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Originally published April 21, 2012 at 8:05 PM | Page modified April 21, 2012 at 8:21 PM

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Cantwell opponent repeats myths, overstates case on health law

Mostly false: GOP Senate candidate Michael Baumgartner says U.S. Sen. Maria Cantwell voted to take away our choice of doctors, to force us to buy the insurance she mandates, and to give our choice of treatments to an unelected board of bureaucrats.

Seattle Times Washington bureau

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Claim: U.S. Sen. Maria Cantwell voted to take away our choice of doctors, to force us to buy the insurance she mandates, and to give our choice of treatments to an unelected board of bureaucrats, said Michael Baumgartner, a Republican state senator who is running to unseat Cantwell.

What we found: Mostly false.

In an email to supporters last month, the freshman legislator from Spokane resurrected favorite GOP attacks against the 2010 federal health-care overhaul — the Patient Protection and Affordable Care Act — some of which have been repeatedly debunked by fact checkers.

Baumgartner accused Cantwell, a Democrat, of hoping that voters forget the act represents "government taking over our health care." That oft-repeated line earned the news group PolitiFact's 2010 Lie of the Year.

The law adds new regulations but largely relies on the current free-market health system to increase the number of Americans covered under private insurance. In fact, the liberal-supported "public option," known as "Medicare for all," did not make it into the act.

Aside from that, Baumgartner makes three specific contentions about Cantwell's support for the health law, including that "Cantwell voted to force us to buy the insurance she mandates."

By that, Baumgartner said, he meant the law "both mandates we buy insurance and mandates what type of insurance we can buy."

His first point is true. Unless they are among the millions of people in exempted groups (Native American tribes, undocumented immigrants, the very poor), Americans starting in 2014 must carry health insurance to avoid financial penalties.

But Baumgartner overstates the case in claiming that the federal government will dictate the type of plans that private insurers can sell.

The Affordable Care Act does impose a slew of specific coverage rules. Health plans, for instance, must pay for routine vaccinations or preventive services without requiring co-pays; must cover mental-health, maternity, emergency and outpatient services; and must cap patients' annual out-of-pocket costs.

What's more, bare-bones catastrophic plans with high deductibles can be sold only to people who are under 30 or have very little income.

The rules are meant to protect patients from skimpy, inadequate coverage, said Karen Pollitz, senior fellow with the Kaiser Family Foundation, an independent health-policy think tank in Washington, D.C.

"There is real junk out there," Pollitz said.

Such government regulation of health insurance is not unprecedented. Washington state, for example, requires health plans to permit patients to see chiropractors, acupuncturists and naturopaths for covered services.

Pollitz, however, noted that under the Affordable Care Act, final benefit designs will be left to insurers and employers, not the government. So while the law specifies insurance plans must cover prescription drugs, for example, it is up to the carriers to decide what medicines they will cover and at what level.

And despite the numerous federal dictates, consumers will still have a range of choices in health plans. They will range from "bronze" plans that cover only 60 percent of medical costs to "platinum" or richer plans with up to 94 percent coverage.

Health-savings accounts, which are pretax plans with high deductibles, will also still be allowed.

Baumgartner's second claim, that the law will reduce choice of doctors, is a stretch. He says the law sets price and regulatory controls that inevitably will lead to limits on provider choices.

To back up his point, he cited a 2010 article in The New York Times about insurers offering plans that restrict patients to smaller networks of doctors and hospitals in return for lower premiums.

Insurers were testing the plans in anticipation of new insurance exchanges created by the law, where consumers will be able to comparison shop for private coverage.

But health-policy experts say tightening provider networks is just one consequence of ballooning health-care costs, a trend that long predates the Affordable Care Act. For instance, doctors in recent years have been increasingly dropping out of Medicare, complaining of low reimbursement rates. Plus, private insurers already limit choice of doctors and hospitals via tiered coverage for in- and out-of-network providers.

Finally, Baumgartner repeats a charge made by many Republican candidates that the health law allows bureaucrats to make treatment choices. This claim, too, has been found by fact checkers to be false, or at least highly misleading, depending on the variation.

Baumgartner said he was referring in part to the Independent Payment Advisory Board that will have the power to curb Medicare's spending growth if it exceeds targets. The board's 15 members by law won't be bureaucrats but rather doctors, employers, insurers and consumer advocates who will serve as executive-branch officers.

In addition, the board is explicitly barred from rationing care or reducing Medicare benefits. It will have nothing to do with approving treatments for individual patients. It can recommend legislation to reduce Medicare payments or other options to reduce spending but can't dictate, for example, what brand-name drugs or what type of prosthetics won't be covered.

Congress has the final say in adopting the board's proposals to trim payments to providers, or passing its own plan.

Another "unelected board of bureaucrats" Baumgartner had in mind is the U.S. Preventive Services Task Force. The task force is actually a long-standing independent group of nonfederal experts in primary care, including pediatricians and gynecologists, who make recommendations about evidence-based medicine.

The health law will require insurers to cover, without co-pays, preventive services such as screening for diabetes or cervical cancer that are deemed highly effective. Nothing bars insurers from covering non-recommended services if they choose. So the task force arguably will have limited power over patients' "choice of treatments" — but only to compel, not deny, coverage.

Baumgartner rightly points out that the new law contains many government mandates on health care.

But he distorts facts in claiming that it would strip Americans of their choice of doctors and treatments while entrusting treatment choices to bureaucrats. For that, we deem his assertions mostly false.

Kyung Song: 202-662-7455 or ksong@seattletimes.com

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