As the contentious and pivotal election year rolls on, opponents who fought viciously against the Affordable Care Act (ACA) continue to smear the health reform law months after its passage. Senator Mitch McConnell’s (R-KY) talking-points-driven opinion piece on CNN.com is one of the latest in this mission of misinformation and fear-mongering (“GOP Leader: Truth catches up to Democrats on health care”). Despite the title, it is clear that Mr. McConnell’s central theme is not about the “truth” and is not about health policy, but is political: to score points against his opponents by lying and scaring the public about health reform. In doing so, he attacks the ACA with frightening labels and buzzwords, calling it a “so-called reform that leads to a government takeover where premiums are increased but health care is delayed, denied and rationed.”
There is no government takeover. There is no rationing.
These buzzwords are hallmarks of Mr. McConnell’s and others’ myth-mongering, just like “death panels” and “socialized medicine.” But it is sheer, irresponsible fallacy. The ACA in fact employs free market principles by establishing a structure of health insurance exchanges, where the uninsured and small businesses can shop for plans as part of purchasing pools to get better prices in a competitive marketplace. They can qualify for subsidies to make it even more affordable. Thus the ACA actually corrects the lack of free market choices that exist in many states right now. But McConnell erringly calls this structural reform a “government program.” While not mentioned in his piece, another reform that addresses the problem of the uninsured is the expansion of Medicaid eligibility, vilified by McConnell and other opponents as costly expansion of government; on the contrary, increased federal support for state Medicaid serves to cut the astronomical costs that the public already pays to provide free care to the uninsured patients. According to the Congressional Budget Office, the nonpartisan scorekeeper, these major elements together will expand access to health insurance to 30 million Americans, a historic feat that has eluded the country for decades.
But Mr. McConnell ignores this achievement. He also fails to give credit to the ACA for doing what he and other opponents repeatedly agreed upon throughout the reform process: ending health insurance industry’s abuses. Among several regulations, the ACA prohibits dropping coverage due to pre-existing conditions, eliminates of annual and lifetime limits, and requires minimum standards for basic health insurance. These were bipartisan, consensus-driven achievements of Congress, a deliberate omission from Mr. McConnell’s talking points.
On Medicare, Mr. McConnell’s statements are the most reprehensible because they create and play on the fears of senior citizens. He writes that the law “takes more than $500 billion from Medicare” and millions “will be forced from Medicare Advantage programs they know and like.” The truth is seniors will continue receiving the same benefits as before. And, while cost control is a favorite topic, he doesn’t mention that the Government Accountability Office found that Medicare Advantage (MA) private insurance plans are over-paid, costing the government 12% more than standard Medicare, even as they cherry-pick healthier Medicare seniors, charge more out-of-pocket from them, and provide no marginal additional benefit. Even so, the ACA would not force MA plans to close if they can save on admin costs, and some can even earn bonus payments if they prove high quality.
The frightening of senior citizens continues: Mr. McConnell attacks the ACA on prescription drugs, citing an AP article that reports the ACA may decrease the number of prescription drug plans available, and bills this as a broken promise to Medicare recipients. But the same article reports that the American Association of Retired Persons supports this change because the current array of prescription plans are “dizzying” in their number (about 1,600), confusing to seniors, and add little in variety. Mr. McConnell claims that the half-trillion dollar savings are not given back to seniors. But taken as a whole, just the opposite is true. Among its provisions, the ACA increases benefits to Medicare recipients because preventive services will now be free. In addition, the “doughnut hole” of Part D drug benefits, which left millions of seniors with high out-of-pocket drug costs, will shrink and eventually be closed by 2020.
Regarding cost control and the financing of the ACA, Mr. McConnell conveniently mixes up the complexity of federal budget accounting with the more simple facts about the ACA’s fiscal impact: the CBO estimates the law will cost under $100 billion per year on average over the next 10 years, and through cost savings, will cut the federal budget deficits by $140 billion in the first 10 years and $1 trillion from 2020 to 2030. These savings are gradual, but they are indeed detailed in the law: a mix of fraud elimination, waste identification, and introduction of payment reform with the creation of an Independent Payment Advisory Board.
Mr. McConnell states that opponents had offered their detailed “common-sense alternative reforms aimed at lowering costs” and yet when the CBO scored one alternative plan, it saved less money than the ACA and did not make a dent in the uninsured. Most striking is that the details Mr. McConnell provides in his piece, “encouraging wellness and prevention”, “more robust competition,” and addressing the needs of small businesses” are all in the ACA. That’s right. Even the study of reforms of medical liability laws is in this law after decades of non-action on this issue.
In publishing this piece at this crucial election time, Mr. McConnell tries to re-energize another old falsehood: that Americans are against the ACA. Now, good health policy should not be about popularity, and opponents have employed populism to attack health reform efforts. But even on this point, more than ever, Mr. McConnell is simply wrong. The Kaiser Family Foundation’s Health Tracking poll in July found that 50% of Americans now have a favorable view of the law, and numbers are getting better. Even last year, when separated into its parts, such as the prohibition of insurance abuses, or small business tax credits to purchase insurance , the health care reform legislation was always much more popular, as high as 70% favorable for these items (subscription required).
The polling discrepancy demonstrates the disappointing effectiveness of Mr. McConnell’s and others’ propagation of falsehoods and fears through constant repetition. But as physicians, we have an obligation to present the facts to our patients and dispel myths, and we will continue to counter the opposition’s scare tactics. Because repeating the truth can be effective, too.
Attending Physician’s addendum:
A new Health Tracking Poll was released yesterday by the Kaiser Family Foundation reporting that support for the Affordable Care Act had slipped between July and August. Among many very interesting details in the study, the poll reflects clearly that the public’s opinion about the bill as a whole is very different compared to their opinion about pieces of the law. For example, when the public is asked “given what you know about the health reform law” as a whole, the opinion is 43% favorable (a 7 point drop from July) and 45% unfavorable (a 10 point increase from July). But, when the pollster names specific elements of the law and asks the polltaker what they feel when they hear it, the favorability rating jump across the board (72% for eliminating pre-existing condition exclusions, 71% for providing tax credits to small businesses, and even 53% for regulating insurance companies’ medical loss ratio).
The rest of the results for the poll are fascinating (especially how the number one source of health reform info is from cable news!), and I encourage you to take a closer look. The bottom line is that the misinformation campaign of opponents like Mr. McConnell, strategically and falsely simplifying the law as a whole, is unfortunately working. Therefore, it is up to us to provide the facts about the specifics of the law and their benefits to ordinary Americans.