Sicker Quicker, Broke Faster: Seniors’ Fate If Health Law Is Repealed

Sicker Quicker, Broke Faster: Seniors’ Fate If Health Law Is Repealed

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The Affordable Care Act (ACA), the nation’s new health care reform law, strengthened the Medicare program. It promises to improve care for America’s seniors and other individuals with Medicare coverage.

This week, however, the House of Representatives is expected to approve legislation that will repeal this new law and the improvements it makes in Medicare. Repealing health care reform would eliminate the new Medicare benefits and patient protections included in the new law. And it would place Medicare on less stable financial footing.

Health care reform opponents spent much of last year criticizing the ACA’s Medicare spending reductions. They charged that these changes would starve the program and limit care. They generally pointed to reduced growth in the formulas used to pay doctors and other providers, and a significant change in payments to the Medicare Advantage HMOs and related programs.

These reductions, however, were reasonable in the context of previous budget bills and the systemic goals of the new law. ACA seeks to create a more affordable health care system that works for all Americans by improving coverage, enhancing quality and increasing efficiency.

Also see: How Health Care Reform Benefits People of Color and What Will Happen to Small Business if Health Care Is Repealed

The law also would strengthen Medicare’s financial position. Changes in payments to Medicare Advantage plans may affect some who enroll in these private-insurance options, but overall these changes result in fairer treatment across all Medicare beneficiaries.

The national debate over health care reform also obscured the new law’s other improvements to Medicare program and other services for many Medicare beneficiaries, such as in long-term care coverage.

Specifically, the law:

  • Improves Medicare coverage for preventive services: ACA creates new coverage for an annual wellness visit and eliminates copayments and deductibles for preventive services such as mammograms and colonoscopies. These improvements will enable people with Medicare coverage to better manage their own health. Also, increased use of preventive services will result in program savings over time
  • Establishes discounted drug prices for individuals who hit the so-called “doughnut hole” in the Medicare Part D prescription-drug benefit: Individuals enrolled in Part D who have high prescription drug needs will save up to $1,500 on their drug costs instead of paying the full cost of their medications once they hit a preset limit. [At present, after beneficiaries receive initial coverage, the fall into the “hole” where Medicare pays nothing until Medicare patients pay several thousand dollars more out of pocket.]
  • Improves access to primary care physicians: The law increases Medicare payments for primary care services by 10 percent.
  • Extends the solvency of the Hospital Insurance Trust Fund by an additional 12 years: This trust fund finances hospital services and other care for people with Medicare coverage. This trust fund now has sufficient assets to cover the cost of care through 2029.
  • Fosters changes in Medicare provider-payment arrangements designed to improve quality and coordination of care: These changes include a new Center for Medicare and Medicaid Innovation, which will test new provider-payment models developed to improve efficiency and quality. These efforts should help to further hold down the costs of health care for Medicare beneficiaries over time.
  • Creates a new national, voluntary long-term care insurance program and strengthens Medicaid-financed home- and community-based services for low-income people with long-term care needs: Among these improvements are enhanced federal financing for attendant-care supports; extended federal and state investment in home- and community-based services, such as home care or adult day care; and establishing medical homes for chronically ill Medicaid beneficiaries. New nursing home diversion programs will keep many people from being institutionalized before their time.
Quite simply, repealing the Affordable Care Act would mean that people with Medicare will lose new benefits and protections. Those with high prescription-drug costs will continue to struggle to pay for their medications once they hit the doughnut hole. Enrollees’ access to primary-care doctors may erode as their payment rates continue to lag well behind those of specialists.

And beneficiaries will continue to be responsible for Medicare deductibles and copayments when they seek a flu shot, a mammogram or other preventive services. Meanwhile, repeal would force Medicare spending back to its pre-reform trajectory.

Were repeal to happen, Congress would consequently need to consider severe changes to the Medicare program—changes likely to threaten beneficiaries’ access to affordable care—in the face of the return to more rapid spending growth and without the extra protections for seniors’ health.

In addition, Medicare would lose its new ability to test, replicate and spread innovations in health care delivery and health care payment that will improve quality of care while saving program dollars.

With repeal, Medicare beneficiaries with chronic illnesses and others who need significant care would continue to experience disjointed, poorly coordinated care. They would remain at risk for duplicative care, repeat hospitalizations and unnecessary services while navigating the health care system on their own.

In short, repeal of the new health care law promises Medicare beneficiaries greater costs—for prescription drugs, preventive services and lower quality care—as well as greater uncertainty about the program’s future.

Marilyn Moon is senior vice president and director of the health program at the American Institutes for Research.