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Fact or fiction? Gov’t would decide treatments

Critics claim the House Dems' health insurance reform bill would create a board that could mandate treatment without accountability. Is the claim accurate?

Claim: Health reform will create a new government committee to decide medical treatments and benefits.

The House Democrats' insurance bill would create a Health Benefits Advisory Committee that would decide what medical treatments would be paid for by insurance plans. Critics, and groups such as the National Association of Health Underwriters, which represents insurance agents and brokers, say that this board would have power without accountability.

Is it fact or fiction?
A little of both. The House bill creates a 26-member board, with 17 members appointed by the president, to recommend to the Health and Human Services secretary what benefits, beyond those mandated by law, should be offered.

HHS secretary has the power
It would be up to the HHS secretary to decide whether or not to accept the board's recommendations, so the board itself has limited power. It would be the HHS secretary who wields the power. The board and the secretary would be grappling with sensitive issues such as which treatments are truly cost effective and which are only marginally useful.

Medicare is already doing this
HHS secretary Kathleen Sebelius said determination of what procedures get covered already "goes on every day. It's how the Medicare benefits get decided." According to Medicare expert Joe Antos at the American Enterprise Institute, private insurance firms that contract with Medicare have traditionally decided what treatments to cover based on local standards of medical practice in each part of the country.

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