In anticipation of the Republican National Convention starting this week, I wanted to counter some of misinformation that just might be forthcoming from the Tampa area with regard to the ACA, Medicare, and more.
THE ACA AND THE DEFICIT: With the presumptive Vice Presidential nominee Paul Ryan, there is bound to be a lot of talk about the deficit. There’s been some misinformation about the impact of the Affordable Care Act and the deficit, wso let’s review. The most recent CBO analysis does show that the Affordable Care Act (aka ACA, or Obamacare) actually *reduces* the deficit by about $109 billion in the first ten years, and over a trillion in the second ten years. Contrary to Paul Ryan’s assertions, the CBO analysis shows that the ACA extends the life of Medicare for about ten years (and yes, there’s more to do).
Unhappy with these conclusions, some cherry-pick specific facts for their arguments while ignoring the overall conclusions. Others will try to attack the nonpartisan Congressional Budget Office, which has always been the referee of these matters. One attack has been about the recent changes in the estimates. But actually, the CBO estimates have been remarkably consistent, the differences in estimates have been on the margins, or through predictable updates based on the passage of time or policy changes (not doing the CLASS Act, the Supreme Court allowing states not to do Medicaid expansions.)
THE ACA AND MEDICARE: Much has been made about what the ACA does with regard to Medicare. Let’s be clear–the only change by the ACA in Medicare benefits have been improvements–notably increasing coverage for prescription drugs (closing the so-called “donut hole”) and allowing for free preventative services with no cost-sharing.
The ACA is partially funded through savings from Medicare, as the result of a negotiation with the health industry–since they are getting so many more paying customers, they agreed to reduce the rate of growth of the costs for the existing Medicare patients.
Romney and Ryan attacks those “cuts,” but in his Ryan budget, he includes the same cuts/savings–but without the expansions that made them possible (and acceptable to health providers), and without the benefits of better drug coverage in Medicare. Instead, he uses the savings for tax cuts, largely skewed toward the rich.
THE DIFFERENCE BETWEEN ACA AND THE RYAN BUDGET: The ACA is our best chance at deficit reduction, because it is the most serious effort to deal with base health care costs–which impacts Medicare, Medicaid, as well as private coverage. It’s the biggest attempt ever by Congress to try to reduce the rate of growth in health care costs (from investing in prevention to information technology to comparable effectiveness research, to better bulk purchasing power and streamlining systems).
Paul Ryan’s budget proposals don’t control costs, they simply shift costs, from the federal govt to states (Medicaid block grants) or seniors (Medicare vouchers). Plus, his proposals actually don’t reduce the deficit–the cuts go to finance massive tax cuts (skewed to the wealthy).
The honest debate shouldn’t be about the math–it’s about priorities of how these resources are used. The actual debate is not about finding savings in Medicare (which Ryan put in his own budget), but how you get them, and what those savings are used for: providing financial assistance to low and moderate folks to better afford health coverage (ACA); or to finance a tax cut for high-income folks that Ryan calls “job creators.” (Ryan budget).
To be fair, Ryan and Romney say that shifting costs to individuals means they will have more of a financial stake in their health care and shop around more. So their strategy for controlling cost is to shift the burden onto individuals, who will either figure out how to force providers to provide cheaper care, or will be stuck with the difference.
Individuals are uniquely ill-equipped to shop around for health care: they lack 1) the information and medical and actuarial expertise to make certain comparisons, 2) the group purchasing power against the big insurers and providers, and 3) the ability to say “no” in all but a handful of situations. It’s hard for large purchasers for CALPERS, with their market power, and expert analysis, to shop on the basis of cost and quality–for an individual it seems impossible. The ACA attempts to get more people into large purchasers–whether by employers or Exchanges–to help do this work on our behalf.
MORE TO COME: I have a feeling the RNC speeches will inspire more need for clarification on what will be called Obamacare. I can hardly wait.