Democrats: Talk To Older Voters About GOP Plan To Repeal Medicare Benefits

The Affordable Care Act (ACA)  not only provides affordable access to health insurance for working-age Americans and their families, it also provides older Americans covered by Medicare and Medicaid a list of additional covered benefits. The ACA, a.k.a.Obamacare, improved Medicare coverage, boosted taxes and reduced program spending. Older Americans on Medicaid also would face a significant loss of benefits, because any effort to repeal Obamacare would affect the law’s major expansion of Medicaid, including how Washington pays states for administering the program.

For starters, the ACA greatly expanded the roster of tests and procedures that Medicare enrollees can get with little if any cost to make sure enrollees are healthy and to help them stay that way. Medicare’s list of so-called wellness provisions includes many items added by the ACA:

• Abdominal aortic aneurysm screening
• Alcohol misuse screening and counseling
• Bone mass measurements
• Breast cancer screening (mammograms)
• Cardiovascular disease (behavioral therapy)
• Cardiovascular disease screening
• Cervical and vaginal cancer screening
• Colorectal cancer screening
• Depression screening
• Diabetes screening and self-management training
• Glaucoma tests
• Hepatitis C screening test
• HIV screening
• Lung cancer screening
• Medical nutrition therapy
• Obesity screening and counseling
• Prostate cancer screening
• Sexually transmitted infections screening and counseling
• Shots (flu, pneumococcal, and Hepatitis B)
• Tobacco use cessation counseling
• “Welcome to Medicare” preventive visit
• Yearly “Wellness” visit

Good health does cost money, of course, but so does having to treat people who have not been taking care of themselves. Perhaps all of these measures would survive the repeal process. However, considering that some of these benefits might disappear, Medicare enrollees ought to work with their doctors right now to make sure they’re taking full advantage of these wellness benefits.

Another main Obamacare feature has been its reduction in out-of-pocket spending in Part D Medicare prescription drug plans. This has been accomplished through the elimination of the so-called “donut hole” by 2020. Medicare says enrollees have saved more than $2,000 per person, on average, because of this single change.

It’s quite possible, of course, that the donut hole will be totally gone by the time the “replace” components of “repeal and replace” actually have taken effect. Given the shouts from both parties about high drug prices, it seems unlikely that Republicans would have much appetite for being tagged with efforts to make people spend more money on prescription medicines.

Obamacare’s other big Medicare impact came via financial improvements it put in place to help the program. It raised a bunch of taxes, including requiring high-income wage earners to pay higher Medicare payroll taxes and stiff premium surcharges for Medicare Part B and D premiums. Health providers and Medicare Advantage insurance plans were also willing to accept lower payment levels from Medicare in exchange for the law’s provisions that would expand their access to more insurance customers.

Before the passage of the ACA, the Medicare trust fund that pays claims for Part A hospital and nursing home expenses had been projected to run short of funds by 2017. The ACA has pushed that date out more than 10 years.

Republicans reportedly want to do away with many of these taxes. Unless other funding streams are created to replace them, the longer-term finances of the program would be at greater risk. Ironically, these actions would “force” Republicans to cut health care spending to curb runaway deficits.

As actual GOP plans come into sharper focus, sharp Medicare battle lines will form for politicians and the public alike.  Expect the proposals to come coated in friendly sounding packages that tout health care improvements. But it will be crucial to look inside the packages to get an understanding of whether the Medicare program that would emerge from their enactment is one you want to have.

READ MORE: How plans to repeal the Affordable Care Act could affect Medicare

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