Values Policy Concerns With the Pelosi Health Bill

Values Policy Concerns With the Pelosi Health Bill

NOVEMBER 4, 2009

On October 29, 2009, Speaker Pelosi and House Democrats introduced H.R. 3962, the Affordable Health Care for America Act.  The legislation combines provisions approved by the Committees on Education and Labor, Energy and Commerce, and Ways and Means, as well as other provisions negotiated behind closed doors by the Democrat leadership.  The bill is expected on the floor later this week.  The following are the non-abortion values policy concerns with the Pelosi Health Bill.

RATIONING

H.R. 3962 sets up an Institute of Medicine to study "high-value" health care and requires the Institute to recommend, and the Department of Health and Human Services to implement, changes to Medicare policies.  The bill gives the Secretary complete waiver authority to implement these changes, unless Congress passes a joint resolution of disapproval blocking them.  The changes would take effect unless Congress passes a joint resolution of disapproval, likely requiring a two-thirds majority as it is highly unlikely that President Obama would sign a resolution undermining his Administration's own work. 

The bill lacks any safeguards against rationing.  As it is currently written, federal bureaucrats would be the arbiters of "high-value" health care-eventually denying patients life-saving but expensive treatments. 

SCHOOL BASED HEALTH CLINICS

H.R. 3962 prohibits the use of school based health clinic grants for abortion and defines such clinics as those that do not perform abortion.  However, there is no language prohibiting school based health clinics from referring for or facilitating an abortion offsite.  (Sec. 2511, pg. 1352) 

This concern is aggravated by the fact that no federal law regulates parental notification or consent for abortions and many States do not have any requirements for minors seeking abortion. 

ASSISTED SUICIDE

H.R. 3962 requires plans to disseminate information regarding end-of-life planning, but does not pre-empt State laws regarding advanced care planning and assisted suicide.  Because laws in States like Oregon and Washington explicitly forbid the term assisted suicide, choosing instead to call euthanasia "dying with dignity," some Members may be concerned that such States could be permitted to distribute materials about assisted suicide options.  (Sec. 240, pg. 129) 

SEXUAL PREDATOR GRANTS

The Indian Health Service (IHS) Reauthorization language would provide federal tax dollars for grants to help perpetrators of child sex abuse seek treatment.  Specifically, the bill would provide funds for support groups and programs to treat "perpetrators of child sexual abuse."  The bill would require that a bureaucrat determine when a sexual child abuser is no longer a threat to children before concluding their treatment.  (Sec. 713, pg. 1925)

NEW COMPREHENSIVE SEX EDUCATION PROGRAM

The bill creates a new program and an entirely new funding stream for comprehensive sex education, intended to replace the Title V Abstinence Education program (which was never reauthorized after expiring in June 2009).  The new teen pregnancy prevention program (Sec. 2526, pg. 1398) was offered by Rep. Capps (D-CA) during the Energy and Commerce Committee consideration of the bill, and passed by a vote of 33-23. 

However, instead of funding abstinence education, the funding will likely be directed to "comprehensive" sex education programs.  Such programs are already heavily funded and proven to neglect abstinence education because they are inherently run by individuals who ignore the evidence that supports the efficacy of abstinence education.  In addition, parents support abstinence-centered education by a margin of two to one, and many "comprehensive" sex education curricula have been shown to include sexually explicit material that many parents consider inappropriate for their children. 

CONSCIENCE PROTECTIONS

Current law provides conscience protection for health care entities by preventing local entities from discriminating against them if they refuse to provide, pay for, or refer for abortion (for the purposes of Medicaid and Medicare).  This provision is the yearly "Hyde-Weldon" "rider" in the Labor, Health and Human Services, and Education Appropriation Act. 

H.R. 3962 contains similar language to protect health care entities that choose not to provide, pay for, or refer for abortion (Sec. 259, pg. 148).  However, the bill does not contain broader protections to defend the right of conscience generally.  This is particularly significant given that it is likely that contraception will be mandated under the federal minimum required benefits package.  Members may want this conscience protection to be expanded so that it includes contraception (including the morning-after-pill) and other services in order to protect the conscience of health care providers, such as many Catholic hospitals, who object to the provision, paying for, or referring for services to which they have a moral objection. 

SAME SEX HEALTH BENEFITS

H.R. 3962 extends current tax benefits for health insurance-including the exclusion from income and payroll taxes for participants in employer-sponsored coverage, the above-the-line deduction for health insurance premiums paid by self-employed individuals, and Flexible Spending Accounts and Health Reimbursement Arrangements-to "eligible beneficiaries," defined as "any individual who is eligible to receive benefits or coverage under an accident or health plan." 

Under current law, while employer-sponsored coverage provided to spouses and children is generally excluded from income, domestic partners do not qualify for similar treatment.  The Internal Revenue Code does not classify them as dependents, and the Defense of Marriage Act (P.L. 104-199) prohibits their classification as spouses.  H.R. 3962 expands the current-law health insurance tax benefits to domestic partners and their adopted children.