Broken Promises in the 2010 Affordable Care Act

Wednesday, March 21, 2012

 

In 1994, the health care reform bill proposed by then President Clinton failed, in large part, because it would fundamentally changed health care coverage for nearly every American.  In 2009, President Obama decided he would combat the failure of the Clinton Administration by repeating over and over again to the American public "if you like what you have, you can keep it."

 

It is my understanding he said that on 47 separate occasions while the bill was being debated in Congress.  And while it may have been political useful to make that promise to the American people, it remains a promise he can't keep.  The fact is that millions of Americans are seeing changes in their existing health plan due to the health law.

 

The Administration's regulations governing so called "grandfathered health plans" will force most firms?and up to 80 percent of small businesses?to give up their current plan by next year.  When those businesses lose their 'grandfathered' status, they immediately become subject to costly new mandates and the increased premiums that follow.

 

Families in 17 states no longer have access to 'child-only' plans as a result of the health law.  It's not known how many of the families that lost coverage for their children because of the law have been able to find an affordable replacement.  In Medicare Advantage, there is one study showing Medicare Advantage enrollment will be cut in half, choices available to seniors will be reduced by two-thirds.

 

Then there is the open question about Americans who receive their health care through large employers.  The Congressional Budget Office recently released a report with that constructed a scenario where as many as 20 million Americans could lose their employers coverage.  And while I acknowledge the Congressional Budget Office report provided the number I just mentioned as only one plausible scenario, there are many of us who believe it is very plausible given the incentives the health law creates for large businesses.

 

***

 

The President made a further promise that I think we should talk about.  On July 29, 2009, during the consideration of the health law, the President said "Medicare is a government program.  But don't worry: I'm not going to touch it."

 

So let's take a look at the health care law and see if that promise was kept.  The health care law made significant cuts in the Medicare program.  On April 22, 2010, the Chief Actuary for Medicare analyzed the law and found that it would cut Medicare by $575 billion over ten years.  The President said about Medicare "I'm not going to touch it."  The bill cuts $575 billion from Medicare.  The Congressional Budget Office wrote that over $500 billion in Medicare reductions "would not enhance the ability of the government to pay for future Medicare benefits."  The President said about Medicare "I'm not going to touch it."

 

The CMS actuary had this to say about the Medicare spending reductions:  "Providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program."  The President said about Medicare "I'm not going to touch it."

 

The CMS actuary said, in essence, these cuts could drive providers from the Medicare program.  I have a hard time understanding how these massive cuts to Medicare count as not touching the program.  On the other hand, the biggest problem facing Medicare in the near term is the physician payment update problem that we constantly have to address here in Congress.  Of course, the health care law did nothing to address that problem.  Perhaps that's what the President meant when he said about Medicare, "I'm not going to touch it."

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