Medical Maze

Top Five Questions About Health Care Reform—Answered

Jimmy Magahern | Oct 3, 2012, 9:47 a.m.

“Because people will be doing a better job of controlling their chronic conditions, their need to go to a more expensive form of health care should be reduced,” says Plese.

As for limiting your choice of doctors, it’s true that expanding health care to 32 million more people will require a corresponding expansion of the medical workforce, which is already understaffed. But the act will provide federal funding for training medical residences and other health professionals, which has been applauded by both the AMA and the Association of American Medical Colleges as an incentive to draw more young people into the medical field. Plus, the shift to a more wellness-oriented program will create more jobs for nurse practitioners and physician assistants, to help patients stay healthy while avoiding more costly doctor’s visits.

3 What will happen to Medicare?

Probably the scariest rhetoric for seniors has been the ongoing debate about how the ACA will affect Medicare. The figure Paul Ryan used during his convention speech in claiming Obamacare will “raid Medicare of $716 billion” was actually pulled from a report by the Congressional Budget Office, the nonpartisan federal agency tasked with providing economic data to Congress, which estimated that the changes to Medicare under the ACA will reduce spending by a total of $716 billion between 2013 and 2022, largely by streamlining the system to eliminate duplications in service, catching fraudulent overpayments to insurance companies and (beginning in 2018) taxing high-premium plans.

That projected savings will go toward improvements in the Medicare system itself, says Banner’s Bill Harris. “It will narrow the prescription drug ‘doughnut hole’—the amount of out-of-pocket money seniors have exposure to after exceeding a certain dollar limit each year,” he says. Plus, there will be more preventive care for seniors. “Before, Medicare never paid for wellness checks,” Harris says. “It always paid for disease management and sickness care. But beginning this year, Medicare began offering wellness checks. That’s never happened before.”

Contrary to the political sound bites, the ACA actually prohibits cuts to guaranteed Medicare benefits and does not eliminate the more expensive Medicare Advantage plans; it merely reins in the costs, and provides higher reimbursements to the plans that perform better. “We don’t expect benefits to change,” says Harris.

Furthermore, the individual mandate doesn’t require Medicare beneficiaries to purchase additional coverage on top of what they already have. “If you already have Medicare, you won’t necessarily see a lot of changes, at least not any time soon.”

4 How will the plan affect Medicaid?

What may change is whether or not states commit to the expansion of Medicaid, the federal health care plan designed to assist low-income families. The Supreme Court shot down the ACA’s provision that states would be required to expand their Medicaid coverage to individuals and families with incomes up to 133 percent of the federal poverty level (currently $18,310 a year for a family of three) or forfeit their previously apportioned Medicaid funding, ruling instead that individual states could either opt in or set up their own state health insurance “exchange.”

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