Proposed Changes for SSI

There have recently been some proposed changes to the way the government determines if someone with cystic fibrosis is eligible to receive SSI. This would obviously affect many in the community, and if you feel that the changes would negatively impact your own situation, I highly recommend having your voice heard. 3 of the most talked about changes are....

1.       FEV1 values based on age/height/gender.  Basically, from what I gather they are lowering the FEV1 value to meet criteria, making it harder to qualify based on lung function. Some people may be “sicker” with even moderate lung function, but they would no longer meet the more strict criteria.

2.       “Episodes of Illness”- currently you have to have 6 “episodes” in a 12 month period, and a hospital stay counts for 2 of those. But they propose to no longer count doctors visits, ER or other outpatient interventions as episodes. We almost always try to treat oral/output first to avoid an inpatient say, and for our “healthier” patients this generally works. Exposes less to hospital environment/cross infections and IV abx which builds resistant bugs. Even an “outpatient” intervention could be home IVs. Even when we are treating outpt, we ask that pts go from 2 to 4 treatments a day including ACT. This has a significant impact on if someone could attend work or school.

3.       If you have chronic infections of bugs like PA, Cepacia, etc that require ongoing nebulized “antimicrobial” therapy IE, TOBI or Cayston or Colistin. I didn’t see anything in there about those criteria.

As one CF social worker who I greatly respect put it,  "I think the biggest changes proposed are lowering FEV and also not counting outpatient physician interventions anymore BAD !!!!". (Also, big thanks to her for providing the three bullet points above)

If you would like to have your voice heard on this matter and/or read the proposed legislation, click here.

$$$ for Preexisting Conditions Pain ACA

From Medpage Today

The high cost of covering adults with preexisting conditions before 2014 could signal greater costs for all individuals within the broader health insurance market, a health economist warned lawmakers.

The Pre-Existing Condition Insurance Plan (PCIP), which the Affordable Care Act (ACA) created as a way to provide health coverage to those with preexisting medical conditions before other aspects of the law take effect in 2014, does nothing to reduce the costs of care for those patients, Thomas Miller, JD, resident fellow at the conservative American Enterprise Institute here, said at a congressional hearing Wednesday.

Despite garnering only 110,000 enrollees -- far less than the 375,000 expected -- the PCIP program has run out of the $5 billion Congress gave it.

.....

The concern is that those with preexisting conditions could spell more trouble for the broader population if more healthy young people -- those still paying premiums but not using as many services -- don't sign up for health coverage when open enrollment starts later this fall. Health insurance companies would need those premiums to help offset the most expensive individuals it would have to cover.

No Democrat and only two Republicans attended the hearing while Congress was out of session and most lawmakers were back in their home districts.

However, the committee's top Democrat, Rep. Henry Waxman (Calif.), issued a statement supporting the ACA while adding the law's reforms starting next year will better solve the problems PCIP tried to address.

"The program was always designed to be a temporary solution to help some of the sickest Americans who had been locked out of the insurance market to get coverage," Waxman said. "It was also set up to be more accessible than the many state high-risk pools that have high premiums, long waiting lists, or are closed to new enrollees, as Florida's has been for more than 20 years."

To read the full article, please click here for access to Medpage Today.

Top Ten Questions about the Healthcare Bill

As most of us are well aware, the President will be signing a new healthcare bill into law today. Here's my top ten questions about it as we move towards the future. If you think you know the answers, please feel free to chime in :)

10. When will I be able to get private insurance on my own?

9. How costly will my insurance be?

8. Will it be as good as my current insurance that I have through my mom?

7. Will my doctors pay be decreased?

6. Is there a lifetime max?

5. I'm sure there is something else, but I forgot to put a #5 in the original blog, thanks Piper!!

4. Will there be longer waits to see doctors and to get into the hospital?

3. Will care become better, worse or stay the same?

2. Will insurance profits go up or down?

1. Ultimately, who is the buck getting passed to to cover all of this?

What are your questions?

How Will HCR Impact the CF Community?

Since we haven't talked much about Health Care Reform lately, I thought I would re-post some of the past blogs we've had on the subject. I encourage you to click on the titles below and read through the guest post that we've presented here on RSR about Health Care Reform. Thank you again for those who contributed. If you are interested in writing a guest post on HCR (or any other topic) for this blog, please contact me and let me know what you'll be writing about.

Health Care We Can Afford? Not Likely.

Your Health or Your Wallet? The "Choice" is Yours

Why We Need Health Care Reform

Health Care Reform: He Said, She Said

I'm sure you have some opinions on this topic. I'm also sure that the opinions are very wide ranging by the readers of this blog. Please, take the time to leave a comment about how you feel. I'd especially like to hear your thoughts on how you think HCR will impact the CF community. I look forward to reading what you guys have to say.

Healthcare Reform and Obesity – The Connection

There’s still a huge debate raging over the pros and cons of President Obama’s proposed healthcare reforms. Most people are worried if healthcare as they know it will undergo a sea change (for the worse) because of the socialistic nature of this proposal. In order to ensure that every American is able to afford healthcare because it is a basic human necessity, Obama plans to fund this new venture by eliminating waste in the system, improving efficiency and cutting down the tax cuts for the superrich. But, will the healthcare reforms address preventive measures, the kind that has proven to be the best when it comes to cutting back on medical and healthcare costs? Will it tackle head on the problems of obesity, addiction and excess that plague our nation and make it one of the unhealthiest in the world (in terms of lifestyle)?

The Strategies to Overcome and Prevent Obesity Alliance, which includes the American Diabetes Association, the American Heart Association and the U.S. Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity and Obesity, has urged US policymakers to address the growing pandemic of obesity as a vital part of the healthcare reforms. The statistics are not good – over two-thirds of Americans are overweight and obesity rates have doubled for adults and tripled for children in the last 30 years.

We are so addicted to high fat, high sodium and high sugar foods that we have lost sight of what is important in the long run – good health. And as a result, we are being punished with diseases like cancer, diabetes, cardiac problems, strokes and obesity, all of which are inter-related with one leading to and bringing on the others. Because of this, our healthcare costs increase by as much as $150 billion every year, according to research published in an issue of the magazine Health Affairs. This figure amounts to nearly 10 percent of the entire healthcare budget.

Along with the other measures that have been taken to reduce the overall cost of healthcare and make it affordable and accessible to all Americans, perhaps the President should include campaigns against junk food, processed food and a sedentary lifestyle in his proposal. Incentives for those who are healthy and fit would probably lead to others following their example. The nation must also be warned against smoking, with frequent users of cigarettes being made to pay more for health insurance. After all, why should you use public money to fund your healthcare when you’re knowingly destroying your health?

But with fast food and tobacco lobbies too powerful, it is up to the individual to make a healthy and wise choice, one that will not only save their lives, but also their money.

This guest article was written by Adrienne Carlson, who regularly writes on the topic of nurse practitioner schools . Adrienne welcomes your comments and questions at her email address: adrienne.carlson1@gmail.com

Note from Ronnie: I'd like to present as many different views as I can about this debate on Health Care Reform. This particular guest post may not be specifically related to CF, but I thought it was very interesting and would like to get your thoughts on it. If you would like to chime in on this topic, please contact me and we may be able to use your commentary on this blog. Comments and questions are encouraged, I just ask that you keep them constructive and respectful. Thanks.

Health Care Reform: He Said, She Said

Because I know not all of you, or any of you for that matter, read back through comments on this blog, I thought I would highlight an exchange from Your Health or Your Wallet? The "Choice" is Yours post from a couple weeks ago. I present to you a little "he said, she said" concerning health care reform....

He said:

One thought though... For CF'ers (and others as well) you aren't really buying health "insurance." Insurance is a bet, on your part and on the part of the insurance company. They are betting that the premiums they charge you, will, on average, be a larger amount than the healthcare they are obligated to pay for. You are betting that it will be cheaper for you to pay a monthly premium, just in case some huge medical bill occurs.

For CF'ers... it ain't a bet. You and the insurance company know there is absolutely no way you could pay premiums high enough to cover the cost of your care. So bottom line... you are asking other people to pay for care you can't afford for yourself.

I would much prefer an insurance system that functions as insurance, and find the best way to provide that as cheaply as possible. And then find a way to deal with those who are un-insurable. Rather than designing all kinds of perverse incentives into an insurance system, to deal with people who insurance isn't really the appropriate means to pay for care.

Some more random comments on the post above:

Strike all pre-existing condition clauses?

We don't demand that you be able to buy fire insurance to pay for the damages AFTER your house has burned down. Or flood insurance AFTER it is filled with water. Or car insurance AFTER you've gotten in a wreck. Or life insurance AFTER you've died. If we required the above, it should be pretty obvious that what you are buying is no longer "insurance" in any sense of the word.

So why do we demand that people be able to buy health insurance AFTER they have gotten sick?

As I said above, if you have a pre-existing condition, you aren't insurable in the true sense of the word. I'm not saying I know what the solution is for those with pre-existing conditions, but I do think that basically dismantling the insurance system to deal with those issues is the wrong way to go.

More random comments:

"fair pricing despite level of health"

I assume you mean by "fair" that all people pay the same price, regardless of their health?

Once again, compare this to other insurances you buy. Do people demand "fair" pricing for car insurance for someone with a perfect 10 year driving record versus the high school student who has been in 3 accidents already? Or "fair" pricing for life insurance for the 20 year old health nut versus the 95 year old chain smoker? Or "fair" pricing for home insurance for the $100,000 home versus the 4 million dollar mansion?

So why do we demand that all people, regardless of health status, pay the same amount for health insurance?

I know, I know... people don't always have a choice in their health status, while most of the above situations are a choice. But for those who do, I'm not sure I see why their shouldn't be a consequence for health choices. For those who have no choice in their health status... like I said, I'm not sure insurance is the appropriate vehicle for paying for health care.

"My choices in my care should not be made by my pocket book, but they are, all the time."

Not trying to be offensive, so if it sounds that way, blame it on the limits of internet communication...

Why shouldn't choice in health care be made (at least in part) by money? You make choices every day based on money. Where to live, how big your house is, what kind of car to drive, what kind of job to take, what to eat, how to entertain yourself, etc. Why should health care be any different?

In my mind, part of the problem with the current insurance system is that there isn't ENOUGH decision making based on cost. With most PPO type insurances, there is very little connection between what I pay, and how much something costs. I might only pay 10%, or a $20 co-pay, for something that costs far more. Of course, I am also paying for the rest of it, but through my premiums. There is very little direct connection between the value of a health service, and how much I pay for it.

I really think the HSA route is the way to go, because it has a huge connection between cost and value. We just switched this year, and I find myself constantly asking "Is what we are going to pay for this really worth it?" (just like I do for everything else I purchase.) I NEVER recall thinking that on our PPO. If people aren't asking that question, health care is only going to get more expensive, not less. And the public option makes even MORE of a disconnect between the cost and the value.

She said:

Few things that I feel like addressing:

1. Your analogy of other types of insurance is flawed in several ways. If all insurance was ran like health insurance, then we would have a lot of problems. Say that you had a small fire in your house five years ago. It caused no structural damage, few possessions were damaged, you didn't even use insurance money for it, but called out the fire department just to make sure your house was safe. Now five years later you buy a new home and want fire insurance. If they were like the insurance company, they could deny you because of your past history of fire. Or say, you are going to get car insurance. You've never had an accident and have a perfectly clear record. You expect to be covered without a problem. However, it seems your family members seem to crash into anything on the road, and off the road, and have several tickets. The insurance company denies you because of your family history of car wrecks. Both would happen if insurance was ran anything like "health insurance".

Also, not having fire insurance, I take a financial risk if something happens. Not having car insurance, I take a fiscal and legal risk. Not having health insurance? Not only is there a huge financial risk, but you are also risking your life. No other insurance is that true of.

2. Making decisions based on pocket book. Yes, I decide where I live, what I spend descresionary funds on, and how much I drive based on pocket book. But I can live in a cheaper house, not buy that shiny new computer, and drive a 10+ year old car... it's not going to kill me. But not getting drugs, going to the doctor, and millions of other things that are involved in health care very well could kill me.

3. I think of health insurance, or how I think health care should be paid for like the police, or the fire department, or like countless other services that my tax dollars go to. I haven't needed police help in years, but I'm very happy they are there if I need it, and I know that my community is a better place for it. My neighbor had a garage fire this week, that without the quick reaction of my neighbor and the fire department, I would have lost my own home. Again, something I pay for, rarely use, but am very glad they are there when I need it. I don't have kids, but I know that my community is better by tax dollars that go into their education, removing them from abusive situations, and helping them get vaccinated if they can't afford it. I've never been on food stamps, but I know that my community is better if everyone has something to eat. The same thing could be said about healthcare. Yes, I use it often, and many people out there wouldn't, but everyone's lives are made better by everyone having a chance at health. I don't understand how anyone could think differently.

4. HSAs are a crock. Spend a single day in a hospital and the $6,000 bill will eat through nearly every HSA account I've seen. Let's hope you don't need surgery, ongoing medication, or more than one day in the hospital... because not only is your healthcare money gone, but you also can't be insured again.

He said:

1) Sure, the analogy isn't perfect. But it is true that people are demanding things of health insurance that we don't demand of any other insurance we buy. And those demands transform it into something that is no longer insurance.

2) Again, I'll agree health care is somewhat different than other things you buy. Although where you live or what you drive could also kill you. My point was more that your comment implies you should be able to decide on your health care options regardless of cost. That isn't reality, just as you don't make any other decision regardless of cost. Which is why people argue that public healthcare always leads to rationing. Because when we don't pay for it directly (ie we make healthcare decisions with little regard to the true cost) we end up demanding far more healthcare than if we paid for it directly. We demand more healthcare than we can collectively pay for. And since the gov't controls the public option, they end up deciding based on the collective pocketbook. Which is exactly what many people are opposed to.

3) So did your neighbor have fire insurance, or did the fire department pay for all the damage caused to his house by the fire? The police only come to collect the evidence after the crime. They do nothing to reimburse you for the ongoing effects of the crime. The fire department shows up to put out the fire. They do nothing to pay for the damage your house suffers (in fact, that is why you buy fire insurance.) I would argue the healthcare equivalent to the police or fire department would be EMTs, which, oddly enough, already exist.

4) Our HSA is working just fine, thank you. And yup, one day in the hospital (which my wife already had this year) will wipe out your HSA account for the year. Which is exactly why you have an insurance policy connected to it. After her hospital stay, we had paid our deductible, and the insurance covers 100%. If I desire, next year I can switch back to the PPO that my employer offers, although I see no reason to do so. HSA's provide an incentive for me to actually attempt to save money, to consider whether the value of the service is actually worth what I am paying for it. It works exactly like insurance should... I pay for the little day to day stuff, but have insurance in case of an emergency. It's not a crock for us, and is actually working quite well so far, even with a major hospital stay.

Here's a great article in the WSJ with some excellent suggestions for how to reform the system, without going to single payer...

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

So, who do you think wins this one? The "he" or the "she"?

I love that they both took this opportunity to share their opinions. Thanks guys! If you'd like to share your thoughts and opinions on Health Care Reform please contact me for the opportunity to write a guest post.

Why We Need Health Care Reform

Note from Ronnie: I'd like to present as many different views as I can over the coming months about this debate on Health Care Reform. To see previous posts, "Health Care We Can Afford? Not Likely." and "Your Health or Your Wallet? The Choice is Yours" please click here and here. If you would like to submit a blog on this topic, please contact me and we may be able to use your commentary. Comments and questions are encouraged, I just ask that you keep them constructive and respectful. Thanks.

This blog post is brought to us by Christina. She says "I live in Wichita, KS. I have 3 children, Haley (15) Lauren (6), and Dominic (4). Haley has has Cystic Fibrosis and was diagnosed when she was 8 weeks old. I also work as an advocate for people with disabilities and I love my job. My hobbies include reading, and writing. I write quite a bit I have journals, and blogs, and I keep notebooks all over the place in my house, car, and at work and jot down my thoughts constantly. I also twitter and my user name is @advocate4all. My personal blog is daurey.wordpress.com and I just recently started an advocacy blog at humanrightsadvocate.wordpress.com.

(Whether you are for or against reform please read)

The health care reform debate has created a great division in this country. I believe that the fact that I work in the Social Services field and have a daughter with Cystic Fibrosis gives me a special viewpoint of the debate. I already knew this country was in desperate need of health care reform before I had heard of Barack Obama. Even so, I have been accused of drinking the Obama Kool-Aid. What I do know is that there is a huge gap between people who qualify for Medicaid or Medicare and people who are able to obtain health insurance through an employer.

Here are some facts. According to the US Census Bureau in 2007 the number of people covered by private health insurance was 67.5%. Also, according to the US Census Bureau in 2007 the poverty rate in the US was 12.5% and therefore those people qualify for Medicaid. So this means that in 2007 20% of people were without and/or had no access to healthcare coverage. Another interesting statistic is that 1 in 3 people will become disabled before they retire.

I happen to work for a non-profit agency that works with people who have a disability(s). Most of these individuals became disabled during their adult years. These people were not born with their disability(s) they obtained them through an accident, or an illness, etc. Once people have a disability their choices become very few. They can A) receive disability payments and Medicaid and live well below the poverty level, B) be lucky enough for employer to actually hire them despite their disability and offers health insurance to boot or C) go to work for themselves and not be able to obtain health insurance because they have a pre-existing condition.

I also happen to have a 15 year old daughter who was born with a very expensive disease called Cystic Fibrosis. Now we are very lucky because her father works for a company that has excellent health insurance coverage. She has several medications that cost a couple thousand dollars a month and we only have small co-pay. This is great now, but there are two major problems with this in the future. First, the industry her father works in, is always laying people off. We’ve had to bite our nails through many lay offs, and even as of today, there is a chance he will be laid off next month. Secondly, my daughter is only covered while she is still in school, so when she graduates she will have to scramble to find a job that offers health insurance and hope that her health remains stable enough to keep that job. I suppose she could marry someone who has health insurance, but I really hope my daughters’ choices do not come down to her marrying someone just so she can have health insurance coverage.

As for the 67.5% of people who have insurance they are still taking a gamble because if they become disabled, or obtain a significant health issue before they are old enough to receive Medicare these people are screwed. They will be left with the same choices as the clients that I work with through my agency. I also know that Health Care Reform is not the same as Universal Health Care. It is not meant for the people who already have insurance and are perfectly happy with it (like me). It is there for the people who don’t have it, and as a back up just in case your life doesn’t end up just the way you planned it. Because let me be the first to tell you life is not going to end up how you planned it.

*Statistics obtained by the US Census Bureau at http://www.census.gov/prod/2008pubs/p60-235.pdf

To view Christina's blog, please click here or go daurey.wordpress.com. Remember, keep all comments constructive and respectful. This is a chance at some open dialogue between people who will be directly impacted by new policies formed in the Health Care arena.

Health Care Reform, Doctors...and my Truck?

I have so many things to be thankful for this Thursday. Here are a few:

- I'm so thankful for a place to have open dialogue. I've been able to put up a couple different perspectives on the current Health Care debate and I've been so happy with the dialogue that has followed. This issue will obviously effect a CFer and their family more than it would the average joe and it's been nice to hear different opinions. We're also fortunate that some readers of this blog are from other countries and have also been able to relate to us their experience in care of Cystic Fibrosis. If you'd like to have your written blog featured here on RSR please send it to me, and as long as it is a positive contribution to the discussion, I will post it. My email can be accessed through my profile.

So which side do you pull the toilet paper from? I think we can come to a sensible conclusion to this before we start with Health Care...gotta start with baby steps.

- I'm very very thankful for my CF doctors. This past Monday was such a telling example to me that my docs just really want to do what's best for me. When I reported my symptoms and my decline in PFT numbers, Dr. Grad didn't hesitate in offering up a hospital stay. Why am I thankful for the offer? Cause I know that some CF doctors feel pressure by insurance companies for their patients to avoid the hospital because of the cost and sadly, they give in to that pressure. My doctors however fully stand behind decisions I make when it comes to my health and trust me when I say I need to come in or if I can fight the battle outside of the hospital. (Just a quick side note: my January hospital stay cost 350,000+ dollars)

It's pretty crazy when you actually SEE how much money is spent to keep me alive and healthy. When I say "I feel like a million bucks", I really mean it!

- I'm so thankful for my truck. Sounds kind of weird to say, but it makes sense when I tell you that I was with out it for 3 days due to a dead battery. When I went to start it a couple Saturdays ago, it responded with absolutely nothing. It was deader than a doorknob as they say. Upon returning from the lake, I tried (and failed) to jump start my truck. I also tried to remove the battery myself and bring it down to Checkers and get a new one. Because I didn't have the proper tools (or skills) to do this, my truck sat there for a few days and collected dust. As I was "working on it" one night, my neighbor offered a helping hand and actually got it jump started. I drove directly to Honda where they replaced my battery with a new one. She's been running like a gazelle ever since and it's nice to have her back.

My truck is white like this one but sure doesn't look as fancy. I'm pretty sure this is a new one. I just thought the picture looked pretty sweet.

So What's the Truth in Health Care Reform?

I know many of you are following this health care reform battle daily and trying to figure out what would be the best for you and your family. For Sound-off Saturday I've decided to provide 3 points of view (Click on titles to link to original article) that I've read over the last week and see if any of you out there have any insight onto what's actually going on with this whole mess. The first article is President Obama's bullet points on what reform will do. The second is from a House Republican Leader on what the reform will actually do. The third article is debunking the myths that the GOP is putting out there about health care reform.

I know one thing for sure: when it comes to politics, it's very hard to separate the truth from lies. So guys, tell me what you think!

Facts About Health Care Reform

Why we need reform:

Over 46 million Americans have no medical coverage at all; millions more are under-insured or fear losing coverage. If we continue on our current path health care costs will continue to soar and within the next decade one out of every five dollars will be spent on health care.

This is unacceptable, the system is broken and we cannot postpone meaningful reform any longer.

What's in it for you:

Your choice of doctors and plans will be protected; those that are happy with their current coverage can keep it or choose a new plan--including a public option.

Additionally, everyone will benefit from eight protections that will ensure stability and security for families across the country:

1. Coverage Regardless of Pre-Existing Conditions

Insurance companies will be prohibited from refusing coverage because of medical history.

2. An End to Exorbitant Out-of-Pocket Expenses, Deductible and Co-Pays

Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

3. Full Coverage for Preventive Care

Insurance companies must fully cover--without charge--regular checkups and tests that help prevent illness, including mammograms or eye and foot exams for diabetics.

4. No Dropped Coverage for the Seriously Ill

Insurance companies will be prohibited from dropping or lessening coverage for people who become seriously ill.

5. No Gender Discrimination

Insurance companies will be prohibited from charging people more because of their gender.

6. No Annual or Lifetime Caps on Coverage

Insurance companies will be prevented from placing annual or lifetime caps on the coverage people receive.

7. Extended Coverage for Young Adults

Children will be eligible for family coverage through the age of 26.

8. Guaranteed Insurance Renewal

Insurance companies will be required to renew a policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal if someone becomes sick.

"This isn't about politics. This is about people's lives.
This is about people's businesses. This is about our future."

-President Barack Obama

Top 10 Facts About House Democrats' Health Care "Reform" Legislation Democrats' Bill Would Increase Taxes, Raise Health Care Costs & Ration Care; House Republicans Are Proposing Better Solutions Washington, Jun 10 - House Democrats have begun rolling out their long-awaited health care “reform” legislation, and it turns out there’s not much “reform” to it after all. Instead, it would increase taxes, raise health care costs, ration care, and leave key medical decisions to government bureaucrats, rather than patients and their doctors – a proposal that House Republican Leader John Boehner (R-OH) warned in an op-ed published on Townhall.com could cause more than 100 million Americans to “be forced out of their current health care plan and onto the government rolls.” With a debate on health care reform slated to begin in Congress, here are the top 10 facts about the House Democrats’ health care proposal: 1. A Government Takeover of Health Care. The House Democrats’ plan will create a new government-run program, will make health care more expensive, limit treatments and ration care, and put bureaucrats in charge of medical decisions rather than patients and doctors. Translation: higher costs, lower quality, and fewer choices for patients. 2. Forcing More than 100 Million Out of their Health Care. The House Democrats’ plan will force more than 100 million Americans out of their current health care plan and onto the government rolls. A Lewin Group study confirms that under a new government-run health plan millions will lose their current health care coverage. 3. Rationing Health Care Treatments. The House Democrats’ plan establishes an “advisory committee” that will put bureaucrats and politicians in charge of deciding patient treatments and cures. Translation: The government will make health care treatment decisions rather than doctors and patients. 4. A New Mandate on Individuals. The House Democrats’ plan mandates that every American buy health insurance or pay a hefty tax to Washington. This would force more Americans into government-run system that will make health care more expensive, ration care, and put bureaucrats in charge of medical decisions. 5. A New Mandate on Employers. The House Democrats’ plan would impose employer mandates and cost jobs by requiring some employers – especially small businesses – to pay a new tax to Washington. The plan would also slap employers that are unable to offer coverage the government deems adequate with another new tax to Washington. These two new taxes will make it more difficult than ever for small business owners to reinvest in their businesses and create and retain good paying jobs. 6. Harming Small Businesses. The House Democrats’ plan doesn’t yet define “small businesses,” which is troubling news for millions of Americans who depend on these engines of economic growth. One Democratic draft plan revealed to date only provides assistance to ease employer mandates for small businesses with an average of 27 or fewer employees. This leaves a huge number of small businesses to deal with the onerous and expensive mandates of the Democrats’ government defined health benefit plan (“small businesses” are traditionally defined as employing less than 500 people). 7. Expanding Entitlements. The House Democrats’ plan expands the Medicare and Medicaid programs without reform, ignoring the pending insolvency of programs that millions of seniors and families rely upon. These policies will result in benefit cuts and premium increases for many Americans who depend on these programs. 8. Unfunded Mandates on States. The House Democrats’ plan creates new unfunded mandates for already cash-strapped states by expanding Medicaid, forcing both the federal government and states to pay more to finance this entitlement expansion. This will leave states no choice but to raise taxes or reduce services for citizens of those states. 9. How Many Taxes Will Democrats Raise? The House Democrats’ plan expands benefits and includes massive new subsidies and government-dictated benefits, but it doesn’t identify any significant savings to help pay for the new scheme, nor does it acknowledge the massive new costs it will impose on individuals, employers, and states. In the past, Democrats promised a series of new tax hikes to pay for their plan. How many will there be? When do Democrats plan to reveal them? 10. Shifts Massive New Costs onto Taxpayers. The House Democrats’ plan represents a bait-and-switch that will make health care more expensive and hit the middle class particularly hard with higher taxes, rationed care, and new health costs. As millions of middle-class families are struggling to make ends meet while making responsible choices, this plan forces those that make responsible decisions to foot the bill for those who don’t. House Republicans believe there is a better way, and led by Rep. Roy Blunt (R-MO) and his Health Care Reform Solutions Group, they are crafting better solutions to expand access to affordable, quality care regardless of pre-existing conditions; protect Americans from being forced into a government-run plan, making certain that medical decisions are made by patients and their doctors, not Washington bureaucrats; and let Americans who like their health care coverage keep it, while giving all Americans the freedom to choose the plan that best meets their needs. Will Democrats finally agree to work with Republicans on a plan to expand access to high-quality, affordable health care without raising taxes and rationing care? Or will they barrel ahead with their government-run plan? Middle-class families and small businesses are awaiting the answer. 8 COMMON MYTHS ABOUT HEALTH INSURANCE REFORM 1. It's a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies. 2. It's a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis. 3. It's a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions. 4. It's a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans. 5. It's a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average. 6. It's myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors. 7. It's myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them. 8. It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you - and the same rules of privacy will apply as they do for all other electronic payments that people make.