This column is the fourth of a series that examines claims House Republicans make to defend their budget that actually better describe the Affordable Care Act. The focus of this column is the claim that the House budget protects patient choice while the Affordable Care Act will lead to a rationing of care. It’s really the reverse: The House budget ends Medicare and replaces it with a voucher program, which will lead to more seniors having to forgo care or pay more. The Affordable Care Act works to bring down costs while giving patients more health care choices.
The House Medicare proposal would likely lead to rationing of care
The House Republican budget ends Medicare for those born after 1956 and replaces it with a voucher to help purchase a private plan. The voucher will increase with the rate of inflation, not health care costs. The nonpartisan Congressional Budget Office, or CBO, found that a typical 65-year-old in 2022 would pay double what they would pay under the traditional Medicare program, or $6,400 more. The value of the voucher would shrink over time as health care costs increase faster than inflation, meaning beneficiaries will pay more out of pocket over time or forgo care.
Moreover, CBO warned these higher costs under the House budget could limit care for future beneficiaries:
Private insurers would have flexibility—to limit benefits, change co-payment arrangements, manage utilization, and control provider networks—that does not exist in traditional Medicare, and such steps could serve as alternatives to limiting payments to providers in restraining health care costs and insurance premiums. But the significant increase in payments by Medicare beneficiaries under the proposal might also affect the quality of care that they would obtain. For example, beneficiaries’ greater cost-sensitivity could result in a slower introduction or less frequent use of new, costly, but possibly beneficial, technologies and techniques than would occur under current law.
Don Berwick, the administrator for the Centers for Medicare and Medicaid Services, said in an interview that the House budget is “withholding care from the people who need the care. You tell me what that is?” Moreover, House Majority Leader Eric Cantor (R-VA) suggested right now the private sector is making decisions on who gets what care at what cost.
The Affordable Care Act protects patient choice and does not ration care
House Republicans charge the Affordable Care Act will lead to rationing of care with its Independent Payment Advisory Board, or IPAB. This is false.
Under the law, IPAB will consist of 15 members appointed by the president and confirmed by the Senate to make recommendations to bring down Medicare costs only when they increase too rapidly. Congress can veto those recommendations. Moreover, the law specifically prohibits the board from “submitting proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income subsidies under Part D.”
Even Alice Rivlin, who collaborated with Rep. Paul Ryan (R-WI) on a different Medicare proposal, thinks IPAB will help bring health care costs under control without jeopardizing care.
“I view it as a much more benign device to improve the efficiency of delivery systems in a lot of different ways,” she said.
Further, one of the Affordable Care Act’s goals is to provide patients with more health care choices. The law establishes exchanges where small businesses and individuals can shop among a set of competing health plans and choose the one that suits them best. This is similar to how members of Congress get their health care.
Conclusion
The charge that the Affordable Care Act will ration care is false and better describes the House Medicare proposal. The House budget shifts costs onto seniors by ending the program for future beneficiaries and replacing it with a voucher paid to private insurance companies. These higher costs mean seniors will have to pay more for coverage or forgo care. The program that protects patient choice is the Affordable Care Act.
Tony Carrk is Policy Director for the ThinkProgress War Room.
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