There is a twitter list being passed around about the healthcare bill. Are you wondering if these tweets are true or not?

Analysis by Fox News Channel Brain Room

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THE TWEET: Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!! WTF!!

MOSTLY TRUE

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THE BILL: Study of differences between insured and self-insured plans in the bill. Page 22, Lines 9-11.

Sec. 113 sets up a study, not necessarily a recurring audit.  Although the section doesn’t give much detail about what information will be required from companies to determine their financial solvency or capital reserve ratio, the information might already be available to the IRS and SEC.

SEC. 113. INSURANCE RATING RULES

(b) STUDY AND REPORTS.—

(1) STUDY.—The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:

(C) The financial solvency and capital reserve levels of employers that self-insure by employer size.

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THE TWEET: PG 24 Sec 116 of HC bill Govt effectively sets prices for ALL private health plans. WTF!!!!

HALF TRUE

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THE BILL: As the Committee’s summary states, Sec. 116 – Ensuring value and lower premiums, requires qualified plans to meet a specified medical loss ratio as defined by the Health Choices Commissioner. If plans exceed that limit, rebates to enrollees are required.

The section isn’t precisely about setting prices, but the high required loss ratio could limit how much participating private plans could charge.  The loss ratio is the amount of each premium dollar that is spent on actual medical care costs.

What this means is that the bill sets a percentage of premium dollars that must be spent on medical costs; it limits the percentage that can go to administrative costs and profit. The bill would provide that the medical loss ratio must be at least 85 percent.

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THE TWEET: Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE IS RATIONED!!!

FALSE

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THE BILL: SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.

(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE.—

(2) ANNUAL LIMITATION.—

(A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

The above lines are line 4-16 of page 29.  They don’t pertain to any rationing.  This paragraph limits annual out-of-pocket spending in the essential benefits package, that all plans must meet, to $5,000 for an individual and $10,000 (indexed to CPI) for a family.  Out-of-pocket maximums are already common in health insurance plans.

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THE TWEET: Pg 30 Sec 123 of HC bill – THERE WILL BE A GOVT COMMITTEE that decides what treatments/benes u get.

MOSTLY FALSE

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THE BILL: SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.

Sec. 123 establishes a Health Benefits Advisory Committee, chaired by the Surgeon General. The Health Benefits Advisory Committee is a government committee – it is a committee formed by the government – but most of its members would not be Federal employees or officers.  The President would appoint most of its members; the Comptroller General of the U.S. would appoint a number of them as well.  The membership is supposed to reflect a wide variety of interests, “a balance among various sectors of the health care system” as the bill details.

The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services benefit standards.  The benefits standards do include categories of covered treatments, items and services within benefit classes, and cost-sharing.  Such standards, if adopted, would decide a minimum level of benefits an individual would get, depending on what plan option they choose. 

However, recommending such standards and “deciding” such standards isn’t exactly the same thing. The Secretary of HHS, as detailed in Sec. 124, shall review the standards recommended by the Committee and shall determine whether to propose adoption of such standards as a package.  If the Secretary doesn’t like the standards as a package the Committee will get a chance to modify their recommendation.  In the end, if the deadline for recommending the standards is looming, the Secretary shall propose adoption of initial benefit standards.

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THE TWEET: Pg 37 Sec 132 of HC Bill – The Govt will be reviewing grievances about

themselves and will decide on appeals for rejected claims.

FALSE

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THE BILL: SEC. 132. REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS.

As the Committee’s summary states, the bill requires each qualified plan to meet standards defined by the Health Choices Commissioner for timely internal grievance and appeals mechanisms and to establish an external review process that provides for an impartial, independent and de novo review of denied claims. The determination is binding.

The internal review requirements don’t appear to be anything all that new; they’re the same as the requirements under Title I of ERISA.  If the government is the provider, as it would be with a public option, the government, HHS, would apparently handle the internal appeals process. 

However, the public health insurance option would apparently be subject to the external review process, established by the Commissioner, that provides for an impartial, independent, and de novo review of denied claims under this division.  The bill doesn’t indicate that the government will be the party conducting the independent external reviews.

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THE TWEET: Pg 42 of HC Bill – The Health Choices Commissioner will choose UR HC Benefits 4 you. U have no choice!

FALSE

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THE BILL: SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER.

The Commissioner establishes plan standards, works out the operation of the Exchange, and administers affordability credits.  He doesn’t choose what plan an individual must choose and therefore what benefits an individual will have.  As with many parts of this bill, the standards concern what must be offered at a minimum.

The Commissioner will hold health benefit plans accountable for meeting federal requirements.  Plans that don’t meet federal requirements could be penalized, suspended, or terminated.

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THE TWEET: PG 50 Section 152 in HC bill – HC will be provided 2 ALL non US citizens, illegal or otherwise.

HALF TRUE

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THE BILL: SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE.

(a) IN GENERAL.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

The bill doesn’t explicitly allow services to illegal immigrants and this section isn’t, on its face, intended to extend coverage to illegal immigrants. But critics say the bill needs a specific exemption to bar immigrants from receiving health care through emergency rooms and community health centers. Some critics say budget estimates for the health bill already factor in illegal immigrants receiving taxpayer-funded insurance due to the health bill not requiring verification of citizenship for people receiving services.

In Sec. 246 the bill specifically states “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”  Groups opposed to illegal immigration have argued that the bill doesn’t do what is necessary to be sure that prohibition is actually enforced.

This civil rights provision, Sec. 152, would most likely protect individuals from discrimination on the basis of age, race, national origin, etc.  It will arguably also offer protection to lesbian, gay, bisexual and transgender individuals.

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THE TWEET: Pg 58HC Bill – Govt will have real-time access 2 individs finances & a National ID Healthcard will b issued!

FALSE

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THE BILL: SEC. 163. ADMINISTRATIVE SIMPLIFICATION.

(a) STANDARDIZING ELECTRONIC ADMINISTRATIVE TRANSACTIONS.—

‘‘(2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS.—The goals for standards under paragraph (1) are that such standards shall—

‘‘(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;

Hardly.  This bit of Sec. 163 is meant to require a quick determination of how much an individual owes for a visit to a provider: they want you to be able to find out how much your bill will be without waiting too long. 

The machine-readable health plan beneficiary identification card that may be utilized would be a card that they don’t have to type the number in, but rather includes possibly a magnetic strip or machine-readable code.  No other standards for such a card are indicated, nor is any indication given that such cards will be issued by parties other than the plan provider.

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THE TWEET: Pg 59 HC Bill lines 21-24 Govt will have direct access 2 ur banks accts 4 elect. funds transfer!

HALF TRUE

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THE BILL: SEC. 163. ADMINISTRATIVE SIMPLIFICATION.

‘‘(4) REQUIREMENTS FOR SPECIFIC STANDARDS.—The standards under this section shall be developed, adopted and enforced so as to—

‘‘(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;


Sec. 163 sets a standard where electronic funds transfers (EFTs) must be enabled, but this paragraph doesn’t require EFTs to be used.  It’s an efficiency measure, or as the bill section says an “administrative simplification”, but apparently not a mandatory one.  If an individual did use the public option then the government could have some access to their bank accounts during the course of an EFT, but the doctor’s office or other point of service would most likely be the ones processing any payments from patients.

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THE TWEET: Pg 61 HC Bill lines 22-24 Congress has no clue what Elec. Med Records will cost. Asks for estimate.

TRUE

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THE BILL: SEC. 163. ADMINISTRATIVE SIMPLIFICATION.

‘‘(6) IMPLEMENTATION AND ENFORCEMENT.— Not later than 6 months after the date of the enactment of this section, the Secretary shall submit to the appropriate committees of Congress a plan for the implementation and enforcement, by not later than 5 years after such date of enactment, of the standards under this section. Such plan shall include—

‘‘(E) an estimate of total funds needed to ensure timely completion of the implementation plan; and

Yes, the bill requires the Secretary to submit to the appropriate committees of Congress an estimate for how much money he or she will need to implement and enforce their administrative simplification plan.

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THE TWEET: PG 65 Sec 164 is a payoff subsidized plan 4 retirees and their families in Unions & community orgs (ACORN).

MOSTLY TRUE

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THE BILL: This is correct (although probably would not apply to ACORN). 

It establishes a government-run "temporary" reinsurance fund with $10 billion of tax-payer funds.  The government can use these funds to pay claims of retirees in employer-sponsored health care programs or VEBA Trusts, with the purpose of the reinsurance being to ensure that these retirees do not have higher out of pocket costs. 

        The most relevant angle on this might be the UAW VEBA.  The government already used taxpayer dollars to give the car companies to the UAW.  The UAW and the Democrats made a big deal out of the "sacrifice" by the UAW because the UAW VEBA was taking a risk that the company stock it received as a "concession" to assist the car makers might not be enough to cover the VEBA costs / retiree claims.  The Dem health care bill now retroactively ensures that the UAW took no "risk" because any shortfall as a result of the stock not being worth as much as the administration said it would be would be funded by another $10 billion of taxpayer funds through the “reinsurance” program. 

        Another point to make is that this goes far beyond “health care reform.”  It does not deal with the uninsured or health care costs.  These plans exist and can certainly get reinsurance coverage on their own through the private markets (and there is no requirement that the plan show that it cannot get private coverage before getting the government cheese “reinsurance”). Finally, calling it “reinsurance” is strange because there is no requirement in the legislation that the retiree health care plan actually pay anything to the government for “reinsurance” – this seems to be a pure taxpayer-funded subsidy of union retiree out of pocket health care costs and premiums.

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THE TWEET: Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps 2 sign up indiv. for Govt HC plan.

MOSTLY TRUE

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THE BILL: This is correct (although ACORN is not specifically mentioned in the bill). 

        The relevant section provides that the "Health Choices Commissioner" created under the government plan "may work with other appropriate entities to facilitate the dissemination of information" regarding the government-run plan. 

        The bill does not specifically mention ACORN as an "appropriate entity" that may be chosen to provide information and facilitate enrollment in the government plan.  However, as with the Census and housing counseling, this administration has a penchant for hiring groups such as ACORN to provide similar services.             

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THE TWEET: Pg 110 Lines 13-18 An excise tax on ALL goods from companies not offering Govt HC. ALL Americans pay. 

MOSTLY FALSE

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THE BILL: This is incorrect / exaggerated. 

        The legislation calls the penalty on employers who fail to provide health insurance to their employees an "excise tax."  The author of the analysis correctly notes in another point that this is a tax on the employer.  However, the author suggests in this statement that the tax will also apply to every good sold or manufactured by the employer (similar to a VAT tax).  This is incorrect. 

        Companies will certainly pass the costs of the government penalty onto either its workers (through lower wages, less benefits, etc) or consumers (through higher prices) or both – thus it is likely that at least some and possibly "ALL Americans pay."  However, it is incorrect to state or suggest that the government will directly impose a tax on all goods made by the employer.     

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THE TWEET: pg 124 lines 24-25 HC No company can sue GOVT on price fixing. No "judicial review" against Govt Monop

TRUE

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THE BILL: This is correct.  The bill provides "[t]here shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224."  These sections deal with the government-plan payment rates.  Because there is no possibility for judicial review of payment rates, there is the possibility that the government can fix prices. 

        It should be noted that price fixing requires more than 1 participant.  The government would therefore need to be conspiring with some other entity to fix prices.  This section would seem to immunize both the government and the other conspirator from price-fixing charges. 

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THE TWEET: pg 127 Lines 1-16 HC Bill – Doctors/ #AMA – The Govt will tell YOU what u can make

FALSE

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THE BILL: This is incorrect / exaggerated. 

        The provision at issue relates to the government rates for payment of physician services.  This is the same as the current Medicare payment rates.  Setting compensation rates for given services (which all health insurance policies do) is far different from capping or dictating compensation limits for doctors (i.e., the "Pay Czar" and financal institutions). 

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THE TWEET: Pg 241 Line 6-8 HC Bill – Doctors, doesnt matter what specialty u have, you’ll all be paid the same:

BARELY TRUE

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THE BILL: This is true, but exaggerated. 

        This section of the bill establishes conversion factors based upon service categories for Medicare and Medicaid.  It is accurate to state that these changes apply "without regard to the specialty of the physician furnishing the service."  However, it is inaccurate to suggest that this means that all doctors – regardless of specialty – will be paid the same under the Medicaid / Medicare reimbursement system. 

        Here is an example.  Let’s assume that the government reimbursement schedule for Medicare periodic check-ups is $100.  Under this section, a world-renown brain surgeon who decides that he wants to spend some time performing general check-ups for Medicare recipients will receive the same government reimbursement as a general practitioner providing the same services to the same Medicare patient — $100.  That is because this section fixes the compensation based on the service provided – not the level of attainment of the physician providing the service. 

        Conversely, the government will presumably set higher reimbursement rates for brain surgery on Medicare recipients, which the world-renown surgeon will be able to receive but the GP will not because the GP lacks the expertise and training to perform these types of complicated procedures.           

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THE TWEET: Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval. Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.

MOSTLY TRUE

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THE BILL: This is generally correct (although it also does not mention ACORN by name).

This looks a lot like a mini-version of the Community Reinvestment Act – which also gave community input into expansions (in that case bank mergers).  "Community organizing" groups used that power to essentially extort money from banks, getting money in exchange for not opposing bank mergers. 

        There are certainly valid reasons why community input might be relevant, and even advisable, for a decision about expanding a hospital’s size.  However, the echoes of the CRA make it seem like another potential financial windfall for community groups. And the increased costs to make up the extortion payment would be born by the hospital’s patients.          

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THE TWEET: End of life claims:  The e-mail contains a group of claims related to end of life provisions in the health care bill (pages 425-430).  These claims either state explicitly or suggest that the government will require that the recipient receive these services. 

FALSE

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THE BILL: The suggestion or explicit statement that these services are mandatory is incorrect.  These provisions all deal with voluntary services – provision of information requested by the consumer. 

        There may be several problematic aspects of these provisions, including having medical professionals (as opposed to lawyers) advising and counseling individuals on end of life documents such as health care proxies, living wills, etc.

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THE TWEET: PG 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt in2 ur marriage. 

FALSE

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THE BILL: This is exaggerated. 

        The author is correct when he states that the bill expands the definition of covered medical services under existing government health plans to include marriage and family therapy. 

        However, this does not "insert the government into your marriage" any more than Medicare regulations authorizing the payment of chemotherapy treatments "inserts the government" into your relationship with your doctor. 

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THE TWEET: Pg 769 3-5 Nurse Home Visit Svcs – “increasing birth intervals btwn pregnancies.” Govt ABORTIONS any1?

FALSE

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THE BILL: This is exaggerated. 

        The author is correct when he states that the bill provides for federal payment of charges for visiting nurse services when the services are determined by the Secretary of Health and Human Services to be effective in, among other things, "[i]mproving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies."

        The provision covers only "home visits by trained nurses to families with a first-time pregnant woman, or a child (under 2 years of age)" that meets the income threshold requirements for government medical assistance.  The provision does not specifically mandate that the visiting nurse advise the pregnant woman or low-income family to have abortions as a means of increasing birth intervals.   

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