Stop Scaring Grandma! Health Care Reform and Medicare

On the heels of the election and John Boehner’s grudging acknowledgement that the Patient Rights and Affordable Healthcare Act (health care reform) is “the law of the land,” Newsmax, purveyor of the highest quality right-wing pseudo-news (they also cure arthritis with spices and collect scrap gold) is trying its best to scare seniors by implying that the ACA will take away their Medicare.

If this were just sore-loser politics along the lines of Fox News (“2016,” anyone?) I would probably just roll my eyes, but this is worse, because Newsmax is aiming their misinformation at seniors, for whom, in most cases, Medicare is their primary (in many cases, only) coverage. This is bad behavior – more so because Newsmax knows that many seniors take the word of people around them, family, neighbors, and so on. Newsmax is counting on those faithful friends to terrify seniors for no purpose — except that it might, in the next election cycle, make a few seniors afraid to vote Democratic.

Many of us have elderly loved one we care about or care for. The ACA is a large and complex bill because it addresses a large and complex subject. Here are a few simple facts, and some resources. I know that we all know people in their mid-sixties who are totally computer-adept, but for aged parents and grandparents, maybe you should be the one to do the reading and start the discussion.

The Donut Hole:

The ACA narrows the “donut hole” that was created when Medicare Part D (Drug) was invented. Many seniors who hit the first spending limit and went into the donut hole in 2010 got a $250 rebate. Beginning in 2014, any senior in the donut hole (Medicare Drug won’t pay for their meds) will be eligible for a 50% discount on their prescription drugs.

Preventive Services:

Many preventive services such as mammograms, immunizations and disease screenings must now be provided at no additional cost to Medicare participants. Medicare participants can also get an annual physical at no cost.

Increased Medicare Drug premiums for higher-income participants:

Some Medicare users who are high-income will have to pay a higher premium for Medicare Drug.

“Medicare Part B Premiums will go to $247/month in 2014!” This is a baseless lie. It was invented during the original passage of the ACA and it has been reincarnated, this time even with a paper-mail or e-mail stationary that looks like it came from Anthem/Blue Cross of Alabama. Antehm/Blue Cross has thoroughly repudiated it. This is a hoax.

Medicare Advantage (Medicare Part C):

Nationally, about 25% of Medicare participants have managed Medicare, called Medicare Advantage. The misinformation about Medicare Advantage from the beginning of the discussion of health care reform has been that it “goes away under Obamacare.” There is certainly no reason to think that. The bill reduces the rates Medicare Advantage programs can charge (they charge about 14% more than Medicare fee-for-service) and requires them to spend 85 cents of every dollar on health care. You raise your eyebrows and say, “Well, what else would they spend it on?” Well, administrative costs, profits, bonuses, and so on.

Programs that meet an evidence-based five-point quality rating system will be awarded bonuses under this system, but programs that do not meet the spending requirement or the health outcomes must provide a corrective action plan to the Department of Health and Human Services, and might be decertified if they don’t improve.

Now, I totally understand that a profit-based organization might chose to end their Medicare Advantage program once they discover they are going to be held accountable for how they use the taxpayers’ money. That is a corporate decision, not a government one. Some, (not all) Advantage programs are non-profit. And frankly, because the programs still make more than fee-for-service, I doubt that very many will shut their doors.

Fraud and Waste:

“Obamacare cuts $716 billion from Medicare!” No, it doesn’t. It does not cut services, and it does not cut payments except as I’ve listed above. The savings come from reducing provider fraud and waste, like the massive multi-state fraud carried out by Columbia/HCA in the early 2000s.

Resources:

If you’re lucky enough to live in California you have a wonderful non-profit organization called Health Insurance Counseling and Advocacy Program (HICAP). HICAP exists completely to assist people, mostly seniors, with questions about Medicare, Medicaid (Medi-Cal in California) and private health insurance. They have a toll-free number, 1(800)434-0222, and a website.

AARP has some good information, but be aware that while they talk like an advocacy group, they are a marketing group too, and they are trying to sell long term care insurance and a Medicare Advantage program. Just keep that in mind. (Their site has an annoying number of pop-up ads.) They do, however, have a nice blog called “Ask Ms. Medicare” that provides good information.

The California Health Care Foundation has six short videos that give a very broad overview of the effects of the ACA, but they are worth watching.

The federal Health and Human Services website has thorough information, especially if you follow the links under 23 Key Features of the Law. They have some FAQs, but would not be very helpful for a specific question. For that, my money is on HICAP.

Don’t let the elders in your life lose sleep because the voices of the sore losers are whispering in their ears. I’d recommend starting the discussion, asking them questions about what they know or understand. If they hear it from the next door neighbor, their grocery checker, or that guy in their water exercise class, you will be in the mode of tearing someone down, and that’s not where we want to be. Get your foot in the door first.