The ACP Advocate Blog
by Bob Doherty
Thursday, January 19, 2012
Politicians won’t admit it, but repeal means taking real benefits away from real people
Politicians who favor repeal of the ACA like to talk in general terms about getting rid of the two thousand pages of law (“monstrosity” is their preferred description) that it created, ignoring the fact that those same pieces of paper extend or improve benefits for hundreds of millions. It is easier to make rhetorical points about “government-run” health care than to explain what you are willing to take away, and from whom, or what you would offer to replace it.
The reason for this, I think, is mainly political: if the politicians really leveled with the people about what they and their families will lose if the ACA is taken away—and without a realistic alternative—many voters would think twice about repeal.
Consider this. Imagine that it is a week from now, and Mitt Romney is in St. Petersburg, Florida, campaigning to wrap up the GOP nomination. Imagine if he gave the following speech to a group of mostly senior citizens:
“Dear friends. As you know, I am opposed to ObamaCare. I am opposed to government-run health care, and my first item of business when I am President will be to repeal it. But you have a right to know what this might mean for you.
Say you are a senior citizen who is receiving a 50% discount on brand-name drugs filled through Medicare’s donut hole—I see there are quite a few of you in the room! After repeal, the discount will disappear. So if you are now paying $100 a month for a prescription, you will pay $200 monthly after ObamaCare is repealed. This means that after repeal, a typical senior enrolled in traditional Medicare will pay $3500 more for their drugs over the next decade.
Also, if you are a senior on Medicare, you now get routine preventive exams, like screening tests for cancer and an annual wellness exam at no cost to you. But after repeal, you will have to pay out of your own pocket for the deductible and co-payments. Yes, the 1,348,087 Florida seniors who now get these services for free will have to start paying for them.
Your internist will get paid less to take care of you. Right now, primary care doctors get a 10 percent Medicare bonus on their office and nursing home visits. After repeal, they won’t get the bonus. What this means is that a typical internist will end up being paid $8000 less from Medicare after repeal. Also, starting in 2013, primary care doctors were supposed to get a big raise from Medicaid, so that the program would pay no less than Medicare. In Florida, this would have meant that Medicaid payments to your primary care doctor would have gone up about 45 percent. But after repeal, Florida Medicaid will go back to paying primary care doctors only a little over half of what Medicare pays them.
Some of you may have granddaughters and grandsons who just graduated from college—congratulations!—and are out looking for a job. In the past, they probably would have lost their health insurance after graduation and until they got employed. Not now, though: the health reform law allows them to be covered under their parents’ plans—some 2.5 million young adults nationwide in 2011 got health insurance as a result. But after repeal, their parents’ plans no longer will have to offer them coverage, and they probably will have to find an affordable plan on their own, if they can.
Some of you may have a grandchild with a pre-existing condition, like asthma. Today, insurance companies can’t turn them away. After repeal, though, nothing will stop an insurance company from turning away or dropping kids who are unfortunate enough to be sick and need health insurance.
Right now, insurance companies must spend at least 80 percent of the premiums they collect from working people on patient care, not profit and administration. After repeal, there are no limits on how much they would be allowed to take out of premiums to pay their CEOs eight-figure salaries and hand out big profits to their shareholders.
Finally, starting in 2014, most of the nearly 4 million people in Florida who don’t have health insurance will get coverage, either through Medicaid or a private health insurance plan that the government will help pay for. After repeal, most of them likely will still be without coverage.
These are the facts, folks. I want to be honest with you, repeal means taking real benefits away from real people. But I favor repeal, because I don’t think the federal government should be involved in your health care. I don’t think we can afford it. I don’t think people should be required to buy health insurance. I don’t think we should tell insurance companies how to run their businesses. And if you need help from the government, I think you should ask Governor Rick Scott for help, because the states can always do it better than the federal government, right? Don’t you agree?”
Mr. Romney saw that the room was strangely silent, many in the audience seemed visibly upset, and few even had their calculators out. Funny, he thought to himself, the polls say that a majority of Americans favor the ACA’s repeal. I guess they weren’t really ready for straight talk about what is really in the law and what they could lose. Next time, I think, I will stick to the tried-and-true railing about government-run health care, and leave out the details about what benefits the voters will lose. They can always find that out after I get ObamaCare repealed.
Obviously, no politician in his right mind would give a speech like this. And I understand that Republicans like Mr. Romney have strong philosophical and pragmatic reasons for opposing the Affordable Care Act, notwithstanding the benefits that it offers to millions. I also understand that President Obama and the Democrats aren’t leveling either with the American people on the fact that Medicare and Medicaid can’t be sustained as they currently exist, and that pretending otherwise and demagoguing solutions does a disservice to the public. But I do think the public has a right to know that “repeal ObamaCare” means that they and their families will get less in benefits and pay more for their health care, and if the politicians won’t tell them, then someone else must.
Today’s question: Do you think politicians who favor repeal should level with the American people about the benefits they will lose if the law goes away?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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