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The Medicare Fight and the ACA

Jun 08, 2011 | By Jean Sammon

I’m tired of the Medicare fight. But I’m afraid we’ll have to endure it for at least another 18 months since 2012 election politicking has already started, and Medicare is the hot issue. 

If we want to save Medicare, which political party should we trust?

The Republicans say that Medicare will go broke because Democrats are doing nothing to make it solvent. The Democrats say that Medicare will no longer exist if Republicans get their way. Both sides are using the issue to whip up fear among seniors who are on Medicare now, and near-seniors who are looking forward to getting Medicare.

Demagoguery on Medicare is nothing new. In recent history, during the debates on the Affordable Care Act (ACA) in 2009 and 2010, opponents accused supporters of “cutting Medicare.” As with most sound bites, the actual truth was a bit more complex. The ACA cut funds to Medicare Advantage plans, which are optional private insurance plans that seniors can get. They sometimes offer additional benefits such as vision and dental coverage.

(I don’t know exactly why Medicare Advantage came to be, but I do remember that Sr. Catherine Pinkerton, who was NETWORK’s healthcare lobbyist at the time, saw this as a step toward privatizing Medicare and did not approve.)

It turns out that the federal government pays about 11%  more for each Medicare Advantage enrollee than it does for an enrollee in traditional Medicare. This is due to a complicated formula that allowed Medicare Advantage insurance companies to get higher payments than traditional Medicare fee-for-service costs. Most of these overpayments went to the insurance companies, not to additional benefits for the people enrolled. So in an attempt to cut growing Medicare costs, the ACA will restructure payments to Medicare Advantage insurance companies to bring them more in line with traditional Medicare costs. But there were no cuts to basic Medicare benefits in the ACA.

Now the Democrats are saying they want to preserve “Medicare as we know it”, meaning the traditional Medicare plan run by the government. And Republicans want to change Medicare into a plan that would give government subsidies to seniors to buy private insurance. To me, the Republican plan sounds similar to what the ACA did for people under 65 who couldn’t afford insurance: give subsidies to help them buy insurance in the private market. So I’m not sure why Republicans complain so much about the ACA if they like that idea.

I do know why most seniors don’t like the private insurance idea. Seniors typically need more healthcare than younger people do, and it cost them more to get it. The Republican-proposed subsidies would not increase at the same rate that healthcare costs increase. And I’m guessing that seniors would have more “pre-existing” conditions when they retire and therefore have a hard time getting private insurance. Come to think of it, isn’t that why Medicare (as we know it) was put in place to begin with?

Most people agree that we need to find ways to control not just Medicare costs, but healthcare costs in general. The Affordable Care Act has many provisions to experiment with different ways to pay for healthcare services. Some of these have the potential to make our whole healthcare system more effective and efficient.

We should give the ACA a chance to work, and build on what we learn to do more to control healthcare costs for everyone. Other countries have done this, and America should be able to do this too.

I just hope we don’t have to wait another 18 months before we can have a rational discussion on healthcare.

If you would like to read a little more about the current Medicare fight, I recommend this article: http://www.kaiserhealthnews.org/Columns/2011/May/052511cohn.aspx