Summary

The Republican National Committee this week posted a “Health Care Bill of Rights for Seniors,” which RNC Chairman Michael Steele and others have taken to the airwaves to publicize. It contains a number of claims we’ve seen and criticized before, but also contains one new one that has some truth to it, and another fresh one that has very little.

The RNC says that cuts proposed by Democrats "threaten millions of seniors with being forced from their current Medicare Advantage plans." That’s certainly possible. Ratcheting down payments to the private insurance plans in Medicare Advantage would likely cause them to reduce benefits or even withdraw from the market. That might force an unknown number of beneficiaries to find new plans or go back to the traditional system, which still covers 78 percent of the Medicare population.

(Update, Aug. 31: At least 3 million of the more than 10 million Medicare Advantage beneficiaries would likely go back to traditional Medicare, one independent expert says.)

(Update, Aug. 31: At least 3 million of the more than 10 million Medicare Advantage beneficiaries would likely go back to traditional Medicare, one independent expert says.) Another new wrinkle in the RNC’s "Bill of Rights" is a claim that Democrats have proposed raising TRICARE insurance costs for retired military and their families. This one is false. It was actually the Bush administration that most recently proposed changes in TRICARE, which the hospital industry said would cost hospitals $458 million in its first year.

The RNC "Bill of Rights" document also recycles claims that Democrats are proposing $500 billion in Medicare cuts without mentioning that much of that is offset by proposed Medicare increases. It falsely says that a comparative effectiveness research panel set up earlier this year could limit care based on a patient’s age, when in fact the law expressly prohibits the council from issuing such mandates. And the RNC implies, wrongly, that seniors who meet with their doctors to discuss end-of-life care could have their treatment cut off involuntarily. In fact, these discussions would be voluntary and any directives limiting treatment would have to come from the patient.

Analysis

At this particular point in the health care debate, we’re finding that there’s not much new under the sun when it comes to false claims being made about the overhaul proposals. But just in case pretty new packaging threatens to rope unwary citizens into believing some of these misrepresentations, we stand at the ready, and it is in that spirit that we tackle the Republican National Committee’s new "Health Care Bill of Rights for Seniors." RNC Chairman Michael Steele and others in his party have been touting the document all week; Steele penned an op-ed that ran in The Washington Post, and did interviews on National Public Radio, ABC’s Good Morning America, and Fox News Channel, among other outlets. Here’s what he said in the Post:

Steele, Washington Post, Aug. 24: The Democrats’ plan will hurt American families, small businesses and health-care providers by raising care costs, increasing the deficit, and not allowing patients to keep a doctor or insurance plan of their choice. Furthermore, under the Democrats’ plan, senior citizens will pay a steeper price and will have their treatment options reduced or rationed. Republicans want reform that should, first, do no harm, especially to our seniors. That is why Republicans support a Seniors’ Health Care Bill of Rights, which we are introducing today, to ensure that our greatest generation will receive access to quality health care.

We’ll take the particulars of the "Health Care Bill of Rights" in the order they are presented.

Raiding Medicare?

RNC: PROTECT MEDICARE AND NOT CUT IT IN THE NAME OF HEALTH CARE REFORM: President Obama and Congressional Democrats are promoting a government-run health care experiment that will cut over $500 billion from Medicare to be used to pay for their plan. Medicare should not be raided to pay for another entitlement.

FactCheck.org: As we noted in our article More ‘Senior Scare,’ the bill that’s currently pending in the House would indeed "cut" $500 billion or so from Medicare, but it would also increase expenditures in some areas. The net amount that would be taken from the program would be about $219 billion, according to the Congressional Budget Office. That’s a 10-year figure, by the way. And any implication that seniors’ Medicare benefits would be cut is false. Rather, the bill calls for holding down payments to hospitals and other providers, other than physicians.

As we’ve noted before, Republicans are accusing Democrats of pretty much the same thing that Obama wrongly accused John McCain of doing last year, when the GOP nominee proposed to pay for part of his own health care measure with "savings" in Medicare. We called it a false scare tactic when Obama’s TV ads said benefit levels would be reduced. The RNC document doesn’t go quite that far, but fails to make clear that what Democrats are proposing isn’t a cut in benefits.

Government Boards and Rationing by Age?



RNC: PROHIBIT GOVERNMENT FROM GETTING BETWEEN SENIORS AND THEIR DOCTORS: The Democrats’ government-run health care experiment will give patients less power to control their own medical decisions, and create government boards that would decide what treatments would or wouldn’t be funded. Republicans believe in patient-centered reforms that put the priorities of seniors before government. PROHIBIT EFFORTS TO RATION HEALTH CARE BASED ON AGE: The Democrats’ government-run health care experiment would set up a "comparative effectiveness research commission" where health care treatment decisions could be limited based on a patient’s age. Republicans believe that health care decisions are best left up to seniors and their doctors.

FactCheck.org: Both of these claims have their root in fundamental miscastings of the Federal Coordinating Council for Comparative Effectiveness Research, a body created by the economic stimulus bill signed into law in February. The council isn’t an "effort to ration health care based on age," nor would it get "between seniors and their doctors." As we’ve explained repeatedly, the council was created to monitor government research on the efficacy and cost-effectiveness of various treatments, and to help get the findings out to practitioners. But the stimulus legislation even specifies that no dictates would come from this body regarding coverage of or reimbursement for any treatments: "Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. … None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment." And just in case that wasn’t clear enough, the House Energy and Commerce Committee adopted an amendment to the House health care bill expressly prohibiting the comparative effectiveness research from being used to "deny or ration" care.

According to the RNC, the first claim also refers to something called the Independent Medicare Advisory Council, which the administration wants to create and imbue with the power to make an annual package of changes in what Medicare pays doctors. The president could only block them by rejecting the entire package, and Congress could only do so by means of a congressional resolution. The idea is to take politics out of these decisions, which could indeed ease the way for unpopular cost-cutting measures and possibly for reductions in some future benefit levels. But IMAC is not a part of the pending bills.

Operative Word: Optional

RNC: PREVENT GOVERNMENT FROM INTERFERING WITH END-OF-LIFE CARE DISCUSSIONS: The Democrats’ government-run health care experiment would have seniors meet with a doctor to discuss end-of-life care that could mean limiting treatment. Republicans believe that government should not interfere with end-of-life care discussions between a patient and a doctor.

FactCheck.org: This is a somewhat milder version of the claim that was going around in a chain e-mail that the Democrats wanted to require seniors to undergo counseling every five years on how to end their lives sooner. Former New York Lt. Gov. Betsy McCaughey furthered the myth, and in former Alaska Gov. Sarah Palin’s interpretation it took the form of so-called "death panels" that would decide whether elderly Americans are "worthy of care." We dealt with that in our piece "False Euthanasia Claims" as well as in "Palin vs. Obama: Death Panels." It’s simply not true. What the bill would do is allow seniors to have counseling sessions on end-of-life care issues with their doctors, which Medicare would pay for once every five years. The sessions would be voluntary, and the discussions would only involve "limiting treatment" if that’s the sort of directive that a senior wanted to give, say, in a living will.

Medicare’s Private Plans

RNC: ENSURE SENIORS CAN KEEP THEIR CURRENT COVERAGE: As Democrats continue to propose steep cuts to Medicare in order to pay for their government-run health care experiment, these cuts threaten millions of seniors with being forced from their current Medicare Advantage plans. Republicans believe that seniors should not be targeted by a government-run health care bill and forced out of their current Medicare coverage.

FactCheck.org: The vast majority of Medicare recipients would see little change in their interactions with the health care system under the bills currently pending. But it’s probable that some unknown number of the 22 percent of seniors, or more than 10 million individuals, who participate in Medicare Advantage programs would indeed need to pay more out of pocket, change plans or face reduced benefits – though never less than participants in traditional Medicare receive.

Update, Aug. 31: The number likely to switch back would be 3 million or a bit more, according to Kenneth E. Thorpe, professor and chair of the Rollins School of Public Health at Emory University. Thorpe is co-author of a 2007 study that estimated the effect on Medicare Advantage beneficiaries of possible policy changes. We contacted Thorpe, who said the study used "a similar proposal" to what is now contained in H.R. 3200. At the time of the study the total number of Medicare Advantage enrollees was just over 8 million, and it is over 10 million currently. So Thorpe said the number displaced by the House bill would be "at least" 3 million.

A little background: Medicare recipients since the 1970s have been able to choose to receive their benefits through private health plans, rather than through the traditional, government-run, fee-for-service form of Medicare. Medicare Advantage is the most recent incarnation of this alternative. Republicans have generally favored these private options more than Democrats, and in 2003 the GOP Congress and president increased the amount Medicare paid to the plans to handle Medicare beneficiaries.

At this point, government payments to Medicare Advantage plans are 14 percent higher per enrollee, on average, than the cost of traditional fee-for-service in a given geographical area, according to the Kaiser Family Foundation. What do the plans do with the additional money? Often they use at least some of it to reduce premiums or cost-sharing for recipients. In some cases, though not all, seniors have been able to save money by signing up for a Medicare Advantage program.

But according to the Medicare Payment Advisory Committee, which is an independent congressional agency, the additional spending for Medicare Advantage programs – which adds up to billions each year – is hastening the depletion of the Medicare trust fund. It has also meant higher premiums for all Medicare beneficiaries, according to the Government Accountability Office, another nonpartisan arm of Congress. As GAO put it, "beneficiaries covered under Medicare FFS are subsidizing the additional benefits and lower costs that MA beneficiaries receive."

Long recognized as a possible source of savings – and mentioned as such by Obama during the presidential campaign – payments to Medicare Advantage programs under the House bill would be reduced over several years until they are equal to the costs of traditional Medicare. (Medicare payments are calculated by county.) The measure would reduce the growth of future Medicare spending by $156 billion over 10 years. The result, based on prior experience with tinkering with the payment formulas, could be that some plans decide to withdraw from the Advantage program, said Brian Biles of George Washington University’s Department of Health Policy in a telephone interview, leaving them to choose from surviving Medicare Advantage plans or return to the traditional Medicare fee for service program that currently covers the other 78 percent of beneficiaries.

Riling the Vets, Too

RNC: PROTECT VETERANS BY PRESERVING TRICARE AND OTHER BENEFIT PROGRAMS FOR MILITARY FAMILIES: Democrats recently proposed raising veterans’ costs for the Tricare For Life program that many veterans rely on for treatment. Republicans oppose increasing the burden on our veterans and believe America should honor our promises to them.

FactCheck.org: The RNC tells us this refers to a budget proposal floated last spring by the Obama administration that would have allowed the Department of Veterans Affairs to bill vets’ private insurance companies for the cost of treating combat-related injuries. But as we noted earlier this year, the idea was quickly dropped and never made it into the president’s budget, due in part to protests from veterans. But more to the point, it had nothing to do with TRICARE, which is the Department of Defense health program covering active duty and retired military members and their families, or TRICARE for Life, which is for military retirees or family members who are 65 or over or otherwise eligible for Medicare.

In attempting to back up this claim, the RNC also cites a series of budget-cutting options issued by the nonpartisan Congressional Budget Office last January. The ideas included raising out-of-pocket costs and other fees for veterans in TRICARE. But that was just one of 115 ideas for cutting costs or otherwise changing federal health care programs, and CBO made clear that "the report makes no recommendations." The TRICARE idea does not appear in the pending health care overhaul bills.

And in fact, one of the news articles the RNC cites in support of this claim mentions that it was the Bush administration that most recently proposed TRICARE cuts, which were protested by many hospitals. The news item speculated that "Obama also might follow the lead of his predecessor" and seek higher TRICARE fees, but so far Obama has not done so.

–by Viveca Novak

Correction, Aug. 31: We originally wrote that government payments to Medicare Advantage plans were 114 percent higher than payments to traditional fee-for-service plans. In fact, they are 114 percent as much – that is, 14 percent higher. We have corrected this in the story.

Sources

U.S. House. "H.R. 3200."

Obama, Barack and Joe Biden. “Barack Obama and Joe Biden’s Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Care Coverage for All.” barackobama.com. Accessed 28 Aug 2009.

Philpott, Tom. “Obama Drops Vet Insurance Plan.” Military.com. 19 March 2009, accessed 28 Aug 2009.

Rucker, Philip. “Obama’s Turnabout on Vets Highlights Budgeting Nuances.” The Washington Post. 21 March 2009.

Morgan, Paulette. “Medicare Advantage.” Congressional Research Service. 3 March 2009.

Steele, Michael. “Protecting Our Seniors.” The Washington Post. 24 Aug 2009.

The Henry J. Kaiser Family Foundation. “Medicare Advantage.” April 2009.

Biles, Brian, Jonah Pozen and Stuart Guterman. “The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009.” The Commonwealth Fund Issue Brief. May 2009.

U.S. Government Accountability Office. “Medicare Advantage: Higher spending relative to Medicare fee-for-service may not ensure lower out-of-pocket costs for beneficiaries.” Statement of James Cosgrove. 28 Feb 2008.

Medicare Payment Advisory Commission. “Report to the Congress: Medicare Payment Policy.” March 2009.

Atherly, Adam and Kenneth Thorpe. "The Impact of Reductions in Medicare Advantage Funding on Beneficiaries." Emory University. April 2007.