Medicare visions: A skunk in the GOP's woodpile

“Did you hear that Obamacare is taking away billions from Medicare?” my husband exclaimed, with a tinge of  panic in his voice.

“Where have you been? I have heard that one repeated every year since Obamacare was proposed”, I, the family consumer advocate,  retorted. “Look, I said, we both are one of 28% on Medicare Advantage   that combines Medicare and Medigap.   But most likely we will see no change, Medicare Advantage will continue. At least that is what a survey made by the Kaiser Family Foundation (KFF) found. Regardless, our Medicare benefits will not change, either.”

“ Won’t our Medicare Advantage premiums go up?”  he countered.

“  I am not sure because as KFF reported, there are many elements that go into determining costs.They only went up a tiny bit this year, like in past years..  What I am sure of is that the Medicare Advantage insurance providers had been raking in more from the government  than it cost for government  to administer Medicare . Those excessive subsidies were cut . Even Rep. Paul Ryan, the GOP House guru on budgets, kept cuts to Medicare Advantage in his  2012 planning. Besides, did you notice you had lower co-pays  for your prescriptions, and no copays for  checkups and cancer screenings? That was one of the Obamacare  benefits to seniors, closing the donut hole,  and repeal would put us back to where we were before.

“  Medicare patients were getting charged for   repeat tests and unnecessary readmissions .  Now hospitals have to share test records electronically and since 2012 they  had to pay penalties for excessive readmissions.  Readmission rates have taken a dive.   That  cuts costs to Medicare.

“In fact,  Congress’ own independent  Congressional Budget Office predicted  all of these measures will add a decade of life to Medicare. Those who want to repeal Obamacare  will just be making the time sooner  when we must do something to prop Medicare up.

Hubby: “So what happens when Medicare goes broke…shouldn’t we make some changes now? What about privatizing Medicare and making people pay more for premiums, giving them money to go buy their own insurance, and cut out government administration?

“ There’s a skunk in that woodpile”, I answered.  “Ryan’s  newest plan (passed by the House this April); DOA in the Senate) would have given seniors of a choice between keeping Medicare and vouchers (premium support) and not guarantee any of that would keep up with inflating medical costs, increase the retirement age, and the wealthy would not qualify for benefits.  We know from Obamacare, even private insurance had sticker shock. Health insurance companies  are allowed  by law to collude to set prices and benefits, making free market competition  no guarantee of lower prices. Ryan claims savings (meaning cuts) to Medicare would be $129 billion over 10 years.

“Privatizing Medicare is  not the only way to go. Simpson Bowles deficit reduction  Commission proposed keeping Obamacare and  government provided Medicare that would keep up with costs. Like Ryan’s, though, they would increase the retirement age and not provide benefits to the wealthy.

“ Don’t worry, though, no politician would ever make changes affecting those already having Medicare or near retirement age; they want your vote”.

Sources tapped for the comments above:

http://kff.org/medicare/issue-brief/medicare-advantage-2014-spotlight-plan-availability-and-premiums/  

Washington Post, February 27,2013, “Health law’s rules help hospitals cut patient readmission rate”

http://www.thedailybeast.com/articles/2014/04/08

Shameless and deceptive anti Obamacare ads flood Colorado

Indeed, an anti Senator Mark Udall ad  running in our market says  Obamacare ( ACA) is “about people”, but the” people” referenced in the ad  are  not  about the   7.1 million who signed up for private insurance through federal and state ACA exchanges  ,  or in Colorado 277,149,  who signed up  as of  March 31 for either commercial health insurance or Medicaid’s expanded version. The anti Udall ad shamelessly exaggerates  the numbers as "millions and millions"    who  could  not sign up after their insurance policies were cancelled .  The GOP mantra,”repeal Obamacare” ,  means that coverage  would be taken away from those “people” for whom it worked to get covered, especially  nasty for the 9 .3 who never had  health insurance before.
..
A Rand Corporation's study reported in the LA Times, March 30, 2014 (Obamacare has led to health coverage for millions more people), found that  4.5 million previously uninsured adults signed up for state Medicaid programs which were expanded to include more by the ACA, 3 million young adults took advantage of the ACA provisions allowing them to stay on their parents' insurance.. 9.5 million who got insurance thanks to ACA provisions were previously uninsured.

The ACA made it possible for at least 15 million to get insurance. if one adds the 7.1 million plus who bought insurance through the state and federal exchanges,  exchanges, the 4.5 million who got Medicaid  thanks to its expansion, and the 3 million young adults who now could stay on their parents' plans,   15 million is a number in the ball park.

Ads have already begun in Colorado, tying Udall to Obamacare (ACA), attempting to bring attention to the fewer who drew the short stick instead of the far more who benefitted.    One, against Obamacare, sponsored by the Koch Brothers, was very deceptive,.  That one featured an angry woman who lost her individual insurance and was suffering, though that she could find alternatives was never even suggested.

 The “about people ad” is a good example of hyping the ACA shortcomings, claiming   “millions and millions” lost their insurance and could not get a replacement. The Washington Post fact checker hit that one hard. (http://www.washingtonpost.com/blogs/fact-checker/wp/2014/03/25/new-anti-obamacare-ad-makes-misleading-claims-video) Per a recent survey by the Rand Corporation,  fewer than a million people who had health plans in 2013 cancelled  are not uninsured  now.  the Rand survey reported in the same LA Times article above.  "We are talking about a very small fraction of the country" who lost coverage, said Katherine Carman, a Rand economist who is overseeing the survey.
http://www.latimes.com/nation/la-na-obamacare-uninsured-national-20140331,0,5472960.story#ixzz2xkg9oyA7   That is  certainly a negative for those in that predicament, but it is  not the “millions and millions” the ad claims.

 Most deceptive was  the claim in the ad that Obamacare forced persons to pay more for less coverage .  Come, come. T he reason those who had individually purchased catastrophic policies got the discontinue notices  was because it did not offer enough coverage Obamacare deemed basic. 

It is such a shame hospitals will see cuts to government subsidies, whines another   ad, implying reduction in  Medicare services to your parents and grandparents. Here’s why that line is so deceptive : so many more will now have health insurance,  uncompensated charity care hospitals must cover  is less; and that hospitals will be held to higher standards, such as reducing readmissions due to sloppy infection prevention practices and unneeded, repetitive tests.

In fact, The Congressional Budget Office projects that a decade has been added to the life of Medicare due to the cost saving measures. Of course,  no benefits are being cut  by Obamacare and traditional Medicare is preserved.  Even Medicare Advantage serving 28% of seniors is projected to continue. http://www.politifact.com/truth-o-meter/article/2013/aug/19/will-obamacare-hurt-medicare-advantage/

Expect future ads to claim Obamacare “is” not working because “in the future” premiums will soar as insurance companies drop out for lack of customers or not enough healthy sign up, causing a “death spiral”    Those are scare tactics.   The ACA foresaw that and insurers will be subsidized to keep policies low until the free-riders feel the pain of ever increasing penalties in the next couple of years. The Congressional Budget office estimates it will take three years for all qualified to sign up. Even if young, invincibles fail  to constitute 40% of the sign ups, mid 20%s will still be enough for the “death spiral” not to happen, per the Kaiser Family Foundation. (latimes.com/business/hiltzik: March 31, 2014, "Obamacare numbers coming in huge: Here's a guide to GOP excuse-making) .
From Kaiser Family Foundation (KFF.org...Metrics are mostly wrong)
"How about the percentage of young people? Everyone seems focused on that.  Young people benefit the risk pool because they are healthier, but it’s really the percentage of healthy people that make or break the risk pool. Even if enrollment of young adults stays where it is – at about one-quarter instead of 40%, which our analysis shows they make up among potential enrollees – premiums would only increase by two to three percent. Though even that isn’t quite right, since many insurers expected this and already built it into their premiums.  Nevertheless, news organizations continue to hammer enrollment by young adults as if it were the sole make-it or break-it factor to the health of the risk pools and, in some news reports, the law.  There  are no data yet on the overall health of enrollees because the law no longer allows insurers to collect that data in order to exclude people with pre-existing conditions from coverage."

For a very comprehensive fact check similar to this, go to http://news.yahoo.com/millions-lost-insurance-214739724.html  published 4/11/2014

How the Democrats could beat the GOP at the Mediscare game

What the Florida special election this week shows is that if last minute ads flood the screens that scare the dickens of an important segment of the electorate with distortions and innuendos, or outright lies, it is possible to beat an opponent, especially when last minute timing gives an opponent  no chance to refute.        It is a political technique as old as democracy and made possible by
 unbridled millions able to be poured into a district by outside groups in these days of permissive election laws. Here is how the Democrats could beat the GOP at the Mediscare game.

Democrat Alex Sink lost by 2% to  David Jolly the Republican  protoge of the  member of the House of Representatives whose death left the seat open in a district around Clearwater, Florida.  The district had voted for the GOP in House races  over the past 40 years, though Pres. Obama had carried it in 2008 and 2012. It is  a district that is heavily populated by seniors.

There are some lessons for Democrats and it was considered a test case for how Democrats in swing states could win.  It turned out to be  more of an example of how Democrats could be beaten. Especially vulnerable in Louisiana  is Sen. Mary Landrieu. The more the GOP can tie her to Obamacare and Medicare, the more successful they will be....especially if they wait until  the last minute of the campaign.

The GOP  message used in the final days of the Sink-Jolly campaign was credited for turning the election from a possible win by Swink to a squeaker win by  Jolly. $5 million dollars flooded from outside money to convey the message.  The ad hit an issue hard: "To pay for Obamacare, Washington is forcing seniors to endure deep cuts to Medicare Advantage".

 The term "deep cuts" is the frightening term.  If 1.9% cut in the program is deep, then your definition is different than mine.
For a senior (and I am one of them on Medicare Advantage), this gets your attention. If you are not listening closely and think this will cause "deep cuts" to Medicare, it would turn your hair whiter. If you do not realize you are one of  the majority not on Medicare Advantage, then you might think Obamacare is going to hurt you deeply. The New Orleans Times Picayune estimates that only 26 % of those on Medicare have Medicare Advantage in Mississipi..

Not everyone is on Medicare Advantage, a program that combines Medicare and Medigap insurance with some gym memberships and is a little cheaper than Medigap supplementals because it limits a person's choice of providers.  (Mine is an employer retiree provided plan and I have a choice of three providers and, yes, my Medicare advantage program premium rose by $30 per month as the change kicked in in 2014; its still a good deal)..

Here is the reality:  About $250 billion of the cuts  is ending the subsidy to private insurers for Medicare Advantage which, strangely enough, is continuing without the subsidy. The private insurers were being paid 17% more to administer Medicare than what the government could do itself….and it resulted in no advantage to improving senior health  outcome  and only  the insurers got the  advantage in bloated federal subsidies. The rest is in cuts to hospitals and providers, but it results in NO, repeat "no", cuts to to Medicare benefits.  In short, money was being wasted on private insurers' overhead and other wastes in benefits provided by the health care industry.

Furthermore, the life of Medicare is extended 12 years by the Obamacare  savings .   For the deficit hawks, Simpson/Bowles Debt Reduction Commission says the cuts are essential to reducing the deficit. Even the Ryan budget proposed a couple of years ago proposed keeping the cuts...only the savings did not go into the health care system as Obamacare requires.

What Landrieu and again Sink must do (the Florida election will be rerun in November)...as well as other Democrats in purple states... is to be ready to anticipate and call out such scare tactics before the last minute barrage  and keep a last minute war chest ready for a quick response. 

The direction Landrieu and other Democrats facing elections in purple states are taking is to just ask for a fix:  i.e. sign a letter asking for Medicare Advantage to be exempted...or delay the individual mandate or other such exemptions affecting certain voter groups..  The problem is much of these cut rollbacks would seriously harm the affordability of the program. i.e. Cuts to Medicare account for a third of the Obamacare savings that would have to be offset by something.  Depending upon how long the individual mandate would be rolled back could destroy the creation of the pool making the entire program a financial disaster and passing on the costs on to everyone else.  The extent of the impact must be weighed; to do otherwise is irresponsible.

Here is how a Democrat could position  the next campaign in anticipation the  GOP might link  Medicare  to Obamacare:.  "While I do not like everything about Obamacare (or do), what it does right is add 12 years to Medicare's life..  What it does is stop wasteful overpayments to insurance companies for Medicare Advantage.  What it does right is not touch Medicare benefits. My opponent wants to restore the abuses to a program we treasure, cut 12 years off its life,  (and where appropriate)...he/ she wants to privatize it, give you a voucher that is not guaranteed to cover your costs in the future."   

That same litany could be used to refute other issues pertaining to Obamacare.  For example:" While I do not like everything Obamacare does, and I am happy to see the web site up and running, what it does right is makes sure pre-existing conditions are covered, that you can get no-copay cancer screenings, allow my 19 year old child to stay on my insurance...etc.  What my opponents want is to make you give up all of this because that is what "repeal" means.  For those of you who have gotten affordable insurance (5-6 million), my opponent wants you to turn in your insurance and trade it  for nothing, zippo, but to risk bankruptcy and to fear again  to get treated for what ever ails you because of the cost." 

Some resources I drew on : http://www.politifact.com/truth-o-meter/article/2013/aug/19/will-obamacare-hurt-medicare-advantage/        "GOP targeting Medicare Advantage cuts in 2014 campaign it hopes will be referndum on Obaamacare: Bruce Alpert, Times-Picayune at NOLA .com  March 12, 2014

Obama administration ought to fight GOP anecdotes with their own anecdotes, the best antidote to GOP cherry picking

In 2014, GOP's tactic to  kill Obamacare will be propaganda by anecdote.  While the figures of the winners in health care reform will far outweigh the losers, the Obama administration should also fight fire with fire to put some perspective on the issue.  It is not just enough to rely on people's experience to spread the good word to their friends and relatives in order to debunk the GOP's scare tactics of  distortions, and misinformation,  scary predictions, and cherry picked stories of the disgruntled.  The Obama administration needs to humanize the success stories in a way that those who benefit relate to the majority who do.
For example,  I received this email from one of those middle aged males living in Connecticut who got bounced off his individually purchased catastrophic health policy. While he has just received a reprieve for a year  from either being fined for not finding another policy,  he decided to go ahead and sign up through his state's exchange.  Here in a nutshell is his experience:

"Finally enrolled in CT Health Exchange program and bought insurance.  I had a very good experience and the web site was super easy to use.  Took much less time than I anticipated.  There were not a lot of choices, but the choices were decent – certainly compared to what I had before.  I purchased an Anthem Blue bronze plan for about 50% of what my “paper” plan from Golden Rule cost.  Insurance has a four star rating.   Let’s see how things work out with them, but at the age of 49, I am pretty happy with what I got.  Can’t say the same thing for any of the folks in the Red States – especially those who could qualify for Medicaid but their own governors would prefer them to continue to access care in the emergency rooms….what a joke."

While it is estimated three million holders of individual policies that were not in conformity with Obamacare standards got notices this fall, the administration believes that only 500,000 of them would have problems affording a replacement or would qualify for a subsidy for their new policies. For that reason, they tweaked and delayed parts of the Affordable Care Act, to allow them to continue with their old policies for a year without a penalty, to be able to sign up  through the exchanges for low cost  catastrophic insurance that was in conformity with  Obamacare standards, including free cancer screenings and no co-pays for check ups and other preventative measures. This same opportunity had originally been restricted to those under 30 and "hardship" cases.  This is in no way a "fundamental change", as shrill voices from the anti health care forces claimed, because of the few impacted.  What the administration needs to do is to tout the other 2.5 million who did find a more affordable, better policy and shout their success stories to the rafters.

60% of those under 65 in the US receive insurance through their employers.  In a passing conversation with a benefits provider to major Colorado corporations, I asked him what will happen in 2014.  He replied," little change. Major employers had already made the adjustments. " In fact, recently the annual increase  in employer provided insurance, which had been climbing years before the Obamacare law was enacted..by as much as 9% a year..had decreased to around 3.5%...the lowest in years.  In spite of some GOP flame throwing, that costs had risen by $2, 500 per family per year, fact checkers blew some good holes in that assertion that it was due to Obamacare.  It is just too soon to tell, they conclude.  http://www.politifact.com/wisconsin/statements/2013/dec/15/ron-johnson/obamacare-health-insurance-premiums-havent-gone-do   The administration needs to provide anecdotes to make their case.

What really aggravates me is the whine  that you cannot keep your own doctor and then claim the President lied again.  What about those 30 million, too, who never had a doctor until now  because they could not afford insurance for either lack of means or pre-existing conditions?  That is a number that should overwhelm any of the disgruntled and their stories need to be touted to the high heavens.

Besides, anyone who changed jobs or their employer changes plans before Obamacare, knows that consumers are always seeking new doctors anyway.  Besides, most affected with having to find a new plan already have a large range of choices, depending on their location...and those choices of providers are the usual brand names.  The administration needs to make that case with anecdotes.  

For us seniors who listened to the Obamascarers, that $400 billion was robbed from Medicare Advantage to help pay for Obamacare for others... the anecdote should come from those like me: I saw no difference this year during open enrollment  and my Medicare advantage plan was unchanged. I got it this year at the same price.  No one I know has had their plugs pulled by some death panel either.  For the fact checkers:  the life of Medicare was extended by 12 years due to the cost savings built into the law.    These stories  to be told by those who have actually experienced the impact of the law.  

This story telling will take some money, given the amount of advertising poured into the airwaves by anti Obama and anti Obamacare forces.  The insurance companies have a great stake in making sure Obamacare brings 30 million new customers into coverage by them.  That is one source of funding. The other is the bully pulpit of the administration and its supporters.  So far the bully part has been .a whisper ...of what it should be and instead, the mistake is being made just to rely on word of mouth by those who have benefited by the new law.  Perception that most have benefited and the rest are a minority of grouches can not be left up to "buzz".  For the sake of protecting their legacy, to fight off GOP's efforts to sabotage Obamacare with "repairs", and to do better in the 2014 midterms, using anecdotes  is the right antidote.