On March 6, House Republicans released their long-anticipated plan to “repeal and replace” the 2010 Affordable Care Act, also known as “ACA” or “Obamacare.”  The effort includes two bills drafted by two different committees, and it seeks to preserve the most popular components of the ACA while repealing the parts that Republicans have been railing against for almost eight years.  For those on Medicare, the path forward is not clear, however.

What is Happening Right Now?

The Speaker of the House, Paul Ryan, explained his effort in detail in a presentation to reporters.  He said that the legislation he released is just the first in a three-step process to a new Republican health care plan.

As Speaker Ryan envisions things, Congress will first pass a limited law that will repeal some of the 2010 Affordable Care Act on a straight party-line basis.

There is a special process called reconciliation in the Senate that allows some financially-related legislation to be passed with a simple majority, which Republicans currently hold.  Major Republican priorities like allowing health insurance to be sold across state lines will probably require some Democratic votes in the Senate so that will be pushed down the road indefinitely.

The second step in Speaker Ryan’s plan is a series of administrative actions led by the White House that will aim to reduce regulatory burdens.

The third and final step will be the major health care reform legislation that Republicans support.

The American Health Care Act

The current bill being debated by Congress only does a few things.  Those things are troubling, through. 

Most alarmingly, as we explained in an earlier post, the biggest worry right now is over Medicaid.  The current Republican bill would undo the expansion of Medicaid that has allowed an estimated 14 million people to get coverage.  Republicans are debating the details of this Medicare expansion repeal effort, but if it passes the end result would likely strip coverage from millions of Americans.

The current bill would also change the subsidy structure for the insurance marketplace.  Subsidies are currently tied to income, but Republicans want to reduce the subsidies and tie them to age.  Republicans also have a repeal of the mandate to buy insurance in their current bill.  They hate the mandate, but it is not clear the existing marketplace will survive without it.  The current bill would also repeal a tax that the Affordable Care Act imposed on wealthy individuals.

What Does this Mean for Medicare?

Frankly, nobody knows.

The current bill does not seem to impact Medicare benefits, so nothing is imminent.  In the longer run, there is more reason to be concerned.  Republicans like Paul Ryan have spent their whole careers trying to reform “entitlement” programs like Medicare.

Ryan has argued that Medicare should be turned into a “premium support” system, which would essentially give eligible individuals a voucher with a fixed value that they could use to shop for health coverage.  Donald Trump ran as a populist and called those reform plans “political suicide.

These conflicting viewpoints will likely come to a head in upcoming budget talks, but for now, Medicare benefit reforms are not on the table.  Medicare will be at risk in the second step of Paul Ryan’s plan, though, which involves executive actions.  Medicare funding could also be hurt by the tax repeal and other legislative attacks on Medicare could come later.

The ACA Is Vital For Patients With Diabetes

A repeal of the 2010 changes to Medicare could be devastating.  During the 2008 campaign, Barack Obama was particularly concerned with chronic diseases like diabetes.  He proposed refocusing the health care system on preventative care, while also working to better coordinate and integrate care.  Then-candidate Obama argued that most people dealing with chronic disease have three or more doctors, and that could lead to duplicate testing, conflicting treatment advice, and conflicting prescriptions.  He wanted to require that all health care plans utilize proven disease management programs.

The 2010 ACA indeed made many important changes to Medicare that helped diabetics.  For one, it closed the “donut hole” in coverage for Medicare Part D, and that saved many diabetes patients about $2,100 per year on their prescription drug costs.  Additionally, following the plans he laid out in the campaign, President Obama’s health care law made a major shift in focus to prevention.  This has been a major boost in the fight against diabetes.  Medicare patients can now receive free screenings, self-management training, medical nutritional therapy, and support for lifestyle changes.  Medicare patients used about $31 million in preventative services in 2012, and this is all at risk in the repeal and replace efforts.

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