Sen. Barrasso Lies At CPAC About The Health Care Reform Law
At the Conservative Political Action Conference, Sen. John Barrasso (R-WY) spoke for over twenty minutes about the Affordable Care Act, unleashing a flurry of misleading statements and outright lies about the impact and implementation of the health care reform law.
CLAIM: Health Care Law Cut $500 Billion From Medicare
Sen. John Barrasso:
And when I say the Obamacare and the Obamacare health care law, everybody knows the one we are talking about. ... You remember this is the one that cut 500 billion dollars from our seniors on Medicare, not to save Medicare, not to extend the life of Medicare, but to start a whole new government program for someone else.
FACT: The Supposed Cuts In The Affordable Care Act Are Actually Savings From Phasing Out Medicare Advantage
FactCheck.org: Cost Saving Provisions "Not A Slashing Of The Current Medicare Budget Or Benefits." According to FactCheck.org: "Whatever you want to call them, it's a $500 billion reduction in the growth of future spending over 10 years, not a slashing of the current Medicare budget or benefits. It's true that those who get their coverage through Medicare Advantage's private plans (about 22 percent of Medicare enrollees) would see fewer add-on benefits; the bill aims to reduce the heftier payments made by the government to Medicare Advantage plans, compared with regular fee-for-service Medicare. The Democrats' bill also boosts certain benefits: It makes preventive care free and closes the 'doughnut hole,' a current gap in prescription drug coverage for seniors." [FactCheck.org, 3/19/10]
Changes To Medicare Advantage Come With Extra Benefits For All Medicare Enrollees. FactCheck.org reported: "The CBO has estimated that the move would change the value of the extra benefits Medicare Advantage participants get, but they would not receive fewer benefits than the rest of seniors who aren't on the Advantage plans. The bill does add some extras for Medicare beneficiaries, eliminating copays and deductibles for preventive services, for example." [FactCheck.org, 12/2/09; emphasis added]
Health Care Reform "Will Keep Paying Medical Bills For Seniors." According to PolitiFact.com: "The government-run Medicare program will keep paying medical bills for seniors, but it will begin implementing cost controls on health care providers, mostly through penalties and incentives. The legislation would reduce payments for hospital-acquired infections or preventable hospital admissions. For Medicare Advantage, the federal government intends to reduce extra payments, taking away subsidies to private insurance companies. Insurers will likely cut benefits in order to not lose profits. The bill does not address the 'doctor's fix,' an expected proposal that Congress usually passes to prevent doctors' Medicare payments from severe cuts." [PolitiFact.com, 3/18/10; emphasis in original]
New England Journal Of Medicine: The Affordable Care Act Phases Out "Substantial Overpayments" To Medicare Advantage Plans. From the New England Journal of Medicine:
A phased elimination of the substantial overpayments to Medicare Advantage plans, which now enroll nearly 25% of Medicare beneficiaries, will produce an estimated $132 billion in savings over 10 years.
The ACA also produces nearly $200 billion in savings by assuming that providers can improve their productivity as firms in other industries have done. On the basis of this presumed improvement, the law reduces Medicare's annual "market basket" updates for most types of providers - a provision that has generated controversy. [New England Journal of Medicine, 7/8/10]
Changes Would Only Affect Medicare Advantage Plans. As reported by Kaiser Health News:
The new health law will cut $136 billion in spending on the Advantage program by 2019, which currently pays private plans to administer Medicare benefits and pays them about 14 percent more than the per-patient cost of the traditional Medicare program. Plans use that subsidy to lure members with lower premium costs or extra benefits not normally paid for by Medicare, such as vision care or better prescription drug coverage. Some Democrats and analysts have argued the higher rates are wasteful.
Even experts who support the change concede that the impact of the cuts could be evident. Robert Berenson, a scholar at the Urban Institute and former Medicare official, said some Advantage plan members will notice skimpier benefits, "but the Republicans have really exaggerated that this will wipe out the Advantage plans."
Marsha Gold, a health policy analyst for the private research group Mathematica, said, "Over time, there will be less rich benefits or higher premiums, but it's going to be gradual," noting that the largest cuts do not begin until 2015.
[Kaiser Health News, 4/6/10]
Medicare Advantage Costs Taxpayers 14% More Than Traditional Medicare. As reported by PolitiFact.com:
Let's back-up for a minute and explain Medicare Advantage: There are two basic ways most people get Medicare coverage. They enroll in traditional Medicare and a prescription drug plan through the government and maybe buy a supplemental policy to cover most out-of-pocket costs. Or they enroll in Medicare Advantage programs (they include drug plans), which are run by private insurers. Medicare Advantage programs typically have more generous benefits such as dental and vision coverage. Some plans even pay the patient's monthly Medicare premium, which can amount to about $100.
The Medicare Advantage program was intended to bring more efficiency from the private sector to the Medicare program, but it hasn't worked as planned. A June 2009 analysis from the Medicare Payment Advisory Commission said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Barack Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use.
CLAIM: Health Care Reform Was Forced On Americans
Sen. John Barrasso:
And this is the program that was crammed down the throats of the American people as the American people were shouting no. That is the health care law that we are going to repeal.
FACT: Americans Do Not Support Repeal Of Health Care Reform
NYT/CBS: Internal Polls Show Less Than One Percent Want To Repeal Key Items Of Affordable Care Act. According to the Washington Post's Greg Sargent:
The NYT/CBS poll then asked the pro-repeal camp whether they want to "repeal all of the health care law, or only certain parts of it." Suddenly the number who favor full repeal drops to 20 percent - one-fifth - while 18 percent peel off and say they want to repeal "certain parts."
It gets even better. The poll then asked people who support repeal an open-ended question: Which parts of the law do you want done away with? The number who said "everything" drops again, this time to eight percent. Eleven percent want the individual mandate repealed. But guess what? The number who called for repeal of other key individual items in the bill - the pre-existing conditions piece; the coverage for people up to age 26; and so on - was consistently one percent or less for each of them. [WashingtonPost.com, 1/21/11]
McClatchy-Marist: Only Three In Ten "Want The Law Completely Repealed." According to a McClatchy-Marist poll released on January 14, 2011: "Republicans in the U.S. House of Representatives are expected to take action to repeal the 2010 Health Care Law, but are voters satisfied with the law? Just 14% of registered voters want the law to exist in its current form. 35% want it changed so that it does more, and 13% would like it altered so that it does less. Three in ten - 30% - want the law completely repealed. Nine percent are unsure." [Marist College Institute for Public Opinion, 1/14/11]
Many Want Reform To Go Farther Than It Did...
CNN: Only 37 Percent Of Americans Agree With GOP That Health Care Reform Is "Too Liberal." A CNN poll conducted from December 17-19, 2010, found that 43 percent of Americans favor the health care law and 13 percent oppose it because it's "not liberal enough," while only 37 percent oppose it because they believe it is "too liberal." [CNN, 12/27/10]
CLAIM: Under The Affordable Care Act Individuals Have No Choice But To Purchase Health Insurance
Sen. John Barrasso:
In this fight in the courts, what is so offensive? Well, it is an individual mandate, a mandate that says you must buy government approved insurance. Have to do it. No choice. You have to do it.
FACT: Individuals Can Choose Not To Purchase Health Insurance If They Pay A Fine
The Affordable Care Act Allows Individuals To Opt Out Of Purchasing Health Insurance By Paying A Fine. From the Christian Science Monitor:
The healthcare reform bill would mandate that most US citizens and legal residents purchase "minimal essential coverage" for themselves and their dependents. They can get this either through their employer, or, if their employer doesn't offer health insurance, they can buy it through new marketplaces that will sell policies to individuals.
If you ignore this mandate and don't get health insurance, you'll have to pay a tax penalty to the federal government, beginning in 2014. This fine starts fairly small, but by the time it is fully phased in, in 2016, it is substantial.
An insurance-less person would have to pony up whichever is greater: $695 for each uninsured family member, up to a maximum of $2,085; or 2.5 percent of household income.
There are exceptions. Certain people with religious objections would not have to get health insurance. Nor would American Indians, illegal immigrants, or people in prison.
[Christian Science Monitor, 3/19/10, emphasis added]
The Government Offers Subsidies To Help Lower Income Americans Purchase Insurance. From the Christian Science Monitor:
The formula is pretty complicated. Basically, though, people who make three or four times the poverty level would get enough federal money so that they would not have to pay more than about 10 percent of their income for a decent health insurance package.
People who make less would have to pay a smaller slice of their income for coverage. For instance, individuals who make about $14,000, and four-person families with incomes of about $29,000, would not have to pay more than 3 to 4 percent of their incomes for insurance.
And those who make even less - under 133 percent of the federal poverty level - would be able to enroll in a newly expanded Medicaid program.
The federal subsidy would go straight to the insurer. It would look like a discount on the policy to the customer.
[Christian Science Monitor, 3/20/10]
CLAIM: IRS Agents Will Investigate Whether Individuals Purchase Health Insurance
Sen. John Barrasso:
Well, as a doctor I am disturbed the law will require more IRS agents to investigate all of us to make sure we actually buy insurance.
FACT: The IRS Will Not Be Auditing Individuals And Their Health Coverage
The IRS's Main Job Will Be To Inform Small Business Owners Of The New Tax Credit, Not To Investigate Individuals. From FactCheck.org:
The IRS' main job under the new law isn't to enforce penalties. Its first task is to inform many small-business owners of a new tax credit that the new law grants them - starting this year - which will pay up to 35 percent of the employer's contribution toward their workers' health insurance. And in 2014 the IRS will also be administering additional subsidies - in the form of refundable tax credits - to help millions of low- and middle-income individuals buy health insurance.
The law does make individuals subject to a tax, starting in 2014, if they fail to obtain health insurance coverage. But IRS Commissioner Douglas Shulman testified before a hearing of the House Ways and Means Committee March 25 that the IRS won't be auditing individuals to certify that they have obtained health insurance. He said insurance companies will issue forms certifying that individuals have coverage that meets the federal mandate, similar to a form that lenders use to verify the amount of interest someone has paid on their home mortgage. "We expect to get a simple form, that we won't look behind, that says this person has acceptable health coverage," Shulman said. "So there's not going to be any discussions about health coverage with an IRS employee." In any case, the bill signed into law (on page 131) specifically prohibits the IRS from using the liens and levies commonly used to collect money owed by delinquent taxpayers, and rules out any criminal penalties for individuals who refuse to pay the tax or those who don't obtain coverage. That doesn't leave a lot for IRS enforcers to do.
[FactCheck.org, 3/30/10, emphasis added]
CLAIM: The Affordable Care Act Does Nothing To Address The Shortage Of Doctors And Nurses
Sen. John Barrasso:
But it fails to deal with the shortage of doctors and nurses in the country to help take care of us. There is going to be a shortage within the next ten years of about 90,000 doctors, a much higher number of nurses, and it's not just family doctors. Family doctors, its surgeons, all across the board.
FACT: The Affordable Care Act Provides Funding For Incentives And Training For Doctors And Nurses
The Affordable Care Act Provides $250 Million In Investments "To Increase The Number Of Health Care Providers." From a Health and Human Services release:
U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced a series of new investments worth $250 million to increase the number of health care providers and strengthen the primary care workforce.[...]
The investments announced today in the primary care workforce are the first allocation from the new $500 million Prevention and Public Health fund for fiscal year 2010, created by the Affordable Care Act. Half of this fund - $250 million - will be used to boost the supply of primary care providers in this country by providing new resources for:
- Creating additional primary care residency slots: $168 million for training more than 500 new primary care physicians by 2015;
- Supporting physician assistant training in primary care: $32 million for supporting the development of more than 600 new physician assistants, who practice medicine as members of a team with their supervising physician, and can be trained in a shorter period of time compared to physicians;
- Encouraging students to pursue full-time nursing careers: $30 million for encouraging over 600 nursing students to attend school full-time so that they have better odds of completing their education;
- Establishing new nurse practitioner-led clinics: $15 million for the operation of 10 nurse-managed health clinics which assist in the training of nurse practitioners. These clinics are staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.
- Encouraging states to plan for and address health professional workforce needs: $5 million for states to plan and implement innovative strategies to expand their primary care workforce by 10 to 25 percent over ten years to meet increased demand for primary care services.
[HHS.gov, 6/16/10, emphasis original]
CLAIM: States Have No Flexibility Or Choice Under The Affordable Care Act
Sen. John Barrasso:
The one I just introduced along with Lindsey Graham, the State Health Care Choice Act, State Health Care Choice Act. Let states decide. Let states decide. After all, isn't that what the tenth amendment was all about in the first place? One size does not fit all, never has. So under this States Health Care Choice Act states can opt out of the different major provisions of the health care law. The Medicaid mandate which is going to bankrupt the states, the individual mandate mandating individuals have to buy insurance that this government approved. Allowing them to opt out of the employer mandate and allowing them to opt out of the benefits mandate. Because what states ask for, and 33 governors wrote to the president recently, what all of our states want is flexibility, freedom, and choice.
FACT: States Already Have Flexibility On How To Implement The Affordable Care Act
Sebelius: The Health Care "Law Already Gives States Most Of The Resources And Flexibility They're Asking For." Health and Human Services Secretary Kathleen Sebelius wrote in the Washington Post:
The Affordable Care Act puts states in the driver's seat because they often understand their health needs better than anyone else - and that is why it is so frustrating to hear opponents of reform falsely attack the law as "nationalized health care."
The truth is that states aren't just participating in implementation of the law; they're leading it. [...]
Although the law gives states the option to design and run their own exchanges, some critics have claimed this could burden states if they're not given adequate resources and flexibility.
I agree. But what these critics miss is that the law already gives states most of the resources and flexibility they're asking for.
States have discretion, for example, to offer a wide variety of plans through their exchanges, including those that feature health savings accounts. Utah and Massachusetts already operate exchanges but take very different approaches: Utah allows all insurers to participate; Massachusetts has stricter standards. Under the law, both approaches could work.
States also have the flexibility to decide what benefits plans must offer. They can choose to require basic protections, based on the typical benefits people get through their jobs, or set higher standards.
And states' costs of designing their exchanges will be fully funded by the federal government through 2015, with additional funds available to help determine which residents are eligible. [...]
The law gives states new flexibility in Medicaid, too. Beginning in 2014, states will be able to offer more affordable Medicaid benefits that resemble typical employer plans. Because costs of long-term care are driving the growth in Medicaid budgets, there are new options and federal support to help states bring down these expenses, such as through cost-effective care models like health homes.
[Washington Post, 2/10/11]
CLAIM: HHS Waivers Are Designed To Protect Politically Connected Unions
Sen. John Barrasso:
And then you're going to hear from Kathleen Sebelius. You remember her, she's the waiver-granting Secretary of Health and Human Services giving waivers to friends in high places. Last week the Department of Health and Human Services granted more than 500 new wavers. They now have 729 Washington waivers from Obamacare. 2.2 million people don't have to live under the law that everyone else needs to live under. And you know who got a lot of the waivers? Union members. Union members who actually supported, lobbied and contributed to work to get this law passed. That is prob &msash; why don't they have to live under the law? They love it, they wanted it, but now here we are. They're the ones with waivers. Union workers are 7 percent of the private employees, yet they got 40 percent of the waivers. If Kathleen Sebelius can give waivers to 2.2 million people who have friends in high places, I think everybody in America ought to be given a waiver against this health care law.
FACT: Many Businesses, Including Those Who Did Not Support The Affordable Care Act, Received Waivers
There Are Many Small Businesses On The Waiver List. According to HHS.gov, the businesses on the waiver list include A. Duda & Sons, Inc., which has 62 employee waivers, and The Wilks Group, Inc., which has 8 employee waivers, among a number of other businesses with fewer than 100 enrollees. [HHS.gov, 12/03/10]
- A. Duda & Sons Has Ties To The Republican Party . A. Duda & Sons, Inc.'s, Senior Vice President of Real Estate and General Counsel, Tracy Duda Chapman, is on the transition team of Adam Putnam, a former chairman of the House Republican Conference now serving as Florida's agriculture commissioner. [Duda.com, accessed 1/19/10; SunshineStateNews.com, 11/5/10; AdamPutnam.com, accessed 1/21/11]
Members Of The National Restaurant Association Received Waivers. More than one National Restaurant Association member has signed up for the waiver program, including Waffle House Corp. and Carlson Restaurants. [National Restaurant Association, accessed 1/21/11; HHS.gov, 12/03/10]
- National Restaurant Association Opposed Health Care Reform. According to a March 19, 2010, National Restaurant Association press release: "The National Restaurant Association today issued a statement declaring its opposition to the latest version of health care legislation based on a unanimous vote of members of the Executive Committee of its Board of Directors." [National Restaurant Association, 3/19/10]
For more on Republican distortions of the waiver program click HERE.
CLAIM: Budget Gimmicks Were Used To Cover Up That The Affordable Care Act Adds To The Deficit
Sen. John Barrasso:
It's up to all of us to continue to remind people of the broken promises. I still remember the one, health care reform, he said, "won't add a dime." "Won't add a dime," he said, to the deficit. They used every trick, a budget gimmick, double counting, six years of services for ten years of taxes. People absolutely get it. Americans fundamentally understand that you can't subsidize coverage for tens of millions of people and simultaneously reduce the deficit.
FACT: The Affordable Care Act Reduces The Deficit And Does Not Use Budget Gimmicks To Do So
CBO: Health Care Reform Repeal Would Increase The Deficit By $230 Billion. In a letter to Speaker John Boehner (R-OH), CBO Director Doug Elmendorf writes:
Because CBO and JCT estimated that the March 2010 health care legislation would reduce budget deficits over the 2010-2019 period and in subsequent years, we expect that repealing that legislation would increase budget deficits. The resulting increase in deficits projected for fiscal years 2012 through 2019 is likely to be similar in size to-but not exactly the same as-the reduction in deficits that was originally estimated to result from the enacted legislation.
As a result of changes in direct spending and revenues, CBO expects that enacting H.R. 2 would probably increase federal budget deficits over the 2012-2019 period by a total of roughly $145 billion (on the basis of the original estimate), plus or minus the effects of technical and economic changes that CBO and JCT will include in the forthcoming estimate. Adding two more years (through 2021) brings the projected increase in deficits to something in the vicinity of $230 billion, plus or minus the effects of technical and economic changes. [CBO, 1/6/11, emphasis added]
CBO: Health Care Reform Package Would Reduce The Deficit By $138 Billion By 2019. According to the Congressional Budget Office: "The reconciliation proposal includes provisions related to health care and revenues, many of which would amend H.R. 3590. It also includes amendments to the Higher Education Act of 1965, which authorizes most federal programs involving postsecondary education. CBO and JCT estimate that enacting both pieces of legislation - H.R. 3590 and the reconciliation proposal - would produce a net reduction in federal deficits of $138 billion over the 2010-2019 period as result of changes in direct spending and revenue." [CBO, 3/18/10]
CBO Director: We Count Savings To Medicare Trust Fund "Only Once." In a 2009 blog post, CBO Director Doug Elmendorf wrote: "The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund. Unified budget accounting shows that the majority of the HI trust fund savings would be used to pay for other spending under the PPACA and would not enhance the ability of the government to redeem the bonds credited to the trust fund to pay for future Medicare benefits. To describe the full amount of HI trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government's fiscal position." [CBO, 12/23/09]
CBPP: Even If You Didn't Count Social Security And CLASS Act Revenues At All, The Bill Reduces The Deficit. According to the Center on Budget and Policy Priorities:
CBO and the Joint Committee on Taxation have concluded that the health reform legislation will reduce employer spending on health insurance, in part because the new excise tax on high-cost insurance plans will lead employers to shift some employee compensation from health insurance to cash wages. Workers will pay Social Security payroll contributions and income taxes on the additional wages.
The legislation also establishes a new, voluntary program of long-term care insurance, called the CLASS Act. Benefit payments from CLASS will be fully financed by premiums that beneficiaries pay and interest earnings. In its early years, as the program starts up, premium collections will substantially exceed benefit payments.
Congressional leaders crafted the health reform bill so that it would be fully paid for without relying on these additional Social Security payroll contributions or the CLASS Act premiums. The CBO estimate clearly shows that if one excludes the net revenues of $29 billion from Social Security contributions and $70 billion from CLASS Act premiums, health reform still reduces the deficit by $44 billion over the first ten years. [CBPP.org, 3/25/10, emphasis added]
CLAIM: The Affordable Care Act Is Bad For Patients And Providers
Sen. John Barrasso:
People get the fact that this law is bad for patients, it's bad for providers, the nurses and doctors to take care of patients, and it is bad for taxpayers.
FACT: The Health Care Reform Law Benefits Patients And Providers
Health Care Reform Benefits Patients
Health Care Reform Prevents Insurance Companies From Rescinding Coverage Over Unintentional Errors. According to the Congressional Research Service, "Effective for plan years beginning on or after six months after enactment, the law generally prohibits rescissions for a group health plan, a grandfathered plan, and a health insurance issuer offering group or individual health insurance coverage. Rescissions will still be permitted in cases where the covered individual committed fraud or made an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage." [Congressional Research Service, 4/15/10, internal citation deleted for clarity]
- Prior To Health Care Reform, Rescission Was Allowed In 43 States. According to the Kaiser Family Foundation, prior to the passage of the health care reform law, 43 U.S. states and the District of Columbia allowed insurance companies to revoke an enrollee's coverage during a "contestability period ... if any, even unintentional, material misstatement or omission is discovered." [Kaiser Family Foundation, accessed 9/21/10]
Health Care Reform Provides Access To Insurance For Americans With Pre-Existing Conditions. According to the Kaiser Family Foundation, the health care reform law "[c]reates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. The plan will be operated by the states or the federal government." [Kaiser Family Foundation, accessed 9/21/10]
Health Care Reform Restricts Insurance Policies' Annual And Lifetime Limits. According to the AARP:
Q. Does the new health care reform law eliminate annual and lifetime limits on health care coverage in insurance policies?
Yes. On Sept. 23, lifetime limits are effectively banned for all plans that begin or are renewed after that date. Insurance companies can no longer cut off policy holders when their medical expenses reach a lifetime limit. Annual limits on coverage will be phased out over the next few years, beginning this year...
The law phases out these annual limits over a period of three years: in the first year, insurers must cover medical expenses up to at least $750,000. That coverage rises to $1.45 million after Sept. 23, 2011 and increases to $2 million after Sept. 23, 2012. Limits will be completely banned starting Jan. 1, 2014. [AARP.org, 8/23/10, emphasis original]
Health Care Reform Gives Americans The Right To Appeal When Insurance Companies Refuse To Pay. According to Commerce Clearing House, the health care reform law requires insurance companies to "implement an effective process for appeals of coverage determinations and claims. This appeals process must include, at a minimum, the following: an established internal claims appeal process; a notice to participants...of available internal and external appeals processes, including the availability of assistance with the appeals processes; and a provision allowing an enrollee to review his or her file, to present evidence and testimony as part of the appeals process, and to receive continued coverage during the appeals process." [Commerce Clearing House, 6/8/10]
Health Care Reform Requires Insurers To Provide Free Preventive Care Services. The new health care reform law "[r]equires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles." By 2018, all private health insurance plans must provide preventive services. [CBS News, 3/21/10]
Health Care Reform Reduces Premiums For Most Americans. According to PolitiFact.com: "The CBO reported that, for most people, premiums would stay about the same, or slightly decrease. This was especially true for people who get their insurance through work. (Health policy wonks call these the large group and small group markets.) People who have to go out and buy insurance on their own (the individual market) would see rates increase by 10 to 13 percent. But more than half of those people - 57 percent, in fact - would be eligible for subsidies to help them pay for the insurance. People who get subsidies would see their premiums drop by more than half, according to the CBO. So most people would see their premiums stay the same or potentially drop." [PolitiFact.com, 1/27/10, emphasis added]
Health Care Reform Insures 34 Million New People With 1% Health Care Spending Increase. According to the Washington Post's Ezra Klein: "First, be clear about what's being estimated. The Congressional Budget Office's estimates look at the deficit. CMS is looking at total national health expenditures. This often confuses people into thinking that there's conflict between the two sets of numbers when there isn't: CBO says that federal spending is going to go up to pay for the coverage expansion, but that savings and revenue will go up by even more, leading to a net reduction in the federal deficit. CMS is looking only at the spending side. And here's what it finds: In 2019, implementation of the Affordable Care Act will reduce the ranks of the uninsured by 34 million people and increase nation health expenditures by 1 percent. One percent... So that's the bottom line of the report: We're covering 34 million people and come 2019, spending is expected to be one percentage point - and falling - above what it would've been if we'd done nothing." [Washington Post, 4/23/10, emphasis added]
Health Care Reform Fills The "Doughnut Hole." According to the Kaiser Family Foundation: "In 2010, Part D enrollees with any spending in the coverage gap will receive a $250 rebate. Beginning in 2011, enrollees with spending in the coverage gap will receive a 50 percent discount on brand-name drugs, provided by the pharmaceutical industry. The law phases in Medicare coverage in the gap for generic drugs beginning in 2011, and for brand-name drugs beginning in 2013. By 2020, Part D enrollees will be responsible for 25 percent of the cost of both brands and generics in the gap, down from 100 percent in 2010." [Kaiser Family Foundation, accessed 8/25/10]
Health Care Reform Benefits Providers, Too
Health Care Reform Funds Scholarships And Loan Repayments For Doctors And Nurses In Underserved Areas. The Kaiser Family Foundation reports that the health care reform law "[p]ermanently authorizes the federally qualified health centers and NHSC [National Health Service Corps] programs and increases funding for FQHCs and for the NHSC for fiscal years 2010-2015." [Kaiser Family Foundation, accessed 9/21/10, emphasis added]
- The NHSC Is A Scholarship And Loan Repayment Program For Providers In Underserved Areas. According to the Congressional Research Service, "The National Health Service Corps (NHSC) program ... provides scholarships and student loan repayments for medical students, nurse practitioners, physician assistants, and others who agree to a period of service as a primary care provider in full-time clinical practice in a federally designated Health Professional Shortage Area (HPSA)." [Congressional Research Service, 3/1/10]
Health Care Reform Funds Mid-Career Training For Health Professionals. According to a report by the University of Iowa's Rural Policy Research Institute, "Grants will be awarded to entities to award scholarships to mid-career public health and allied health professionals for additional training.... Scholarships may create opportunities for mid-career training among rural public and allied health professionals who otherwise may not have had such opportunities because of the cost of programs and displacement." [Rural Policy Research Institute, June 2010]
Health Care Reform Increases Pay For Some Primary Care Providers In Underserved Areas. According to a report by the University of Iowa's Rural Policy Research Institute, "An additional 10% payment will be made to qualifying primary care providers for cognitive care services as defined by specific codes, and for surgical procedures furnished by general surgeons in health professional shortage areas. Primary care providers include physicians, nurse practitioners, clinical nurse specialists, or physician assistants for whom primary care services are at least 60% of allowed charges." [Rural Policy Research Institute, June 2010]
Health Care Reform Ensures Higher Medicaid Payments For Rural Doctors. According to a report by the University of Iowa's Rural Policy Research Institute, "Primary care physicians will be paid Medicare rates when treating persons this legislation makes newly eligible for Medicaid. This provision will apply to 2013 and 2014, with a federal match of 100% of the cost.... This will provide higher marginal payment for rural primary care physicians than would be true if Medicaid rates were used." [Rural Policy Research Institute, June 2010]
Health Care Reform Allows Physicians To Keep Some Money Saved By Providing Cost-Effective Treatment. According to a report by the University of Iowa's Rural Policy Research Institute, the health care reform bill sets up "groups of providers such as hospitals and physicians, operating under a shared governance arrangement, accountable for the patients assigned to them, and eligible to share in savings to the Medicare program that result from more cost-effective treatment." [Rural Policy Research Institute, June 2010]