By Ron Pollack
It’s high time to talk about what the Patient Protection and Affordable Care Act really does.
The new law does not cut Medicare’s guaranteed benefits; it improves them. Before the law was passed, those with Medicare prescription drug coverage faced a growing gap (the “doughnut hole”) that left them vulnerable to thousands of dollars in out-of-pocket drug costs. This year, people in the doughnut hole received a $250 rebate toward the costs of their drugs. Starting in 2011, the gap will gradually close, saving seniors money and helping them get the drugs they need.
Preventive care is also improved. In 2011, all Medicare deductibles and co-insurance are eliminated for preventive services like mammograms and colorectal screenings. And for the first time, Medicare will begin covering a free annual physical. These changes will make sure Medicare does more to keep seniors healthy, as well as covering them when they’re sick.
Other important changes will help our aging—and ailing—grandparents. States have new options to help people get care in their homes rather than being forced to move to a nursing home as their health declines. The new law also increases federal funding for adult protective services, which serve abused, neglected, or exploited seniors. And it boosts support for state Long-Term Care Ombudsman programs, which look out for the rights of nursing home residents and their families.
So, how are these improvements paid for? People with incomes over $200,000 a year ($250,000 a year for couples) will pay more in Medicare payroll taxes. And yes, Medicare spending will grow more slowly in some areas over the next 10 years than it otherwise would have. But Medicare will still grow nearly 6 percent a year. The law makes carefully targeted changes to reduce wasteful services—like doctors ordering the same test twice. It provides more resources to go after fraud and abuse—like beneficiaries receiving wheelchairs that they never ordered and don’t need. These sensible changes help keep Medicare fiscally sound for an additional 12 years, until 2029.
What about Medicare Advantage? These private plans were supposed to provide care more efficiently and at higher quality than the original Medicare program. But in fact, they have cost hundreds of billions of dollars more than original Medicare—costs paid by taxpayers and Medicare beneficiaries, including the three out of four who do not participate in the program. Moreover, the plans have shown no consistent improvements in quality. Over the next few years, the excess payments to these plans will gradually be ratcheted down—with bonus payments for those that provide high-quality care. Putting these plans on a level playing field with the original Medicare program is a good and fair thing to do.
Of course, the new law doesn’t just help seniors. By requiring insurance companies to allow young adults to remain on their parents insurance until they are 26, it enables your grandchild to go to college or start a new job without fear of going uninsured. Prohibiting insurance companies from denying coverage to people based on age, gender, or health status ensures that your daughter is not denied health insurance because she was diagnosed with diabetes. And cracking down on insurance company abuses ensures that no one loses coverage when it is needed most. The Affordable Care Act is not perfect—no law ever is. But it is the most significant improvement in health security in our nation’s history. Undoing the law would be a tragic mistake.
Ron Pollack is executive director of Families USA, a national organization for health care consumers. It is nonprofit and nonpartisan, and its mission is to secure high-quality, affordable health coverage and care for all Americans. www.familiesusa.org.