MYTH: No one Agrees on what should be in Health Care Reform
Fact: Congress agrees on almost 80% of the health care bills pending before the House of Representatives and Senate

Myth: Health care reform will jeopardize Medicare and will mean cuts in services and benefits for seniors.

Fact: Health care reform will help strengthen Medicare so that seniors can continue to receive quality health coverage for years to come. 

Currently, the Medicare trust fund is projected to become insolvent by the year 2017. It is important to act now to ensure that seniors do not face cuts to their Medicare benefits in the years ahead. Health care reform will strengthen Medicare by:

• Combating fraud, waste, and abuse within the Medicare program to help reduce overpayments, which will improve Medicare's financial strength;

• Fixing the Medicare prescription "Donut Hole" by offering discounted pharmaceuticals to seniors who fall within this coverage gap;

• Preventing the scheduled 20 percent Medicare payment cut to physicians who participate in Medicare, based on the sustainable growth rate, which will ensure seniors can still have access to their doctors;

• Offering free preventative care;

• Focusing on treating and preventing chronic diseases; and

• Allowing more generic drugs to enter the market so seniors have affordable prescription drug options.

Learn more about how the health care reform proposals will affect seniors by visiting the following links: 

White House (PDF)  

Senate Aging Committee (PDF)

Third Way (PDF)   

Kaiser Family Foundation (PDF)

MYTH: Health care reform will lead to rationing of health care.

FACT:  Health care reform is aimed at increasing the options for Americans, not limiting them.

Unfortunately, rationing of health care happens all too often now, but is something that Congress is trying to address with comprehensive health care reform. Right now, insurance companies are the ones who decide whether or not you can have a certain test or procedure, based not on what you need or what works, but based on the insurance plan you have and whether the test is affordable. This rationing has left millions of Americans without adequate care or coverage and is taking away the decision making from patients and their doctors, putting those decisions instead in the hands of insurance company bureaucrats.

Health care reform is intended to improve the ability of patients to receive the care they need by setting ground rules for insurance companies to follow.  No longer will insurance companies be allowed to deny coverage for preexisting medical conditions or to discriminate against consumers because of their gender. No longer will insurance companies be allowed to revoke insurance coverage from a patient who has been ill and deemed too sick for coverage. The government will have no role in telling patients what tests they can and cannot have. Health care reform is about improving choice for all Americans. 

MYTH: Health care reform will mean cutting Medicare benefits.

FACT: Medicare will actually be strengthened by health care reform.

Today's forecasts estimate that Medicare will be insolvent by 2017 because of ever-rising health care costs.  Comprehensive health care reform takes aim at that unfolding threat by addressing cost inefficiencies now, instead of waiting until later.  The bills being discussed in Congress would strengthen the financial stability of Medicare by targeting fraud and ending wasteful overpayments to insurance companies, while maintaining the benefits and services to seniors who use Medicare.  The bills also would help Medicare users by offering prescription drug discounts to seniors who are trapped in the "Donut Hole," by creating a better pathway for generic drugs to enter the marketplace, by eliminating the cost-share for preventative services, by promoting coordinated care to prevent avoidable hospital readmissions, and by preventing a 20 percent cut in doctor payment rates that will kick in next year unless Congress acts.

MYTH: The government will encourage or force seniors to choose euthanasia as an end-of-life option.

FACT: This has been shown over and over again to be another false rumor.  None of these bills require that seniors participate in consultations about their end-of-life wishes.

Unfortunately, this rumor has been spreading fast and is worrying many Vermonters and Americans across the country. Nothing in any of the bills being drafted by Congress forces seniors to have consultations regarding their end-of-life choices. The bills would allow patient coverage, for the first time, of voluntary consultations about a senior's wishes, so families and hospitals don't have to guess when the time arrives.  It empowers seniors to have conversations about living wills and other questions they might have but do not have the opportunity to ask.  In no way does the legislation mandate these conversations or tell doctors what options to discuss.  If seniors do not wish to have these discussions with their doctors and families, nothing will force them to.

If you have concerns about this provision, you can read the legislative language of the House bill, Section 1233 entitled Voluntary Advance Care Planning Counseling.

You may also find helpful an article from the New York Times on August 14, 2009 titled "False 'Death Panel' Rumor Has Some Familiar Roots."

For a quick timeline of discussions on end-of-life options from the same article, click here.

Myth: Health care reform will hurt small businesses.

FACT: Health care reform will help small businesses, many of which are struggling now to even afford health plans for their employees.

Small businesses are a vital engine of Vermont's economy. Unfortunately, rising health care costs are hitting small businesses especially hard, putting them at an even greater disadvantage against larger corporations. Health care reform will help level the playing field and give affordable options to small businesses that wish to offer insurance to their workers.

For example, health reform will: 

• Provide tax credits to small businesses to help them offer health insurance to their employees;

• Require insurance companies to provide free preventative care so businesses do not suffer productivity costs because of sick employees;

• End the "hidden insurance tax" that has prevented small businesses from being able to afford to offer insurance to their employees.  This hidden tax is built in to the premiums for insurance to compensate for the unpaid care given to the uninsured.  Health reform will help get Americans health insurance and will end the inflated premium costs.  And investments to lower health care costs overall will help spur the economy, enabling more businesses to thrive;

• Exempt small businesses from the cost-share requirement proposed for larger businesses that do not offer health coverage to their employees. 

If you are interested in a report by the White House Council of Economic Advisors, discussing health care costs and small businesses, click HERE.

Common questions on health reform:

Since I started this webpage, I have received thoughtful and timely questions from dozens of Vermonters about the state of health care in America.  Below are answers to some of the most common questions I have received.

Dear Mr. Leahy,

I just want to know where, in your opinion, does the Constitution give specific authority for Congress to give an individual mandate for health insurance?

Thank you for your time.

Richard
Vt.

Is health insurance reform Constitutional?

The authority of Congress to enact and enforce a requirement to purchase health insurance is found in the core powers given to Congress by Article I, Section 8 of the Constitution. Article I, Section 8 gives Congress the power to act to provide for the “general welfare,” which is in fact one of the purposes given by the Constitution’s preamble for establishing the Constitution. Congress has used this well established power to create the social programs American citizens have come to rely upon including Social Security, Medicare and Medicaid.

In addition, the Commerce Clause of Article I, Section 8 also has been long established as a Constitutional basis for Congress to enact a requirement that all Americans have health insurance. Since the days of the New Deal, courts have upheld Congress’ power under the Commerce Clause to regulate interstate commerce which includes even local matters that substantially affect interstate commerce. In 1944 the Supreme Court ruled that insurance was interstate commerce, therefore subject to federal regulation. The economic effects on the Nation of the rising costs of health care are clear and significant, with millions of Americans without health insurance relying on expensive emergency health care paid for by others and American businesses struggling to provide benefits to their employees.

Both of these constitutional foundations are amplified by another part of Article I, Section 8, the “Necessary and Proper” Clause of the Constitution, which makes it incumbent upon Congress "to make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers and all other Powers vested by his Constitution in the United States." The last century has settled any questions about Congress' power to take serious action to build and secure the social safety net, as it has through the enactment of Social Security Act, and creation of the Medicare and Medicaid programs. Like those key guarantors' of Americans' social and economic security, the current health care reform proposals are firmly rooted in the core powers given by the Constitution to Congress.

For more information about the individual responsibility to purchase health insurance please visit the Health Care Reform Vocabulary section of my website.

Dear Senator Leahy,

In speaking with people here in Vermont and other States too, I want to tell you what I feel are the most important components for Health Care Reform. We would like to see the option of buying health Insurance across State Lines.

I am an Independent and still hold hope for this Senate to give us a Health Reform Bill that the American People really want.

Thank you Senator Leahy for hearing me out.

Ruth
Burlington, Vt.

What affect would selling health insurance across state lines have?

Some have suggested that selling health insurance across state lines would solve the problems with our current health care system. However, I have serious concerns that creating a national market for health insurance without proper safeguards would do more harm than good for consumers.

Allowing health insurance to be purchased across state lines would mean that insurers could sell their products to Americans in any state. The insurers would only have to follow the laws and regulations in the state where the insurance company is based and not the state where consumers or patients live. This could eliminate the consumer protections that states like Vermont have put into place to ensure that health insurance plans contain certain benefits like maternity care or breast cancer screenings.

Additionally, offering current health insurance plans across state lines would do nothing to lower the cost of plans or address the growing cost of health care in this country. In fact, premiums would likely increase for many as a result of healthy young individuals pooling to certain markets, leaving individuals who have preexisting medical conditions without coverage or forcing them to pay high premiums and co-pays for their care.

Offering health insurance plans across state lines does nothing to prevent the discrimination consumers currently face in the individual marketplace or lower the overall costs of providing health care. I fully support increasing competition in the health insurance industry in a way that protects consumers, which is why I have introduced the Health Insurance Industry Antitrust Enforcement Act. Eliminating the health insurance industry’s exemption from federal antitrust laws will ensure that health insurers compete rather than collude to fix prices that are unfair to consumers. Antitrust oversight in this industry will provide consumers with confidence that the price they pay is fair, and the product of a competitive marketplace.  

I don't know a living soul who wants bureaucrats looking at their health records.  Personal privacy is something most Americans cherish, and we have all heard way too many stories of data bases being stolen full of credit card numbers, etc.  I have had my credit card number stolen or lost numerous times!   Next it will be my medical records.  I don't see anyone being in favor of this intrusion into their personal lives.

Dan
Milton, Vt.

Will my medical privacy be compromised with health care reform legislation?

Senator Leahy,

Thank you for providing a convenient format for me to share my concerns about health care reform.

Like many Americans, I perceive that the current debate in Washington and the angst exploding all over the country is the result of a rush to legislation by the administration and congress.  At the moment we seem to have created legislation that is complex and not well thought out.  Having said that I confess that I am totally confused as to what is actually being proposed as the media seems to be concentrating on the 'he said she said' discussion.  I think it's time to slow down, cool off and try to get everybody on the same page.

'Everybody on the same page,' yes everybody.  The health care problem is far too complex to be solved by congress alone.  I would have been much happier to have seen President Obama and Congress agree to appoint a commission made up of health care providers, insurers, citizens, politicians etc to carefully examine the needs, costs and budgetary requirements to fulfill the goal of quality heath care for all Americans.  If the process needs several years to reach consensus, so be it. This is too important to rush.

Senator Leahy, please help this extremely important issue see the light of day. Ask your colleagues to take their foot off the gas and get it right.

Peter N.

Chittenden, VT

Why don’t we just slow down the process on health care reform or start over from scratch?

Another concern we have... as it is now the health care system is not all that efficient. Doctors and nurses seem to be overbooked and over worked,.. what will happen when the millions of uninsured are introduced to this system. How does it accommodate this increase in demand for service.

thanks

Jim

North Montpelier, Vt.

Will we have enough doctors and nurses to deal with the increase in the number of the insured?

It has recently been brought to my attention that Tricare For Life (military retiree health insurance for those on Medicare) may be targeted for removal in the development of the health care legislation being discussed.  If this benefit is taken from those who have helped their country retain it's freedoms it will be criminal.  It seems that when monies are needed the military, both active duty and retirees, are where some in our government look first.  Please do not let this happen again.  I am a current member of Tricare For life and would be greatly impacted if I were to have this benefit reduced or taken away.

Thank you very much for your attention in this matter.

Gail C.

Richmond, VT

Will health care reform affect veterans currently covered by TRICARE? 

Our national defense relies on the sacrifices, the courage and also the good health of those in uniformed service, during and after their service.  We owe them a debt of gratitude that can never be fully repaid, and I've always made it one of my most important responsibilities to help ensure that the members of our Armed Services receive the benefits, support and acknowledgement they we owe them.  We also owe them  world-class medical care from our military hospitals, and nothing less.  As co-chair of the Senate's National Guard Caucus I have also led in expanding National Guard access to TRICARE insurance coverage.  Under all current health care reform proposals, veterans will continue to be covered by TRICARE and the Veterans Administration (VA) health care program.  If you are eligible for VA health care you will continue to be eligible for your benefits.  

The America's Health Futures Act pending before the Senate Finance Committee explicitly states that coverage through the VA health care program and TRICARE program, would be considered adequate coverage and individuals receiving health care through TRICARE would not be required to purchase additional health insurance.

More than 9 million people currently receive health care through TRICARE.  In 2008 the Defense Department spent $42 billion on TRICARE, which represents about 6 percent of total defense spending.  The Congressional Budget Office has forecast that TRICARE will account for 13 percent of total defense spending by 2026.  Health care reform efforts that aim to lower overall health care cost inflation are essential to ensuring that veterans can continue to receive the care they rely on and deserve. 

For more information about health care reform's effect on TRICARE and VA health care I invite you to watch a video message from Matt Flavin, Director of Veterans and Wounded Warrior Policy on the White House website. 

Dear Senator Leahy,

Thanks for keeping me up to date with your emails. I am one of the lucky Vermonters with some health care. I am a retiree and am concerned with keeping my healthcare. So I am writing you to consider keeping the stipulations of house bill 1322 in whatever healthcare reform that you vote for,

Thanks again for your interest in this matter,

Sincerely,

Jim S.

Tunbridge, Vt.  

How will health care reform affect retirees?

Early Retirees, defined as individuals aged 55 to 64, are a sizable segment of our population that sometimes is overlooked when discussing health care reform.  Fewer than half of people aged 55 to 64 work full-time, and while these people are too young to qualify for Medicare, many also lose access to employer-sponsored insurance.  The proportion of large firms providing workers with some type of retiree coverage dropped from 66 percent in 1988 to 31 percent in 2008.  By providing financial relief to businesses that choose to provide health coverage to early retirees, health reform will make it easier for early retirees to get health insurance coverage.  Health reform will also provide financial assistance to employer health plans that cover early retirees, bringing down health costs and premiums by as much as $1,200 per family per year for some plans.  Even if an employer offers retiree coverage, they rarely offer a choice of plans.  Early retirees who seek coverage in the health insurance exchange will have a choice of several quality, affordable health care plans.

Early retirees are more likely to have chronic conditions such as heart disease and diabetes – which insurers can currently use as reasons to deny coverage.  Health insurance reform will prevent any insurance company from denying coverage based on a person's medical history, and it will end discrimination that charges you more if you're sick.  Health reform legislation will also end insurers' practice of charging different premiums or denying coverage based on gender, and the reforms will limit premium variations based on age.

Finally, the health insurance reform proposals also make significant investments in Medicare and, following the advice of experts at the Medicare Payment Advisory Commission, these reforms can mean a variety of changes in provider payments that enhance the solvency of Medicare.  Reform will also extend the life of the Medicare Trust Fund to pay for care for future generations, so that when you are old enough to qualify for Medicare, it will still offer the same benefits that Medicare beneficiaries enjoy today. 

Dear Senator Leahy,

We must stop giving money away to illegal immigrants in the United States. I cannot afford to support those who are not here legally and do not pay into the health care system. What is Congress thinking? I only see bad news ahead for the US Citizens trying to get by in today's economy with this proposal. Thank you for your consideration and please continue to think about the Vermonters! 

Sincerely,
Anonymous
St. Albans, Vt.

How will health care reform affect illegal immigrants in the United States?

Thank you for your question.  I have heard from many Vermonters who are concerned that illegal immigrants will have the ability to receive subsidies for health insurance under the reform proposals in Congress.  I do not support using government funding to subsidize insurance for those who have entered the United States illegally or who are residing in the United States in an undocumented status. 

The Affordable Health Choices Act reported from the Senate HELP Committee, the America's Healthy Futures Act reported from the Senate Finance Committee, and the Affordable Health Care for America Act pending before the House of Representatives all explicitly define who is eligible for health coverage and make clear that undocumented immigrants are ineligible. Below are the portions of the legislation Congress is considering that address this issue: 

House Bill:

Title II:  Health Insurance Exchange and Related Provisions
Subtitle C – Individual Affordability Credits
Section 347, page 267 (click for PDF) is titled "No Federal Payments for Undocumented Aliens"
This section 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."

Senate Bills:

Affordable Health Choices Act - Senate HELP Committee
Title XXXI:  Affordable Health Choices for All Americans
Subpart D Information Regarding Health Insurance Coverage
Section 3116, page 174 (click for PDF) is titled "Definitions"
In this section, an eligible individual is defined as, "a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States."

America's Healthy Future Act - Senate Finance Committee
Title I: America's Healthy Future Act
Subtitle B: State Exchanges and Consumer Assistance
Page 14–15 (click for PDF) Establishment of State Exchanges
While legal U.S. residents will be able to obtain insurance through the state exchanges, undocumented parents will not be able to buy personal insurance coverage through the state exchange but will be able to buy insurance for their U.S. citizen or lawfully present children.

Title I: America's Healthy Future Act
Subtitle C: Making Coverage Affordable
Page 20–21 (click for PDF) Premium Credits
States that undocumented immigrants will not be used to calculate household size, thereby diminishing the credits available to families made up of undocumented immigrants and U.S. nationals.  

Title I: America's Healthy Future Act
Subtitle D: Shared Responsibility
Page 28 (click for PDF) Personal Responsibility Requirement
Requires that U.S. Citizens and Permanent Residents—but not undocumented immigrants—purchase qualifying health insurance. 

I am retired and I have very good health care coverage. Will this new health plan interfere with the coverage I have now?

Janice

South Burlington, Vt.

Will this new plan interfere with my current coverage?

Current health care reform proposals pending before the Senate and House of Representatives aim to provide reforms for insurance companies, expand insurance coverage to those who currently go without health insurance, and halt the growing cost of health care in this country.  In other words, Congress and the President are focusing on ways to fix what is broken in our health care system while maintaining what is working well.  In no way does health care reform aim to interfere with the health care coverage you are currently receiving.

In the Affordable Health Choices Act, which passed out of the Senate Health, Education, Labor and Pensions (HELP) Committee, the legislation specifically states that there is no requirement that an individual must terminate his or her coverage in a plan which that individual was enrolled prior to the enactment of the bill.  Plainly stated, you will not be forced to change your health care coverage if you were enrolled in a plan before a bill is enacted.  I believe with the introduction of a public option, consumers will be given more choices about their health care coverage and so you may choose to change the health care plan for yourself or your family, but that choice remains your own.  Under the proposal which passed out of the Senate HELP Committee, new health insurance plans purchased by individuals would no longer be allowed to exclude individuals based on pre-existing conditions, or impose lifetime or annual benefit limits.  Additionally, new plans would require dependents to be permitted to stay on their parents' policies until age 26.  These changes would be made to policies purchased after health care reform legislation is passed and so would not affect your current plan but rather offer you the option to choose a pan which includes this changes.

Furthermore, I can assure you that no current health care reform proposals pending before the Senate or the House of Representatives would ration health care or allow the federal government to make personal health care choices for Americans. Those choices would remain between you and your doctor.  It is important to recognize that, like you, there are many Vermonters and Americans who are satisfied with their current health coverage and so health care reform would only aim to improve the quality of the care you receive through that coverage while attempting to lower the cost of health care.  Additionally, health care reform efforts aim to extend the option of quality health coverage, like the type you currently enjoy, to Americans who are unable to afford similar coverage, or have lost their coverage along with their job.

There is a lot of fear and scare going around. Could you ground things a bit by telling us where Vermont ranks in terms of health care costs per person per year? What is the US high and low? And, how might healthcare reform lower these per-person per-year costs with everybody having health insurance and with improved practices?

John

Shrewsbury, Vt.

What are the current health care costs per person per year, and will health care reform lower these costs?

Thanks for your question, John.  While Vermont has made promising improvements to the health care offered in our state more must be done in order to ensure that all Americans have access to affordable, quality health care.  Even with the strides Vermont has made, over 66,000 Vermonters still lack health insurance according to the Kaiser Family Foundation's State Health Facts. 

In 2007, Vermont spent $4.2 billion on health care which represents a cost of $6,744 per person.  Nationally, in 2007 the country spent more than $2.2 trillion on health care, which represents $7,421 person.

Vermont ranked 9^th in the country for lowest health care spending per person with Washington, D.C. spending the most in the country ($8,295 per person) and Utah spending the least in the country ($3,972 per person).  You can view a complete chart listing each state's spending on health care per capita at the Kaiser Family Foundation website dedicated to state health care facts.

According to a recent survey by the Agency for Healthcare Research and Quality, premiums for residents of Vermont have risen 92% since 2000.  It is my hope that through comprehensive health care reform we can provide more affordable options for Vermonters and curb the rising cost of healthcare which adds to increases in health insurance premiums.  The inclusion of a public option would provide competition among insurers to keep premium costs low.  Currently, the increasing number of people without health insurance, many because premium costs are too high, adds to the cost of health insurance premiums that Americans must pay for coverage.  When the uninsured cannot afford to pay the entire cost for health care they need, these costs are shifted to those who can pay.  In 2009, this cost-shift means that nationally, family coverage premiums for Americans are an estimated $1,100 higher and individual coverage premiums are an estimated $410 higher.  Specifically in Vermont, families pay an additional $500 in premium costs and individual insurance premiums are $170 higher because of cost-shifting to pay for the uninsured.  By providing better, more affordable options for Vermonters and their families we can help avoid this hidden tax Vermonters are paying for the uninsured.  Additionally, reform efforts would provide limits on out-of-pocket expenses for Vermonters struggling to pay for their health care and lowering the overall cost of health insurance.

For more information about how health insurance reform will specifically benefit Vermont I encourage you to also visit HealthReform.gov.

Dear Senator Leahy,

Please work to keep President Obama's health care coverage on track.  I am the vice president of a small Vermont business in charge of the human resources.  I know full well the cost that our company bears when it comes to health care coverage.  We do it out of loyalty to our employees, but the current available health insurance options are killing us.

Thank you for your time.

Paul A.

Williston, Vt.

How will small businesses be affected?

Small businesses are essential to Vermont's economy.  In fact, 15,048 employers in Vermont are small businesses.  Unfortunately, small business owners in Vermont and across the country have struggled under the rising cost of insuring their employees, and have too often been faced with the decision to either lay-off employees or stop offering coverage.  A Commonwealth Fund study found that the smallest businesses pay an average of 18 percent more in health insurance premiums for the same benefits than larger firms.  And according to a report recently released by The Small Business Majority, small businesses are expected to pay nearly $2.4 trillion in health care costs over the next 10 years under the current system.  However, if health insurance reform is enacted, small businesses could save as much as $855 billion over 10 years, or nearly 36 percent – savings that can be reinvested in the business and used to create new jobs.  The America's Affordable Health Choices Act creates a health insurance exchange where small businesses can shop for health plans, and also introduces a permanent tax credit for small businesses to help them offer coverage to their employees - which phases out as employers' size and average wages increase.  Health care reform would significantly reduce costs for many small business owners, allowing them to help their employees while saving and creating jobs.  As the New York Times recognized, “The small business community would be one of the biggest winners from health care reform.”

I have spent the last year fighting not only illness but [the hospital] and my insurance company. When I hear the people at town hall meetings saying they are worried about panels choosing what care they will and will not get I am surprised that they don't realize this already happens. The difference is that it isn't government doing it. This is much worse because these decisions are being made by people who only care about the bottom line and many of them have no medical training at all.

I also feel that anybody who wants to keep the status quo has not had to use their insurance very much. We have insurance and are still very much in debt because of the high price of health care.

The President's plan may not be perfect but at least he has one. I only hear "no way" from his opponents not any ideas.

Melonie B.

East Wallingford, Vt.

Dear Senator Leahy,

Thank you very much for making this electronic bulletin board available for all of us.

As a retired physician who has "battled" with insurance companies to obtain longer, necessary hospital stays (etc.) for my patients, I believe that we need a governmental insurance system in place to offer an alternative to the present insurance for profit system.