What Does 'Hospitalization' Mean? Under Health Care Bill, Kathleen Sebelius Will Decide

By Adam Brickley | October 28, 2009 | 6:10pm EDT

Health and Human Services Secretary Kathleen Sebelius (Photo by Penny Starr/CNSNews.com)

(CNSNews.com) – If the Senate approves the health-care package passed by the Senate Finance Committee, Health and Human Services Secretary Kathleen Sebelius will determine the meaning of common medical and health insurance terms such as “hospitalization,” "physician services," “premium,” "prescription drug coverage," “deductible,” and “emergency room care.”

The provision giving the HHS secretary this power appears on pages 256 and 257 of the Finance Committee’s gargantuan health-care reform bill, which totals just over 1,500 pages.
“The Secretary of Health and Human Services,” says the bill, “shall, by regulations, provide for the development of standards for the definitions of terms used in health insurance coverage.”
The legislation further breaks down the secretary’s definition powers into the categories of “insurance-related terms” and “medical terms.”
In the “insurance-related” category, the legislation empowers the HHS secretary to define the words: “premium, deductible, co-insurance, co-payment, out-of-pocket limit, preferred provider, non-preferred provider, out-of-network co-payments, UCR (usual, customary and reasonable) fees, excluded services, grievance and appeals." 

It leaves the secretary's power wide-open by adding--"and such other terms as the Secretary determines are important to define so that consumers may compare health insurance coverage and understand their benefits.”

The list of terms in the “medical” category reads similarly, giving the government official the authority to define -- “hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing services, rehabilitation services, hospice services, emergency medical transportation, and such other terms as the Secretary determines are important to define so that consumers may compare the medical benefits offered by insurance health insurance and understand the extent of those medical benefits (or exceptions to those benefits).”

Devon Herrick, a health economist at the National Center for Policy Analysis, blasted the proposed ceding of powers in an interview with CNSNews.com.
“I am very worried about the idea of taking away consumer choice or consumer preferences in the marketplace and replacing those with the Secretary of HHS’ preferences,” Herrick said. “Giving the secretary the power to define and regulate all products in the exchange, you essentially remove all consumer choice.”
Noting that an HHS committee would likely be established to handle these new responsibilities, Herrick said the board would be the target of lobbyists who would want to make sure that their particular good or service is covered by the mandate.
“They are taking the power to basically create the insurance and, really, regulate the insurance that meets their ideas, their needs,” Herrick asserted. “They want to tell consumers what they must have, and this is just a way to make sure that there’s no choice left in the equation.”
Dennis Smith, a senior fellow at The Heritage Foundation, a conservative think-tank, also expressed concern.
“This entire bill is one big question mark, because you’re transferring tremendous power over to the executive branch,” Smith told CNSNews.com. 

The legislation leaves too many things up to the federal government, he added. 

“It’s the details that matter,” Smith said, “and those details are going to be shaped by HHS, not by Congress.”

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