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Attacks on ACA pits Medicare vs. Medicaid, Seniors against the Poor

By Dr. Ram Krishnamoorthi
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In the spirit of political theater and at the expense of the truth, opponents of the Affordable Care Act are speaking to senior citizens about Medicare. They are claiming that the ACA has  “stolen” from seniors by “gutting” Medicare and “robbing” the program of anywhere from $711 to $741 billion from the program. Others accuse the ACA of “raiding” Medicare like a “piggy bank” to pay for a government take-over and a massive new program that is not even meant for Medicare recipients. An even more preposterous criticism is that the ACA, through its “cuts,” will bankrupt the Medicare Trust Fund, a claim that logically doesn’t make sense.

 

First, the claim that the ACA “robs” Medicare beneficiaries of benefits by $716 billion in “cuts” is a frank lie. It has been debunked with ease by every trusted authority on Medicare, including the Kaiser Family Foundation, independent fact-checkers like Politifact.org and major newspapers. The figure is the amount saved by a reduction in the growth of spending, not benefit cuts.  Why so easily found to be a lie? Because the Congressional Budget Office and the Joint Commission on Taxation said so, in a letter to House Speaker John Boehner, on why repealing the ACA would actually cost the American people money.

 

At best, the accusations of robbery may be misguided spin on the ACA’s savings from waste, fraud, and cuts in provider payments. The ACA is projected to save Medicare over $156 billion in over-payments to Medicare Advantage plans, private insurers that have been found to provide little value to seniors but charge them up to 13% more than traditional Medicare. About $260 billion will be reduced in payments to hospitals, $120 billion from home health and skilled nursing services, and $30-60 billion is projected to be saved by prosecuting Medicare and Medicaid fraud.

 

A debate about the effects of these lower provider reimbursements could be a legitimate one, asking whether they reduce access to services for seniors and whether these services are of value. But that doesn’t seem to be the tenor of the attacks.

 

Instead, as Jonathon Cohn writes, opponents emphasize that this phantom government take-over is stealing from senior citizens and giving it to someone else. Who are these beneficiaries? Do they mention that the ACA actually increases benefits to seniors, in the form of 1) closing the Medicare Part D prescription drug doughnut hole, 2) covering preventive services with no co-pay, and 3) reimbursing more for care coordination and other primary care? Do they mention that the ACA actually cuts the federal budget deficit and extends the solvency of the Medicare Trust Fund until 2024?

 

No, they don’t mention those benefits, ones that directly accrue to Medicare recipients. Instead, it has been clear for a while, especially after the Supreme Court ruling in June, that the aspect of the ACA that is particularly loathesome to its opponents is the expansion of Medicaid.

 

In scaring seniors, opponents are pitting Medicare against Medicaid. And in doing so, they do a great disservice in two ways. First, they create a dangerous false choice for Americans between two vulnerable populations, seniors and the poor. Second, they miss the point that achieving universal insurance coverage is good policy for Medicare recipients as well.  

 

It is true that the largest expenditure in the ACA budget is to pay for Medicaid expansion, about $930 billion through the end of the decade mostly by the federal government. But the result will be nearly 15 million newly insured Americans who will have access to primary care, preventing the need to use the emergency room for basic care and saving taxpayers on uncompensated care and costly, preventable hospitalizations. In addition, by insuring more people before they get to Medicare, we can save Medicare dollars. For example, more prevention of and screening for chronic diseases like hypertension and diabetes and behavior changes such as weight loss and smoking cessation can prevent the downstream, costlier sequelae of severe cardiovascular disease in older age. A recent study bears this out by demonstrating that Medicaid expansion in some states improved the health and mortality of its recipients compared to those states that did not expand its Medicaid insured.

 

In truth, many groups benefit from Medicaid, including pregnant women, their children, the disabled, and the elderly poor. It is the most important source of funding for nursing homes, home health and other skilled nursing. Everyone knows somebody on Medicaid, even though this is probably kept quiet for fear of the stigma of being on “public aid.”

 

One of the most important purposes of passing Medicare and one of its biggest successful effects has been in reducing poverty among the elderly.  In 1959, the poverty rate among the elderly was a heart-wrenching 36% and a quarter of their income went for medical expenses. Today, thanks in part to Medicare, under 9% of seniors live in poverty and they suffer less from medical bankruptcy. This is why we decided as a nation that it was our moral duty take care of our elderly, who had saved democracy in two World Wars, endured the Depression without a social safety net, and raised the future generations of Medicare recipients.

 

Medicare is a success.  And so is Medicaid. And each can be strengthened.

 

It’s difficult to ignore politics when discussing health reform policy, and it’s not even desirable. Politics is an exhilarating game of winning hearts and minds with exciting ideas and persuasive argument, grassroots organizing, and the legislative and electoral process.

But then there’s lying. And there’s fear-mongering. And worst, there’s lying about something to make one group of people afraid of another group of people in the country. This is politics at its worst.

 

This weekend, DFA will embark on its Patients over Politics Bus Tour to fight exactly that cynical kind of politics, the type that places scoring points above the truth, political wins over patients’ lives. Please join us, in person, or virtually, by signing a Declaration of Support. We don’t have to pit Seniors against the Poor or any American against another.  We can be united and move forward on Health Reform. 

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