Reality Check on Claim That Obamacare “Raids” Medicare, Lowers Benefits and Adds to Deficit

From today’s Washington Post, a reminder that the Medicare Board of Trustees reports that Obamacare extends the solvency of Medicare and does so without any lowering of benefits to patients.

Repeal of Obamacare, as proposed by the Romney-Ryan ticket (and already passed by the House) would bring insolvency closer. It would also take insurance away from over 30 million people, eliminate the ban on pre-existing conditions, eliminate the new preventive care provisions for Medicare, re-open the prescription drug donut hole, etc.

 The $716 billion in savings helped free up funds to pay for other health programs, like the expansion of insurance to 32 million Americans.

That was the primary purpose, at least. There was also a really important side effect: The health care law extended the solvency of Medicare’s Trust Fund. If the program pays hospitals less, each dollar stretches a little bit further. Earlier this year, the independent Medicare Board of Trustees estimated that with these cuts the trust fund would remain solvent through 2024.

Without those cuts, however, the budget gets a little tighter. Medicare keeps paying providers at the same rates it does now, but each dollar buys less. And that means, according to these trustees, that the trust fund would no longer be able to cover Medicare’s costs as soon as 2016.

Obamacare Has Saved Seniors $4 Billion On Drug Costs

While I would love to see much less dependence on medications and much more on healthy lifestyle changes, the fact that the Affordable Care Act has already kept $4 billion in the bank accounts of American seniors and out of the hands of the drug companies strikes me as a positive development that deserves to be widely publicized.

That’s what a new report from the Centers of Medicare and Medicaid Services has documented.

The Medicare agency released figures showing that millions of seniors and people with disabilities have saved $3.9 billion on medications since the law was enacted.
The data also showed that since the beginning of the year, more than 1 million Medicare beneficiaries have saved an average of $629 on prescriptions in the “doughnut hole” coverage gap. 

“Millions of people with Medicare have been paying less for prescription drugs thanks to the healthcare law,” said Marilyn Tavenner, the head of the Centers for Medicare and Medicaid Services.

“Seniors and people with disabilities have already saved close to $4 billion. In 2020, the doughnut hole will be closed thanks to the Affordable Care Act.”

To close the doughnut hole, the government will cover more and more of the value of brand-name and generic drugs until 2020, when seniors will be responsible for 25 percent of the cost for each.

When the Medicare drug benefit was passed by the Republican-controlled Congress in 2004, it was structured so that 100% of the costs were added to the federal deficit. In contrast, the Affordable Care Act of 2010 (aka Obamacare) was structured so as to decrease the deficit, in accordance with the estimates by the nonpartisan Congressional Budget Office.

 

 

More Confirmation That Affordable Care Act Lowers Deficits While Bringing Insurance to 30 Million Uninsured Americans

The Affordable Care Act is the opposite of an unaffordable new entitlement; it is a way to insure 30 million more people while reducing the federal government’s deficit at the same time, according to today’s report from the nonpartisan Congressional Budget Office, which is the closest thing that the United States has to an unbiased financial umpire.

CBO also scored the budgetary impact repealing the health reform law, as endorsed by Mitt Romney and House and Senate Republicans. They found that repeal would add to the deficit while also taking away the insurance that those 30 million people would have gained. In addition, repeal would overturn rules that bar insurance companies from denying coverage due to pre-existing conditions, from canceling coverage when people become ill, and from placing a lifetime dollar limit on coverage. Other provisions that repeal would reverse are the phase-out of the “donut hole” where seniors have no Medicare coverage for prescription drugs, the right of young adults to remain on their parents’ insurance policies through age 26, and the requirement that insurance companies spend at least 80 or 85% of premium dollars (depending on the type of policy) on health services rather than administration and profits.

Also prohibited under the law starting in 2014 will be annual coverage limits and gender discrimination (women currently can be charged higher rates than men for the same coverage).

From Jon Cohn’s new article in The New Republic:

The Congressional Budget Office just published a newly updated estimate of the Affordable Care Act and its impact on the budget. The estimate largely tells us what we already knew: The law, when fully implemented, will dramatically reduce the number of Americans without health insurance. It will also reduce the deficit.

This last part remains a big deal, if only because so many conservatives—and, yes, so many members of the public—refuse to believe it. Over and over again, you hear people saying that Obamacare will run up the deficit. The CBO, which is our most reliable guide on such matters, begs to differ. 

CBO can’t be certain, because nobody can be certain, how exactly the law will play out. But the best available evidence suggests that, in the end, the law will leave the federal treasury with more money than it would have otherwise. And that’s just in the short- to medium-term. If the program’s efforts at re-engineering the health care system really work, then all spending on health care—from the federal government, corporations, and individuals alike—will stop rising so quickly, freeing up more money for other purposes (like, for example, raises to employees).

The Supreme Court Speaks, Health Reform Continues

My editorial on the health reform law has been posted as part of the new issue of Health Insights Today, here. There’s a focus on the potential effects of the law for chiropractic and CAM, along with broader societal effects that will come with implementation (or repeal).

I hope you all click through to the full editorial. Here’s an excerpt.

First, the landmark provider nondiscrimination rule, Section 2706:

Since most readers of Health Insights Today have a strong interest in chiropractic and complementary and alternative medicine (CAM), let’s begin with the provisions directly related to those fields. First and foremost, the Affordable Care Act’s Section 2706 enacts for the first time a nationwide provider nondiscrimination policy, prohibiting insurance companies from denying coverage based on provider type for services provided by licensed health care practitioners. For example, this policy appears to indicate that if spinal manipulation or acupuncture (or any other service within a practitioner’s scope of practice) is covered when performed by a medical or osteopathic physician, insurers cannot have a policy denying such coverage when the service is performed by a chiropractor or acupuncturist. In the past, such discriminatory policies have had the effect of routing patients away from DCs, LAcs and other non-MD/DO practitioners.

The nondiscrimination rule is a landmark step forward and marks the first time that legislation applies such a policy across the entire nation. However, it does not bar all forms of discrimination. Importantly, insurers are not barred from paying some types of practitioners more than others for the same services. Chiropractors and a variety of other non-MD/DO practitioners sought such a ban but did not achieve it in this legislation. Success on that front will have to wait until later.

The full ramifications of Section 2706 will become clearer over time, as uncertainties are resolved through state and/or federal regulatory actions or litigation. For now, it is seen by chiropractic and CAM leaders and attorneys as the most significant piece of federal legislation in many years. The American Medical Association House of Delegates approved a resolution at its June 2012 national meeting that calls for the repeal of the nondiscrimination policy. While vigilance on the part of chiropractic and CAM organizations remains necessary, this AMA repeal effort faces a steep uphill climb unless the November 2012 election brings a president, House, and Senate that repeals the entire Affordable Care Act. Senate Republican Leader Mitch McConnell and House Speaker John Boehner have pledged to seek full repeal in early 2013. 

I ask each of our readers … please familiarize yourself with what is in the law, so that you will be able to evaluate all claims — pro or con — based on facts rather than distortions.  

 

 

 

As We Await the Supreme Court Health Care Decision, Remember the Impact on Individual Lives

From today’s New York Times:

His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.

No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions. The law, once its major provisions take effect, would prohibit insurance companies from turning people away or charging them more because they are sick. In exchange, most Americans would be required to have insurance, broadening the base of paying customers with an infusion of healthy people. Those who did not buy insurance would be subject to financial penalties.

The Government Accountability Office estimates that 36 million to 122 million adults under 65 have a pre-existing condition. As many as 17 million do not have insurance. Many try to buy coverage on the individual market, but in most states that is either impossible or too costly.

 

Cancer v. the Constitution

A human tragedy, which could become much less common or much more common depending on what the Supreme Court decides.

She hadn’t gone to the doctor because she had no health insurance. The only kind of work she could get in a struggling rural community was without benefits. Her coat and shoes beside the gurney were worn and her purse from another decade. She could never afford to buy it on her own. She didn’t qualify for Medicaid, the local doctor only took insurance, and there was no Planned Parenthood or County Clinic nearby.

So nothing was done about the bleeding until she passed out at work and someone called an ambulance. She required a couple of units of blood at the local hospital before they sent her by ambulance to our emergency department.

I looked at the fungating mass on her cervix. Later the Intern wondered why she hadn’t picked up on the smell. Probably a combination of it being so gradual and denial. It’s amazing what people learn to tolerate when their options are limited.

“I’m very sorry to tell you this looks like a cancer of the cervix,” I said

She looked surprised. “Oh.” She paused in silence as she adjusted to the news. And then quietly she added, “But the doctor back home said you could fix me up. He said you can offer free care because you have the university.”

But we didn’t have free care at the university hospital.

h/t Meteor Blades

… in the Real World

This Washington Monthly blog post, “The Affordable Care Act in the Real World,” frames the question in ways that should matter most, in terms of how people’s lives are actually affected by the health reform law.

A priest I knew many years ago once said to me, “Turning real human suffering into an abstraction is among the greatest sins.” .

My children now have health coverage through mine, and our family’s health will now sustain itself through my children’s 26th birthdays. A mouth full of cavities was treated, and vision has been a godsend, and my daughters have the ability to go to the doctor at $20 a pop, instead of the $150 a pop uninsured rate, and they don’t have to go willy-nilly to a clinic setting!

A dear friend of mine skirted death with a ruptured colon, had surgery to the tune of over $80,000 because they were uninsured. and worried about preexisting conditions when it came to reversing the colostomy, qualified for insurance so he doesn’t have to carry around a bag for the rest of his life.

Amen.

 

What Will Change if the Supreme Court Overturns Obamacare’s Individual Mandate?

Ezekiel Emmanuel’s op-ed in the New York Times addresses some of the changes that will and will not be affected, if the individual mandate to buy health insurance is overturned as unconstitutional.

The very substantial downside is that 16 million people who would have been insured will not be. This number will rise to 32 million if Medicaid expansion is also deemed unconstitutional. According to Emmanuel, this would also trigger a downward spiral threatening to substantially increase insurance premiums for everyone.

On the other hand, changes such as bundling of payments, which have already begun, lead to better coordinated care and lower costs. These changes will continue apace regardless of what the Supreme Court’s decides.

Tens of thousands of Americans die because of hospital-acquired infections every year, and far more are harmed by medical errors. Last year, authorized by the Affordable Care Act, the Obama administration announced a $500 million program called Partnership for Patients aimed at reducing hospital-acquired infections, errors and other preventable complications. The act also requires Medicare to begin posting online each hospital’s rate of certain medical errors and infections, and to cut payments to hospitals with the highest rates.

Consequently, hospitals across the country are working to reduce preventable hospital errors. Once it’s clear that this is a major priority, significant progress can be made. A few years before the health care reform act was passed, the Hospital of the University of Pennsylvania, where I work, started paying attention to reducing preventable errors, and it managed to reduce infections from intravenous lines to 1 or fewer per month from 30 to 40 per month. All it took was removing intravenous lines whenever they weren’t necessary, changing them regularly and using a more vigorous sterilizing technique when inserting them. Many other institutions are making similar progress now. All of this has nothing to do with the constitutionality of the individual mandate and will continue no matter what the Supreme Court rules.

The same goes for the problem of hospital readmissions. Right now, nearly 20 percent of Medicare patients who are discharged from a hospital are readmitted within 30 days. Some are scheduled readmissions; others occur for completely unrelated health problems, like falls and accidents. But many could be prevented by paying more attention to the coordination of care between physicians and hospitals and by better follow-up after patients are discharged. Beginning this year, the health care reform act will penalize hospitals that have high readmission rates for three conditions: pneumonia, heart failure and heart attacks. This list will later be expanded. As a result, all hospitals are now scrambling to figure out how to create “the perfect patient discharge” so patients don’t become hospital “frequent fliers.”

If the Supreme Court rules that the individual mandate is unconstitutional — in my opinion, an improbable and legally indefensible decision — it will not end health care reform. Hospitals and doctors will continue to work to improve care and control costs. But tens of millions of Americans will continue to be excluded from the health care system, which is hardly an optimal outcome.

 

Lead Plaintiff in Anti-Reform Case Declares Bankruptcy, Partly Due to Medical Bills

File under irony, along with genuine sympathy for this family’s plight.

Mary Brown, a 56-year-old Florida woman who owned a small auto repair shop but had no health insurance, became the lead plaintiff challenging President Obama‘s healthcare law because she was passionate about the issue.

Brown “doesn’t have insurance. She doesn’t want to pay for it. And she doesn’t want the government to tell her she has to have it,” said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation’s case, which the Supreme Court plans to hear later this month.

But court records reveal that Brown and her husband filed for bankruptcy last fall with $4,500 in unpaid medical bills. Those bills could change Brown from a symbol of proud independence into an example of exactly the problem the healthcare law was intended to address.

The central issue before the Supreme Court is whether the government can require people to buy health insurance. Under the law, those who fail to buy insurance after 2014 could face a fine of up to $700.

The business federation, along with other critics of the law, calls the insurance mandate a “threat to individual liberty” that violates the Constitution.

Obama administration lawyers argue that the requirement is justified because everyone, sooner or later, needs healthcare. Those who fail to have insurance are at high risk of running up bills they cannot pay, sticking the rest of society with the cost, they argue. Brown’s situation, they say, is a perfect example of exactly that kind of “uncompensated care that will ultimately be paid by others.”