True or False: Seven Concerns About the New Health
Law Checked Out by Kaiser News Staff
Does it ration care for elderly? Will it disrupt
Medicare Advantage plans? Is it the end of TRICARE?
By
KHN Staff
April
13, 2010 - The sweeping health care overhaul signed into law by President Barack Obama is more than 2,000 pages long and has been
dissected by analysts, politicians and pundits. It’s no wonder that some
consumers are confused – and perhaps frightened – about how the law
might affect them. Some concerns were raised during the congressional
debate or have been swirling around the Internet.
KHN staff writers checked out some of the claims:
Comparative effectiveness research will lead to
the rationing of care for the elderly.
Not true.
The law creates a nonprofit Patient-Centered
Outcomes Research Institute charged with examining the "relative health
outcomes, clinical effectiveness, and appropriateness" of different
medical treatments by evaluating existing studies and conducting its
own. The institute would be governed by a 19-member board that includes
patients, doctors, hospitals, drug makers, device manufacturers,
insurers, payers, government officials and health experts.
The law states that the institute does not have the
power to mandate or even endorse coverage rules or reimbursement for any
particular treatment. Medicare may take the institute’s research into
account when deciding what procedures it will cover, so long as the new
research is not the sole justification and the agency allows for public
input.
This is a shift from Congress’ position when it
created the Medicare Part D drug benefit in 2003; back then it banned
any use of comparative effectiveness research in determining what would
be covered.
Many experts believe that as health costs continue
to mushroom, Medicare and private payers will incorporate the
institute’s work into their coverage decisions. Others say history
suggests that’s unlikely. “The graveyards of Washington, D.C., are
littered with government agencies that tried to do comparative
effectiveness research,” said Michael Cannon, director of health policy
studies at the Cato Institute, a libertarian think tank in Washington.
--Jordan Rau
Cuts in the Medicare Advantage plans under the
health care overhaul "will cause massive disruption for the more than 10
million seniors" and many of them will lose coverage.
Partially true.
That was the warning in a
statement from America's Health Insurance Plans, a lobbying group,
days before the health overhaul cleared Congress, echoing a Republican
criticism.
The new health law will cut $136 billion in
spending on the Advantage program by 2019, which currently pays private
plans to administer Medicare benefits and pays them about 14 percent
more than the per-patient cost of the traditional Medicare program.
Plans use that subsidy to lure members with lower premium costs or extra
benefits not normally paid for by Medicare, such as vision care or
better prescription drug coverage. Some Democrats and analysts have
argued the higher rates are wasteful.
Even experts who support the change concede that
the impact of the cuts could be evident. Robert Berenson, a scholar at
the Urban Institute and former Medicare official, said some Advantage
plan members will notice skimpier benefits, "but the Republicans have
really exaggerated that this will wipe out the Advantage plans."
Marsha Gold, a health policy analyst for the
private research group Mathematica, said, "Over time, there will be less
rich benefits or higher premiums, but it's going to be gradual," noting
that the largest cuts do not begin until 2015.
The three-quarters of beneficiaries who receive
traditional Medicare benefits would not be affected by the change.
However, for those in Advantage plans, they may have fewer to choose
from. "You are going to start seeing companies dropping out," said
Robert Moffit, a policy analyst at the Heritage Foundation.
--Christopher Weaver
The IRS will be hiring thousands of new agents
to check that people have health insurance and people who don't will be
sent to jail.
At least partially not true.
These claims arise from a provision of the health
care law that would require Americans to purchase health insurance or
else face penalties. The Internal Revenue Service will be tasked with
enforcing this provision, as well as collecting some new fees and
overseeing government subsidies to help small businesses and lower
income people buy insurance.
The
Congressional Budget Office said the number of new employees the IRS
will need has not been determined, though it did estimate the agency's
cost could reach approximately $10 billion over the next 10 years.
House Ways and Means Committee Republicans used the
CBO estimate in a
report on the bill's effect on the IRS. In that report, Rep. Dave
Camp, R-Mich, said, "the IRS could have to hire more than 16,000
additional agents, auditors and other workers just to enforce all the
new taxes and penalties." Camp called such an increase in personnel, "a
dangerous expansion of the IRS' power." The IRS currently has about
93,000 employees.
Others have raised concerns about IRS sanctions and
the possibility of jail time. Rep. Ron Paul, R-Texas, in an
interview with Fox Business Network about the new health law, said,
"If it was a good program, and everybody liked it, you wouldn't need
16,500 thugs coming with their guns and put me in jail if you didn't
follow all the rules."
The CBO report, however, identifies the $10 billion
as needed for "administrative costs," and does not state that all of the
funds will be used for new employees.
IRS Commissioner Douglas Shulman told a March 25
House Ways and Means Committee
hearing that his agency will report back to Congress on the number
of additional staff members or funds it will need "to serve the American
people." He noted that under the new law, the IRS will not place any
liens against taxpayers and there will be no criminal punishments,
including jail time, for failing to report insurance information to the
IRS. The Department of Health and Human Services, he said, will work
"with the insurance companies to determine" if consumers have
"acceptable coverage." Consumers will then get a form to file with their
tax returns.
In
remarks at the National Press Club on April 5, Shulman added more
detail. He said that since the remedies available to the IRS are
limited, people who fail to provide the proper paperwork to show they
have insurance may likely have part of their refund withheld.
--Maggie Mertens
When health care reform kicks in, consumers will
have longer waits to see a primary care doctor.
Partially true.
With estimates that 32 million more people will
have health insurance by 2019, concerns that there will be longer
waiting times to see doctors are not entirely unfounded. Even before
health reform legislation passed, the U.S. faced a shortage of family
doctors that was expected to grow to around 40,000 by 2020, according to
the
American Academy of Family Physicians. Lori Heim, president of the
AAFP, says that number is likely to increase significantly.
The new legislation contains several incentives
aimed at curbing the shortage by encouraging medical students to go into
primary care rather than choosing other specialties, such as cardiology
or orthopedics, which are generally more lucrative. In addition, the
legislation temporarily raises Medicaid reimbursement rates for primary
care doctors and offers special loan repayment programs to students who
choose primary care. Heim said these incentives should help but won't
eliminate the impact of the new patient load. "All of them fall short
for what it's going to take to truly build a primary care workforce
that's going to take care of everyone," she said.
Patients most likely to be affected by the shortage
are those seeking a primary care physician for the first time, said
Stuart Altman, a professor of national health policy at Brandeis
University's Heller School. Those who already have an established doctor
– and some uninsured patients do have relationships already with
physicians -- are not likely to see much of a change unless they have to
shop for a new one.
Altman points to the recent
experiences of Massachusetts, which approved universal health care
in 2006. The state was already facing a primary care shortage when the
law was implemented. By 2009, a
survey by the Massachusetts Medical Association found that more than
half of internists and 40 percent of family doctors were not accepting
new patients, the lowest acceptance rates since the survey was started
eight years ago.
Fitzhugh Mullan, a professor of health policy and
pediatrics at The George Washington University, agreed that in the short
term, the influx of newly insured patients will put pressure on the
health care system. But he said that in the long term, "it will cause us
to increase and rebalance our workforce" to make it more efficient. He
says the rebalancing will include an increase in the number of physician
assistants and nurse practitioners, who can be trained more quickly than
doctors, to fill the primary care gap and reduce wait times. --Jenny
Gold
The new health law will end TRICARE and force
military families to buy different insurance.
Not True.
The future of
TRICARE, the health care system for about 9.6 million active duty
military and retirees, their families and survivors, was a hotly debated
issue before the March 21 House vote on health overhaul legislation.
Conservatives, Republican members of Congress and at least one prominent
veterans group said the bills did not guarantee that TRICARE’s benefits
would be considered "qualifying coverage" and thus meet the requirements
for a health plan under the bill. They argued that military
beneficiaries might have to leave the plan or pay penalties if TRICARE
was not deemed to meet the new law’s standards.
Thomas J. Tradewell Sr., the national commander of
the Veterans of Foreign Wars of the U.S.,
accused President Barack Obama and congressional Democrats of
"betraying America’s veterans."
But the White House, Pentagon, Department of
Veterans Affairs, congressional Democratic leaders and other military
associations say TRICARE
meets all the law’s requirements and military personnel and their
families can continue to get full benefits under the familiar military
health plan. Even some opponents of the health reform bill agreed that
TRICARE would not be jeopardized.
Some of the confusion appears to stem from the
different approaches taken to TRICARE in the competing Senate- and
House-passed reform bills. The Senate measure, which passed on Christmas
Eve and was sent back to the House for a final vote, did not mention
TRICARE by name, though the original House bill did.
Five House committee chairman issued a letter
saying that TRICARE coverage "would satisfy the requirements" of the
bill. Kathleen Sebelius, secretary of Health and Human Services, also
sent
a letter to Sen. Max Baucus, D-Mont., reassuring him that TRICARE
coverage meets "the minimum essential coverage definition."
The united defense brought a
letter of apology from Tradewell. "I apologize for using too harsh a
word…," he said. “But I did not apologize for our strong advocacy on the
issue." --Lexie Verdon
Federal government employees will be forced to
switch their health insurance coverage and participate in the exchanges.
Mostly not true.
President Barack Obama has repeatedly stated that
people who like their health insurance can keep it. However, that
doesn’t apply to a small group of federal employees.
Currently, government employees and qualified
retirees can get health insurance through the Federal Employees Health
Benefits Program (FEHBP), a "marketplace" with more than 250 plans,
with at least 10 national fee-for-service plans. Government employees,
including members of Congress, the president, vice president, cabinet
members and White House staff all participate in FEHBP. That won’t
change – except for members of Congress and their personal staffs. In
2014, they will instead have to enroll in the new insurance exchanges.
Some Republicans, led by Sens. Charles Grassley of
Iowa and Tom Coburn of Oklahoma, argued that all members of Congress and
staff should be subject to the same coverage that they set up for other
Americans.
The provision has provoked confusion, sparked
emotions and even caused the White House to
announce that the president will voluntarily participate in the
exchange, although he would not be required to do so by the new law.
Walton Francis, a health economist and main author of "CHECKBOOK's Guide
to Health Plans for Federal Employees," said the requirement will be
controversial and may come up again for consideration: "My guess is the
FEHBP exclusion for these members and their staff will probably not
survive." he said. --Jessica Marcy
Illegal immigrants will get free health care.
Mostly not true.
Illegal immigrants already are generally barred
from receiving Medicaid benefits, and the new health law excludes them
from receiving premium subsidies. They are also explicitly banned from
purchasing insurance with their own funds on the exchanges created in
the legislation. Anyone trying to purchase health insurance through
those marketplaces must provide proof of citizenship or legal resident
status.
But some commentators have argued that undocumented
immigrants will get free or subsidized health care when the reforms are
in place, that the enforcement provisions are weak, and undocumented
immigrants might find ways to circumvent the law. Dan Vale of the
Federation for American Immigration Reform said that while the bill
prohibits undocumented immigrants from buying insurance from the new
exchanges, it uses "a 'loosey-goosey' verification policy" that "doesn’t
require a photo ID."
However, Sonal Ambegaokar of the National
Immigration Law Center said the process outlined in the Senate bill is
likely to be similar to what officials currently use in the Medicaid
program. According to Amebegaokar, "There is a history of verification
processes for public programs; we’ve had this for many years in Medicaid
and we have strict citizenship requirements. And we have yet to see a
flood of immigrants in Medicaid."
The Pew Hispanic Center
estimates that of about 12 million undocumented immigrants live in
the United States and more than half of them don’t have
insurance. Nonetheless, the vast majority - nearly 80 percent - of the
uninsured are U.S. citizens, according to the
Kaiser Family Foundation. (KHN is a program of the foundation.)
Advocates for immigrants argue that many
undocumented residents will simply remain uncovered. The Congressional
Budget Office estimates that of the 23 million people who will continue
to be uninsured in 2019, 8 million will be undocumented immigrants.
Without health insurance, many of them will continue to receive care in
free or subsidized community clinics. In addition, the new law doesn't
change the requirement that hospitals offer emergency services to all
patients, including illegal immigrants. --Kate Steadman
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