to the language that continue to pop up in the bills drafted by Senator Harry Reid and Speaker Nancy Pelosi. For ongoing updates, see our Obamacare blog.
Obama-backed House Bill (HR 3200):
Abortion and Death Panel Rationing
The following analyzes the Obama-backed House Healthcare Reform Bill, HR 3200.
Citizens are encouraged to be attentive to similar language making its way into other House or Senate bills, and most importantly the conference report.
HR 3200 Fact 1:
Government-funded Abortion IS Allowed
Nonpartisan FACTCHECK.ORG says Obama incorrect on abortion coverage:
http://www.factcheck.org/2009/08/abortion-which-side-is-fabricating/
"Despite what Obama said, the House bill would allow abortion to be covered by a federal plan and by federally subsidized private plans." Updated 8/25/09
READ THE BILL LANGUAGE FOR YOURSELF:
Read the Capps amendment to HR 3200 that authorizes abortion coverage despite it's phony title saying that it forbids public option abortion coverage:
Click here to read the Capps Abortion-funding Amendment
Click here to see the Vote on the Capps Amendment
The Capps amendment states that some abortions "shall" be covered by the "public option" plan, specifically those types of abortions ... performed in cases or rape or incest, or to save the life of the mother.
As for other types of abortions, the Capps amendment leaves it to the secretary of Health and Human Services to decide whether or not they will be covered. It says, "Nothing in this Act shall be construed as preventing the public health insurance option from providing" abortion services that would not be legal for Medicaid coverage. Factcheck.org
Notably, the House committee REJECTED a pro-life amendment to prohibit government funding of abortion:
Read the rejected Stupak/Pitts Anti-Funding Amendment
See the vote on the rejected Anti-Funding Amendment
HR 3200 Fact 2:
Government-regulated End-of-Life Counseling IS Incentivized
Rationing Healthcare for Senior Citizens?
While the rhetoric of “death panels” has been hyped, it should not overshadow the fact that the language of HR 3200 does indeed raise legitimate questions about whether these consultations create a subtle yet effective means of pushing Medicare recipients to “self-ration” – that is, to sign documents or be subject to doctor's orders declining life-sustaining medical treatments years before they may be needed.
Section 1233 of HR 3200 would authorize Medicare to expand reimbursement for a benefit called an "advance care planning consultations" to discuss future end-of-life decisions every 5 years or more frequently if there is a "significant change in the health condition of the individual"; (pp. 424-434)
During that consultation, an undesignated physician, nurse practitioner or physician assistant "may include the formulation of an order regarding life sustaining treatment"; (p. 429, lines 1-3)
"Order regarding life sustaining treatment" is defined as an "actionable medical order" that may indicate treatment ranging from "full treatment to an indication to limit some or all or specified interventions" including "transfer to a hospital," "the use of antibiotics" and "the use of artifically administered nutrition and hydration"; (p. 430, lines 4-17)
Creating a Conflict of Interest between Doctor and Patient?
HR 3200 requires physicians to report to the government about whether end of life orders or advance care directives have been adhered to. Rather than answering to the best interest of the patient, the provider would then have a conflict because the physician is accountable to the government agency that controls medical payment and the ability to participate in medicare.
HR 3200 sets up physician reporting requirements. The “Expansion of Physician Quality Reporting Initiative for End of Life Care” provisions (p.431, line 16 et seq.) seem to make advance care planning a reportable pay for performance measure for every professional providing services to Medicare patients:
“Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.” (p. 432, lines 7-9)
“The Secretary shall include quality measures on end of life care and advance care planning that have been adopted or endorsed by a consensus-based organization, if appropriate.” (p. 432, lines 3-7)
Mandating Physicians to Promote End of Life Consults?
Certain language in HR 3200 supports the authority of the Secretary to mandate providersto push end of life consultations as a condition for health providers to participate in Medicare:
An August 2008 DHH Report to Congress entitled “Advance Directives and Advance Care Planning: Report to Congress,” states:
“One mechanism would be to require use of such protocols [such as Physicians Orders for Life-Sustaining Treatment (POLST)] by providers accepting Medicare/Medicaid funds.”
(Appendix H, Section 2.c)
Other recommendations included: “Link funding to facilitation of advance care planning and outcomes;” and “Recognize poor advance care planning as a medical errors that require remedy.”
While it is wise to discuss your wishes with your family and your providers, there are DANGERS involved in government-regulated and incentivized consultations that encourage you to decline life-sustaining treatments years before you know your particular medical condition.
PRINTABLE IN-DEPTH ANALYSIS OF END-OF-LIFE PROVISIONS
What will government regulated end of life counseling look like? A clue is the booklet now used by the Obama V.A. for war vets. See page 21 of "Your Life, Your Choices," which asks whether certain circumstances make your life "difficult but acceptable"; "worth living, but just barely"; or "not worth living."
Review the 1,017 pages of HR 3200 for yourself here:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf
November 2, 2009:
Review the 1,900 pages of HR 3962, the new Pelosicare bill, here:
http://docs.house.gov/rules/health/111_ahcaa.pdf
*As a non-profit public-interest legal organizaion, BDF offers this information for public education purposes, and not for the purpose of advocating for the passage of defeat of any particular legislation.
Contact:
Dorinda C. Bordlee
Vice President, Senior Counsel
dbordlee@bdfund.org
(504) 231-7234
Bioethics Defense Fund is a 501(c)(3) public interest legal and educational organization dedicated to advocating against the human rights violations of abortion, human cloning/destructive human embryo experimentation, and euthanasia through litigation, legislation and public education.
Bioethics Defense Fund
Human Rights from Beginning to End
www.BDFund.org
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