Right-wing media have consistently hyped several myths about the Affordable Care Act (ACA) during the lead up to open enrollment for state-based exchanges. As media outlets report on implementation of the health care law, they should be aware of these false claims, including zombie myths that the law includes "death panels" and that Congress is "exempt" from the law.
Fox's Elisabeth Hasselbeck: Obama Administration "Has Decided That Congress And Their Staff Will Receive Extra Benefits That No Other American Gets." Fox News host Elisabeth Hasselbeck claimed that congressional members and staff got an "exemption" from the Affordable Care Act because of an Office of Personnel Management decision:
HASSELBECK: The president's health care law [is] supposed to apply to everybody, but now President Obama's Office of Personnel Management has decided that Congress and their staff will receive extra benefits that no other American gets. How fair is that? [Fox News, Fox & Friends, 9/19/13, via Media Matters]
CNS News: Congress And Staff Members Will Get "Special Taxpayer Subsidies." An August 27 article discussed Rep. Ron DeSantis's (R-FL) proposed legislation seeking to block Congress and its staffs from receiving "special taxpayer subsidies":
Rep. Ron DeSantis (R-Fla.) says it's not fair that members of Congress and their staffs will get special taxpayer subsidies to help them pay their Obamacare premiums in the new health insurance exchanges.
"I don't think it's fair at all," DeSantis told Fox News's Greta Van Susteren. [CNS News, 8/27/13]
NRO's John Fund: Sen. David Vitter (R-LA) Is Seeking To "End An Exemption" That Gives Congress "Generous Subsidies" To Pay For Health Insurance. In a September 16 article by John Fund on the National Review Online, Fund highlighted the argument in Congress over "whether Congress should be treated like the rest of the county when it comes to Obamacare." The article stated further:
Senator David Vitter, a Louisiana Republican, has demanded a floor vote on his bill to end an exemption that members of Congress and their staffs are slated to get that will make them the only participants in the new Obamacare exchanges to receive generous subsidies from their employer to pay for their health insurance. Angry Senate Democrats have drafted legislation that dredges up a 2007 prostitution scandal involving Vitter. The confrontation is a perfect illustration of just how wide the gulf in attitudes is between the Beltway and the rest of the country -- and how viciously Capitol Hill denizens will fight for their privileges.
Democratic and Republican staffers alike were furious, warning that Congress faced a "brain drain" if the provision stuck. Under behind-the-scenes pressure from members of Congress in both parties, President Obama used the quiet of the August recess to personally order the Office of Personnel Management, which supervises federal employment issues, to interpret the law so as to retain the generous congressional benefits. [National Review Online, 9/16/13]
Heritage Foundation: "Washington's Arrogant Political Class Is Getting Exemptions Or Special Treatment Denied To Ordinary Americans." According to a September 16 post on the Heritage Foundation's The Foundry blog, Congress is getting a special subsidy "through questionable administrative action" and is getting "special treatment" not available to the general public:
While Members of Congress and their personal staffs are required to enroll in Obamacare's exchanges, the White House, through questionable administrative action, is providing them hefty taxpayer subsidies to offset the resultant increase in their personal health care costs. In other words, Washington's arrogant political class is getting exemptions or special treatment denied to ordinary Americans. [Heritage Foundation, 9/16/13]
FACT: The Obama Administration Is Not Exempting Congress From The Health Care Law
FactCheck.org: "'Special Subsidy' ... Is Simply A Premium Contribution" The Federal Government Has "Long Made To The Health Insurance Policies Of Its Workers." A FactCheck.org article from August 30 explained that a similar claim made by Rep. Robert Pittenger (R-NC) was "misleading" and that "lawmakers and their staffs face additional requirements that other Americans don't":
Republican Rep. Robert Pittenger is misleading his constituents by saying that he will decline the health insurance offered to members of Congress next year because it includes a "special subsidy" from the president that "exempted" Congress from the Affordable Care Act.
Congress isn't "exempt" from the law. It wasn't exempt back in 2010, when we first debunked such a claim; nor were lawmakers exempt in May when the bogus bit surfaced again. Three months later, they're still not exempt. In fact, as we've said before, lawmakers and their staffs face additional requirements that other Americans don't. And the "special subsidy" to which Pittenger refers is simply a premium contribution that his employer, the federal government, has long made to the health insurance policies of its workers.
Our readers may recall that before this provision was created, there were claims circulating that Congress was "exempt" from the law. This twisted reading of the legislation was based on the fact that originally Congress, like other Americans with work-based insurance or Americans on Medicare and Medicaid, wouldn't be eligible for the exchanges. In other words, Congress was supposedly "exempt" when members couldn't participate in the exchanges, and now that they are required to do so, they're still somehow "exempt" from the law. Neither of these convoluted claims is true. [FactCheck.org, 8/30/13]
Fox News: Dropping Out Of Exchanges Would Increase Premium Prices. A September 16 segment on Fox News' Fox & Friends discussed insurers dropping out of some state exchanges, which Fox Business Network's Kate Rogers claimed could spike prices:
ROGERS: Well we've long known that the Affordable Care Act would propel people into our U.S. health care system, increasing demand for coverage. But what we've seen starting since this past May, were insurers actually dropping out of the individual market and that means that costs could really go up for consumers if demand is going up and supply is going down, both of those things can spike prices. [Fox News, Fox & Friends,9/16/13]
Daily Caller: HHS Released Its Premium Rates And One Think Tank Analysis Found "Many Consumers Are In For Higher Costs." A September 25 article in The Daily Caller claimed that an analysis by the Manhattan Institute for Public Policy Research found that, compared to current insurance rates, many consumers will face higher costs:
Just days away from its launch, the Department of Health and Human Services has finally released premium rates for the 36 state Obamacareexchanges it will run. One analysis found many consumers are in for higher costs.
HHS proudly announced that the final premiums it's decided on are lower than the Congressional Budget Office (CBO) had originally predicted. But though the prices are lower than the CBO had thought, both of those numbers are dramatically higher than what Americans currently pay.
The conservative Manhattan Institute for Public Policy Research compared HHS's numbers to current insurance premium averages and found thatObamacare will almost double underlying insurance rates for the average 27-year-old man, Avik Roy reported in Forbes. [The Daily Caller, 9/25/13]
FACT: Premiums Will Be Lower Than Expected
CBS News: "Premiums Nationwide Are Expected To Be Around 16 Percent Lower Than Originally Predicted." A September 25 CBS News article highlighted a recent report released by the U.S. Health and Human Services Department which found that premium prices nationwide are "expected to be around 16 percent lower than originally predicted" :
When open enrollment begins on the online, state-based marketplaces established under Obamacare, premiums nationwide are expected to be around 16 percent lower than originally predicted, the U.S. Health and Human Services Department said in a new report released Wednesday.
The administration sees the lower-than-expected premiums as a sign that the plan to drive down health costs for consumers by increasing competition is working. They also point to the insurers entering the individual health insurance market for the first time as a sign of strong competition, as well as the variety of plans that will be available on the market.
For families nationwide, "these new options will finally make health insurance work within their budget," Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday. [CBS News, 9/25/13]
HHS: "Nearly 6 In 10 Uninsured Americans Can Pay Less Than $100 Per Month For Coverage In The Health Insurance Marketplace." A September 17 press release by HHS found that under the new state-based exchanges six in 10 uninsured Americans can pay less than $100 a month with subsidies included:
A new report released today by the Department of Health and Human Services (HHS) shows that 56 percent, or nearly six in ten of the people who don't have health insurance today may be able to get coverage through the Health Insurance Marketplace for less than $100 per month.
Beginning on October 1, individuals and families will have a new way to shop for coverage through the Health Insurance Marketplace. They'll be able to compare their options using side-by-side information about price, quality and benefits. With one application they'll be able to see if they qualify for premium tax credits or Medicaid that lower the costs of coverage right away. Coverage through the Marketplace starts as early as January 1, 2014. [HHS.gov, 9/17/13]
Fox's Sarah Palin: "Of Course There Are Death Panels" In "Evil" Obamacare. During a segment on Fox News' Cashin' In, Fox News contributor Sarah Palin advanced the "death panels" myth, saying:
PALIN: Of course there are death panels in there. But the important thing to remember is that's just one aspect of this atrocious, unaffordable, cumbersome, burdensome evil policy of Obama's and that is Obamacare. [Fox News, Cashin' In, 8/10/13]
Breitbart.com's John Nolte: Death Panels "Are Already A Part Of Obamacare." Breitbart.com columnist John Nolte claimed that "death panels" are included in the health care law:
The first services usually axed by death panels staffed with a handful of bureaucrats are the costly and uncertain experimental procedures that sometimes fail many times before leading to a breakthrough, as well as expensive, life-saving operations on the ill, handicapped, and elderly.
Some Democrats, most notably Howard Dean, are already pushing back against the "death panels" that are already a part of ObamaCare. [Breitbart.com, 8/10/13]
Fox's Marc Siegel: IPAB Is "A Death Panel, It's A Rationing Board." On Fox News' Your World with Neil Cavuto, Fox News contributor Marc Siegel called the Individual Payment Advisory Board (IPAB) "a death panel" and "a rationing board." [Fox News, Your World with Neil Cavuto, 8/6/13, via Media Matters]
Fox's Eric Bolling: IPAB Decides "What Medical Treatment I'm Going To Be Able To Get." On Your World, Fox host Eric Bolling said that "the whole point of [IPAB] is to decide what medical treatment I'm going to be able to get." [Fox News, Your World with Neil Cavuto, 8/6/13, via Media Matters]
Rush Limbaugh: "Death Panels" Will Decide "Who Gets What, Who Gets Paid For And Who Doesn't." On his radio show, Rush Limbaugh claimed, "There's a thing in Obamacare called death panels that are going to decide what, you know, who gets what, who gets paid for and who doesn't." [Premiere Radio Networks, The Rush Limbaugh Show, 8/1/13]
Fox's Sean Hannity: "Obamacare Death Panels Are In Fact Alive And Well." On his Fox News show, host Sean Hannity said that "there is new evidence to suggest the so-called Obamacare death panels are in fact alive and well." Hannity interviewed Palin, who said that her "claim that death panels were a part of Obamacare and the rationing of health care services" has "proven to be true." [Fox News, Hannity, 7/30/13, via Nexis]
FACT: Law Does Not Allow IPAB To Recommend Rationing Health Care
Health Care Law Explicitly States That IPAB Cannot Make "Any Recommendation To Ration Health Care." The text of the ACA confirms that IPAB cannot make "any recommendation to ration health care... or otherwise restrict benefits or modify eligibility criteria":
The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria. [Patient Protection and Affordable Care Act, accessed 8/13/13, OpenCongress.org]
PolitiFact: IPAB "Wouldn't Make Any Health Care Decisions For Individual Americans." A PolitiFact analysis of the claim that IPAB would make the final decision on available treatments found that IPAB would make broad policy decisions, not individual recommendations. It also noted that IPAB is "forbidden from submitting 'any recommendation to ration health care'":
The health care law directs a new national board -- with 15 members who are political appointees -- to identify Medicare savings. It's forbidden from submitting "any recommendation to ration health care," as Section 3403 of the health care law states. It may not raise premiums for Medicare beneficiaries or increase deductibles, coinsurance or co-payments. The IPAB also cannot change who is eligible for Medicare, restrict benefits or make recommendations that would raise revenue.
What it can do is reduce how much the government pays health care providers for services, reduce payments to hospitals with very high rates of re-admissions or recommend innovations that cut wasteful spending. Some argue that because the IPAB can reduce the money a doctor receives, this could lead to an indirect form of rationing.
But the board wouldn't make any health care decisions for individual Americans. Instead, as PolitiFact Georgia reported, it would make broad policy decisions that affect Medicare's overall cost. [PolitiFact, 10/3/12]
Wash. Post's Glenn Kessler: The ACA "Explicitly Says That The Recommendations Cannot Lead To Rationing Of Health Care." Washington Post fact checker Glenn Kessler wrote that IPAB "appears aimed at doing the same thing as the House Republican Medicare plan":
The health-care law explicitly says that the recommendations cannot lead to rationing of health care. Of course, "rationing" is in the eye of beholder, and one common complaint is that rationing is not defined. The law also limits recommendations that would change benefits, modify eligibility or increase Medicare beneficiary cost-sharing, such as deductibles, coinsurance and co-payments.
On the surface, the IPAB appears aimed at doing the same thing as the House Republican Medicare plan -- reducing the runaway costs of Medicare, except on a faster track. (The GOP plan would not kick in until 2021, just a few years before the Medicare hospital fund begins to run dry.) [The Washington Post, 10/4/12]
PolitiFact: "Of All The Falsehoods And Distortions In The Political Discourse This Year, "Death Panels "Stood Out From The Rest." In December 2009, PolitiFact named "death panels" its 2009 "Lie of the Year":
Of all the falsehoods and distortions in the political discourse this year, one stood out from the rest.
The claim set political debate afire when it was made in August, raising issues from the role of government in health care to the bounds of acceptable political discussion. In a nod to the way technology has transformed politics, the statement wasn't made in an interview or a television ad. Sarah Palin posted it on her Facebook page.
Her assertion -- that the government would set up boards to determine whether seniors and the disabled were worthy of care -- spread through newscasts, talk shows, blogs and town hall meetings. Opponents of health care legislation said it revealed the real goals of the Democratic proposals. Advocates for health reform said it showed the depths to which their opponents would sink. Still others scratched their heads and said, "Death panels? Really ?"
The editors of PolitiFact.com, the fact-checking Web site of the St. Petersburg Times , have chosen it as our inaugural "Lie of the Year." [PolitiFact,12/18/09]
Fox's Erick Erickson: Shutting Down The Government Over Obamacare Is "The Right Thing To Do." On the September 13 edition of Fox News' Your World with Neil Cavuto, Fox contributor Erick Erickson called defunding Obamacare "the right thing to do":
ERICKSON: You've got dozens and dozens of Republicans who ran into office and got elected saying they were going to do every single thing they could to stop Obamacare. They have a choice now right now to defund it. And now they're saying, "Oh well we can't do that because we might get blamed for a shutdown." So what? It's the right thing to do. American companies are shutting down because they won't shut down Obamacare. [Fox News, Your World with Neil Cavuto, 9/13/13, via Media Matters]
Fox News Radio Host Todd Starnes On Defunding: "Anything Less Is A Betrayal To The People." Fox News Radio host Todd Starnes called on Republicans to defund Obamacare, even if it leads to a government shutdown:
Push will come to shove and Republicans need to be willing to shove back. If that means a government shutdown in October -- so be it.
"If there's ever been a time for politicians to take a risk on their next election, it's stopping the government takeover of healthcare," said Jim DeMint, president of the Heritage Foundation. "This is not about political party or political calculation."
We need men and women who share DeMint's fortitude in the House and Senate. We need lawmakers who are willing to stand their ground and stand up for the American people.
It's time for Republicans to stand up and do the job they were elected to do. Anything less is a betrayal to the people who sent them to Washington, D.C. [FoxNews.com, 9/20/13]
Hannity Applauds Sen. Cruz's Defunding Effort: "I'm With You In This." On the September 23 edition of his Fox News show, host Sean Hannity interviewed Sen. Ted Cruz (R-TX) on his efforts to defund and repeal the Affordable Care Act. After allowing Cruz a platform to criticize ACA and advocate defunding measures which could lead to a government shutdown, Hannity agreed, saying "I applaud your efforts. I'm with you in this. To me, this is a tipping point for the country." [Fox News, Hannity, 9/23/13, via Nexis]
FACT: Health Care Law Would Continue Even During A Government Shutdown
Washington Post: Affordable Care Act Implementation Would Continue Even During A Government Shutdown. According to an article in The Washington Post, "Eighty-five percent of the Affordable Care Act's funding comes from mandatory spending that would not be affected by a shutdown." Therefore, as, David Simas, White House deputy senior adviser for communications and strategy, explained, that while there may be some impacts of a shutdown, "it does not go into the core of what we are doing." [The Washington Post, 9/25/13]
Myth #5: The Affordable Care Act Is "Socialized Medicine" And A "Government Takeover" Of Health Care
Fox News' Monica Crowley: "You Don't Surrender The Nation To Socialized Medicine Just Because You Think That You Can't Win The PR Battle." Fox News' Monica Crowley pushed the idea that Congress should consider a government shutdown unless a resolution funding the government included defunding the Affordable Care Act. When faced with opposition to that opinion from a Fox colleague, Crowley explained that, "You don't surrender the nation to socialized medicine just because you think that you can't win the PR battle." [Fox News, Happening Now, 9/20/13, via Media Matters]
Fox Quotes Heritage Foundation's Jim DeMint: Politicians Need To Stop "The Government Takeover Of Healthcare." According to a September 20 piece on FoxNews.com by Fox News Radio reporter Todd Starnes, Heritage Foundation president Jim DeMint defended a decision to cause a government shutdown over funding the Affordable Care Act claiming it was worth it to"take a risk" in order to stop "the government takeover of healthcare":
"If there's ever been a time for politicians to take a risk on their next election, it's stopping the government takeover of healthcare," said Jim DeMint, president of the Heritage Foundation. "This is not about political party or political calculation." [FoxNews.com, 9/20/13]
FACT: The Affordable Care Act Is Not Socialized Medicine Or A Government Takeover Of Health Care
PolitiFact Named "Government Takeover Of Health Care" As Its 2010 "Lie Of The Year." In its article declaring "a government takeover of health care" to be the Lie of the Year, PolitiFact explained how the law "relies largely on the free market" and "private companies":
"Government takeover" conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:
- Employers will continue to provide health insurance to the majority of Americans through private insurance companies.
- Contrary to the claim, more people will get private health coverage. The law sets up "exchanges" where private insurers will compete to provide coverage to people who don't have it.
- The government will not seize control of hospitals or nationalize doctors.
- The law does not include the public option, a government-run insurance plan that would have competed with private insurers.
- The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.
PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.
It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.
Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.
But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don"t currently have coverage will get it, for the most part, from private insurance companies. [PolitiFact, 12/16/10]
Times-Dispatch: "People Who Want Federal Help Paying For Their Health Insurance Will Not Have To Prove They Are Eligible For It." A September 23 editorial in the Richmond Times-Dispatch claimed that the Obama administration announced in July that people requesting subsidies under the Affordable Care Act's individual exchanges will not have to prove they are eligible for the subsides nor will anyone "check to see whether you're legally entitled to collect them":
People who want federal help paying for their health insurance will not have to prove they are eligible for it, the Obama administration has announced. ("Announced" isn't quite the right word, though - given that the decision was buried in a 600-page regulation quietly released over the Fourth of July weekend.) This means you can apply for insurance subsidies through Obamacare's new state-by-state exchanges, and nobody will check to see whether you're legally entitled to collect them. [Richmond Times-Dispatch, 9/23/13]
Manhattan Institute's Avik Roy: Obama Administration Is "Deliberately Encouraging Tens Of Billions Of Dollars Of Waste, Fraud, And Abuse" By Not Requiring Eligibility Verification. A July 6 opinion piece in Forbes by Manhattan Institute senior fellow Avik Roy explained that the law doesn't require verification before giving subsidies to those who are enrolling in the exchanges and initially only works on the "honor system." The piece continues:
The goal here is plain as day. The Obama administration is laser-focused on making sure that enough Americans enroll onto Obamacare-subsidized health insurance platforms, because if they do, it will be politically impossible for Republicans to repeal Obamacare in the future.
Politics ain't beanbag, they say. But deliberately encouraging tens of billions of dollars of waste, fraud, and abuse in order to achieve a political objective is profoundly immoral. It's a breach of faith with the hard-working taxpayers whose paychecks are being harnessed to a cause many of them don't support. [Forbes, 7/6/13]
Breitbart.com: "Experts Say" Lack Of Eligibility Verification "Could Result In Billions Of Dollars In Waste, Fraud, And Abuse." A Breitbart.com piece pushed comments by Manhattan Institute's Avik Roy who claimed that subsidy fraud could result in "billions of dollars of waste, fraud, and abuse":
Obamacare's delayed implementation of the employer mandate means health insurance exchanges and the Internal Revenue Service (IRS) will be unable to determine whether individuals are eligible for taxpayer-funded subsidies and will instead now rely on the honor system. Experts say the shift could result in billions of dollars in waste, fraud, and abuse.
Forbes writer Avik Roy says the reason for the Obama Administration's decision to move forward with the new scheme is clear.
"The goal here is plain as day," writes Roy. "The Obama administration is laser-focused on making sure that enough Americans enroll ontoObamacare-subsidized health insurance platforms, because if they do, it will be politically impossible for Republicans to repeal Obamacare in the future."
Roy added: "Deliberately encouraging tens of billions of dollars of waste, fraud, and abuse in order to achieve a political objective is profoundly immoral." [Breitbart.com, 7/7/13]
FACT: Government Has Established Subsidy Verification Measures
Full Verification System Is Delayed Until 2015, But Government Will Conduct Audits Of Those Suspected Of Fraud. According to an article in The Washington Post discussing the Obama administration's decision to delay full verification measures until 2015, the federal government will conduct audits for federally managed exchanges and some state exchanges of "a statistically significant sample" of those who underreport their income. [The Washington Post, 7/5/13]
CNN Money: "Exchanges Must Still Check The Applicant's Income Against A Federal Database." According to a July 15 CNN Money article, eligibility will still be checked against an applicant's income. However, the exchange may "choose to rely on what the applicant says":
The new rule doesn't fully excuse exchanges from having to verify income, said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities.
Exchanges must still check the applicant's income against a federal database, which will include information from his federal tax returns and a record of Social Security benefits.
The exchanges will be looking for disparities between what the applicant says and what's in the database.
If it looks like someone is understating his income by more than 10%, and the exchange doesn't have other sources to quickly check against, the exchange may choose to rely on what the applicant says.
But in those cases, the exchange must also conduct a random sample of similar applicants to make sure the verification process is working. [CNN Money, 7/15/13]
Federal Government Already Has Income Verification Tools Which Could Aid In Verifying Eligibility. A September 16 Health Affairs post explained that the federal government can use "Medicaid's third-party liability system and Medicare's coordination-of-benefits mechanisms," which already collect information on "which companies offer and which employees and dependents receive ESI [employer-sponsored insurance]." [Health Affairs, 9/16/13]
Health Insurance Marketplaces Can Verify "7 In 10 Subsidy-Eligible Consumers" By Ensuring Recipients Or Their Spouses Don't Work For Companies That Offer ESI. The Health Affairs article explained that if health insurance marketplaces establish which employers give employer-sponsored insurance by using federal verification tools, they would "verify eligibility for more than 7 in 10 subsidy-eligible consumers," which would allow audits to "focus exclusively on subsidy recipients who work for companies that offer ESI." [Health Affairs, 9/16/13]
CNN Money: Exchanges Are "Only Approving Estimated Tax Credits," IRS Does Final Subsidy Calculation. According to CNN Money, someone who "slips through the cracks - and gets more of a subsidy than he is entitled to" - can still be identified because the exchanges are "only approving estimated tax credits," and the "final calculation of a subsidy's size will be done after the fact by the IRS." [CNN Money, 7/15/13]
Washington Post: "Lying On The Exchange Form Carries With It A Penalty Of As Much As $25,000." According to an article in The Washington Post, "lying on the exchange form carries with it a penalty of as much as $25,000," and an individual who lied about income on the form would have to "pay back the extra subsidies when filing a tax return for 2014." [The Washington Post,7/5/13]
Government Currently Uses The "Honor System In Situations In Which It Collects Data On Millions Of Individuals." The Washington Post quoted Washington and Lee University law professor Timothy S. Jost who explained that "the honor system" -- or the consumer self-reporting system that the government will rely on until other verification measures are in place -- is not unprecedented and is used "in situations in which [government] collects data on millions of individuals" such as "people [who] are expected to report their cash tips to the Internal Revenue Service as income." The article continued:
"An awful lot of the economy is a cash economy," [Jost] said. "If we had to verify every statement that was made to the IRS, our economy would collapse." [Washington Post, 7/5/13]
Las Vegas Review-Journal: If Your Doctor Isn't In The Narrow Network, "You Will Not Be Able To Keep Your Doctor. Period." According to an editorial in the Las Vegas Review-Journal, President Obama's promise that Americans can keep their doctors and health care plans if they like them is false because of "skinny networks" which would cut "the number of doctors and hospitals they contract with":
President Barack Obama's 2009 guarantee was emphatic. "We will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period."
ObamaCare exchanges roll out in less than two weeks. The Patient Protection and Affordable Care Act -- or at least the portions of it the president deems politically expedient -- takes effect Jan. 1. And many Nevadans are about to learn the value of the president's word -- and get notice worthy of an exclamation-point tirade.
As reported by the Review-Journal's Jennifer Robison on Sept. 12, Nevada's insurers are expected to control the costs of dozens of coverage mandates by slashing the number of doctors and hospitals they contract with, creating what local employee benefits consultants call "skinny networks."
If you like your doctor, and your doctor isn't in your new skinny network, then guess what? You will not be able keep your doctor. Period. [Las Vegas Review-Journal, 9/19/13]
Union Leader: Insurers Under Obamacare Will Limit Health Care Access For All. A September 23 Union Leader editorial pointed to limited insurance networks, or narrow networks, created to cover the uninsured as a failure of the ACA:
It turns out that New Hampshire is not alone in having health care choices constrained by Obamacare. The New York Times reported on Sunday that insurers in many states are shrinking their provider networks because of the Affordable Care Act.
"Federal officials often say that health insurance will cost consumers less than expected under President Obama's health care law," the Times reported. "But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers." [New Hampshire Union Leader, 9/23/13]
FACT: Narrow Networks Provide Health Care Coverage While Keeping Costs Low
NYT: Narrow Networks Hold Down Costs For "Low- And Moderate-Income People." According to a September 22 New York Times article, narrow networks make health insurance affordable to the uninsured by reducing costs due to streamlined provider networks:
When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers. [The New York Times, 9/22/13]
BDC Advisors: New Narrow Networks Have An Emphasis On Quality And Cost Savings. According to BDC Advisors, a strategy consulting firm, new narrow insurance networks are focused on providing quality care and cost savings:
A recent BDC survey of national and regional Health Plans indicates there is a resurgence of narrow, tailored, tiered and high performance networks products in the market with premiums substantially below traditional open access offerings and with a new focus on quality. These new benefits plans are now being embraced by the market after falling into disfavor over the past decade for allegedly sacrificing quality for cost, as benefits managers opted for full service HMOs and open access PPO alternatives. Now with employers and patients seeking greater value for their health care dollars, businesses are showing a new willingness to offer narrow network products which encourage members to use more efficient health care alternatives, either by restricting networks to the most efficient providers and/or by having different copays and coinsurance for providers in different tiers of the network. [BDC Advisors, accessed 9/24/13]
EBRI: Employee Benefits Have Generally Relied On Restricted Networks. According to a 2009 Employee Benefit Research Institute (EBRI) study, many Americans who receive employee health benefits coverage are already enrolled in a type of narrow network:
In 2008, 98 percent of Americans with employment-based health benefits were enrolled in some kind of managed care plan (Claxton et al., 2008). Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) represent a great majority of that enrollment, with approximately 80 percent. A managed care system typically provides, arranges for, and finances medical services using provider payment methods that encourage cost containment by contracting with select networks of providers.
Before the spread of managed care in the 1990s, insurance coverage was mostly based on a fee-for-service (FFS) system. Beneficiaries in the plan picked their doctors and hospitals at will. Payment was made by the beneficiary when service was rendered, or the health care provider accepted assignment of the claim from the beneficiary, and afterward claim forms were submitted to the insurance company (or self-insured plan sponsor) for reimbursement. Under managed care, enrollees are often required to follow utilization review and disease management procedures in order to secure coverage for services received. [Employee Benefit Research Institute, accessed 9/24/13]
Massachusetts, Which Uses Narrow Networks, Matches National Average In Health Access And Availability Of Care. According to the Massachusetts Center for Health Information and Analysis, the state's health plan performance --which includes narrow networks-- matches the national average of health care access:
Massachusetts health plan performance was in line with the national average. There was also little variation across plans on two HEDIS measures used to evaluate adults' and childrens' access to primary care practitioners and preventive care, a key indicator of health care access. The measures evaluate the proportion of enrollees that had the recommended preventive care visits; higher rates indicate greater access to preventive care.
For adults, the Massachusetts average score (96%) was in line with the national average (95%) (Figure 14). Among the health plans examined, there was little variation; performance ranged from 94% (Neighborhood Health Plan (NHP)) to 97% (HPHC PPO). On the children's access measure, the average scores were between 97% and 99%. For the seven payers analyzed, scores exceeded national averages and, in all age ranges for children, every product scored above 95% on these measures. [Massachusetts Center for Health Information and Analysis, August 2013]
Las Vegas Review-Journal: Narrow Networks On The Exchanges Apply To Newly Insured Or Those Who Switch Coverage. According to an article in the Las Vegas Review-Journal, narrow networks will appear on exchanges used by people seeking new insurance coverage:
Whether you'll see a trimmed-down network in 2014 depends on your current coverage. If you have a policy through a big company or a self-insured business, and you don't change plans Jan. 1, your network should stay the same. If you have to change plans, or if you're buying for the first time, you could see thin networks. [Las Vegas Review-Journal, 9/11/13]
Betsy McCaughey: Health Care Law "Diminishes Women's Freedom And Privacy." In a New York Post op-ed, former New York Lt. Gov. Betsy McCaughey claimed that the Affordable Care Act "diminishes women's freedom and privacy" and "vastly expands the president's power over your insurance plan, your doctors' decisions and your medical records." [New York Post,3/14/12]
NRO: "President Obama's Signature Health-Care Overhaul Is An Assault On Women's Freedom." A National Review Online piece outlined 10 reasons why "President Obama's signature health-care overhaul is an assault on women's freedom," including claims that it will drive up women's health care costs and make it harder to find doctors. [National Review Online, 6/13/12]
FACT: The Affordable Care Act Significantly Benefits Women
Kaiser Health News: Women Are Entitled To "Free Preventative Care, Including Birth Control." According to a September 24 Kaiser Health News story produced in partnership with Cosmopolitan magazine, women can receive birth control and other preventative care under the ACA:
You're entitled to free preventive care, including birth control. Since 2012, nearly 30 million women have benefitted from free preventive services including checkups, screenings for diabetes and HIV, contraceptives and family planning counseling. The law requires plans to cover all FDA-approved birth control methods without co-pays. This includes pills, injectables, implants, intrauterine devices (IUDs), and sterilization procedures. Plans must cover all brand name contraceptives without generic equivalents, or where the generic equivalent is medically inappropriate. [Kaiser Health News, 9/24/13]
All Plans Will Be Required To Provide Maternity Coverage. According to Kaiser Health News, the Affordable Care Act ensures that all plans cover maternity coverage, which only 12 percent of plans on the individual market currently do:
You'll have maternity coverage, no matter what. You may not know this but only about 12 percent of health plans sold on the individual market currently include coverage for maternity, according to Judy Waxman of the National Women's Law Center. But starting next year, all individual health plans will have to include 10 essential health benefits including maternity care, as well as hospitalization, prescription drugs, mental health services and preventive services. [Kaiser Health News, 9/24/13]
Under ACA, Women Cannot Be Charged More Than Men For Coverage. Kaiser Health News explains that, according to the National Women's Law Center, in 30 percent of cases, nonsmoking women have been charged more than men who smoked. Starting in 2014, "gender rating will be outlawed." [Kaiser Health News, 9/24/13]
HHS: Women Will Receive Eight Preventative Services With No Co-Pays. According to a Health Resources and Services Administration fact sheet, women will receive eight preventative services with no co-pays including: well-women visits, screening for gestational diabetes, human papillomavirus (HPV) testing, counseling for sexually transmitted infections, counseling and screening for human immune-deficiency virus (HIV), contraceptive methods and counseling, breastfeeding support, supplies, and counseling, and screening and counseling for interpersonal and domestic violence. [HRSA.gov, accessed 9/27/13]
Washington Times: "Taxpayer Funding Of Abortions Set To Increase Under Obamacare."According to The Washington Times, ACA funding will be used to provide abortions:
As Americans cast ballots in one of the most critical elections in decades, many would be surprised to learn that the current administration is prepared to funnel millions of dollars in new Medicaid funding to abortion providers. Only President Romney working with the new Congress can stop it. [The Washington Times,10/31/12]
Union Leader: Planned Parenthood Will Receive ACA Funds To Provide "Abortion On-Demand." An August 19 editorial in the New Hampshire Union Leader used the announcement that Planned Parenthood of Northern New England would receive navigator grant money to claim that Planned Parenthood's "core business includes abortion-on-demand," and quoted a source who said that "federal dollars and public funds shouldnot be granted to this organization." [New Hampshire Union Leader, 8/19/13]
FACT: Funding Stemming From The ACA Will Not Cover Abortions
Planned Parenthood VP: Navigator Grants "Have Nothing To Do With Abortion And Won't Be Used For Abortion Services." Planned Parenthood Vice President Eric Ferrero stated that more than 90 percent of Planned Parenthood health centers provide "basic, preventative care" for women, and the funds received under the navigator grant program "won't be used for abortion services" and "have nothing to do with abortion." [Reuters, 8/16/13]
CMS: Planned Parenthood Of Northern New England Will Assist Patients With "Navigating The Health Insurance System." According to the list of navigator grant recipients provided by the Centers for Medicare & Medicaid Services, the Planned Parenthood of Northern New England fulfills the requirements of the grant program because they are a nonprofit health care provider which will assist patients with "understanding new programs" and "navigating the health insurance system to find the most affordable coverage that meets their needs." [Centers for Medicare & Medicaid Services, 8/15/13]
Columbus Dispatch: "Many Employers Are Cutting Employee Hours" So They Do Not Have To Pay For Health Insurance For Their Employees. The Dispatch editorial claimed that "many employers" are cutting their employee's hours to less than 30 hours per week in order to avoid paying their health care costs:
Because the law says full-time employees must be offered health insurance, and then redefines full time as 30 hours, rather than the traditional 40 hours, many employers are cutting employee hours so they don't hit the 30-hour threshold. [The Columbus Dispatch, 8/28/13]
Fox News: "Ohio Clinic Touted By Obama Slashes Budget Due To ObamaCare." According to a September 19 Fox News report, the Cleveland Clinic - the "largest employer in Northeast Ohio" - was forced to cut its budget due to the ACA:
An Ohio clinic that was touted by Obama while he was speaking on health care reform is now blaming ObamaCare after it was forced to cut $330 million from its budget.
Fox 8 reports the Cleveland Clinic, which is the largest employer in Northeast Ohio with about 39,000 workers in the region, announced the cuts to its 2014 budget at a meeting Wednesday.
A spokeswoman for the clinic tells Fox News the clinic is being forced to cut back to prepare for increased costs and decreased revenue under the health care reform law.
These changes will include offering early retirement to approximately 3,000 employees, reducing operational costs, and then layoffs as needed.
The clinic says its main priority is to continue to provide a high quality of care during the transition, an attribute that led Obama to tout it in 2009 as an example of what hospitals could be under ObamaCare. [FoxNews.com, 9/19/13]
FACT: Small Businesses Have Seen Increased Hiring As Economy Improves; Employers Show Few Signs Of Reducing Work Force Due To The ACA
USA Today: The Individual Mandate For Businesses To Provide Coverage Has Not Deterred Hiring. According to an August 21 USA Today article, there is no evidence that the ACA has caused small businesses to stop hiring:
The gains are beginning to shift the terms of the debate over the health care law. Under the law, businesses with 50-plus full-time-equivalent workers must offer insurance to people working 30 hours a week beginning in 2015. That mandate, originally slated for 2014, has not deterred hiring as feared, some economists now say.
As more data come in, the law's impact can't be seen in hiring statistics, says Mark Zandi, chief economist of Moody's Analytics.
"I was expecting to see it. I was looking for it, and it's not there,'' says Zandi, whose firm manages ADP's surveys of overall private-sector job creation. If the Affordable Care Act "were causing a drop, you would see meaningful slowing.'' [USA Today, 8/21/13]
Federal Reserve Bank Of Minneapolis Study: 89 Percent Of Individuals Surveyed Said Their Companies Did Not Plan To Cut Hours For Employees. According to a study by the Federal Reserve Bank of Minneapolis, of the 205 contacts surveyed, 89 percent reported no plans to cut workers' hours due to the Affordable Care Act:
The survey asked: Has your company or organization shifted to more part-time workers in response to the Affordable Care Act (federal health insurance requirements)?
Only 4 percent said they had shifted to more part-time workers, while another 7 percent said they planned to do so. But 89 percent said they had not made, nor were planning, such a move.[Federal Reserve Bank Of Minneapolis, 3/20/13]
CEPR Study: Only 0.6 Percent Of The Workforce Work Just Below 30 Hour Cutoff. According to a July 2013 study by the Center for Economic and Policy Research, an analysis of the Current Population Survey shows that only 0.6 percent of the workforce is currently working just under the 30 hour cutoff for a full-time employee, suggesting "that employers do not appear to be changing hours in large numbers in response to the sanctions in the ACA." [Center for Economic and Policy Research, July 2013]
Federal Reserve Bank Of San Francisco Study: Any Effect ACA Has On Reduced Hours For Workers Is "Likely To Be Small." According to a study by the Federal Reserve Bank of San Francisco, "most large employers already faced IRS rules" preventing them from denying coverage to full-time workers but haven't reduced workers' hours to avoid paying those costs. The report further notes that once the ACA is fully implemented, "the ultimate increase in the incidence of part-time work [...] is likely to be small, on the order of a 1 to 2 percentage point increase or less." [Federal Reserve Bank of San Francisco, 8/26/13]
The Atlantic: "Much Of What The Cleveland Clinic System Is Doing Follows The Recommendations Of Health-Care Analysts Closely." According to a September 20 story in The Atlantic, the Cleveland Clinic has been "working on reducing costs for years" to be viable but reports it is "still hiring" and is following normal procedures in cutting its budget:
In fact, the "Obamacare is killing jobs" story isn't really accurate. It's not totally false -- the Cleveland Clinic will in fact take in less money because of the law --but it's a more complicated story about changes in medicine. When I reached Sheil on Thursday, she seemed a bit confused by the emphasis on Obamacare in reports. "We've been working on reducing costs for years," she said.
"We felt health-care reform was absolutely necessary," Sheil said. "This is the new normal. This is where hospitals have to focus to be viable in the long run. This is not doomsday for the clinic. We're still growing -- we're still hiring. The hardest thing is when it affects people."
Actually, much of what the Cleveland Clinic system is doing follows the recommendations of health-care analysts closely. For example, it has consolidated closely located neonatal intensive care units, because high volumes tend to lead to better results. It's working to reduce the number of procedures its staff performs, since in the current system "physicians are rewarded to do more, not to do the right thing for the patient," as Sheil put it. And there's a new focus on chronic diseases, which are an increasingly important and costly area for treatment. [The Atlantic, 9/20/13]
Fox News' Steve Doocy Suggests The IRS Could Use Health Records To Interfere With Conservatives' Healthcare. Fox & Friends co-host Steve Doocy suggested that the IRS would be able to access Americans' private health information and meddle in specific health procedures:
DOOCY: Well, this is a little scary. Just think about the nexus of IRS with healthcare and the fact that [Sarah Hall Ingram] -- keep in mind, one of the things from the IG report was, one of the problems with the IRS, was they blamed ineffective management. Well, she was the management, and now she's running Obamacare at the IRS? Going forward, just imagine: okay, so you go in and you're, you're trying to get a doctor's appointment; right? And they go, we see from your tax records -- how would that possibly be possible? -- We see from your tax records that you support the Tea Party or conservative groups. You want a doctor's visit? Three weeks. You want hip replacement? Four years. [Fox News, Fox & Friends, 5/17/13]
FACT: The IRS Will "Verify Insurance Coverage, But Nothing More"
Politico: "The Agency Will Verify Insurance Coverage, But Nothing More." A May 16 Politico article disputed the suggestion that the IRS would have the power to stand between conservatives and their doctors, quoting former IRS Acting Commissioner Steven Miller who explainedduring a September 2012 House hearing that the insurers will only provide insurance coverage information to the IRS:
In reality, the IRS is just supposed to verify that people have health coverage -- which means collecting records from employers and insurers, but not doctors.
And in September, then-IRS Acting Commissioner Steven Miller testified at a House hearing that the agency will verify insurance coverage, but nothing more. "It is important to note that the information that insurers provide to the IRS will show the fact of insurance coverage, and will not include any personal health information," he said in his prepared testimony. [Politico, 5/16/13]
Reuters: IRS Deputy Commissioner Steven Miller Testified Agency Will Not Audit Health Coverage. A September 11, 2012, Reuters article reported then-IRS Deputy Commissioner Steven Miller's clarification of the agency's role in implementing the Affordable Care Act to a subcommittee of the House Ways and Means Committee, pointing out that "[i]n most cases, taxpayers will file their tax returns reporting their health insurance coverage, and-or making a payment, and there will be no need for further interactions with the IRS":
The Internal Revenue Service on Tuesday assured congressional lawmakers that agents would play no role in enforcing the controversial requirement that Americans buy insurance under President Barack Obama's healthcare overhaul.
"IRS revenue agents will not be involved. There will not be audits," IRS Deputy Commissioner Steven Miller told a subcommittee of the tax-writing Ways and Means Committee in the Republican-controlled House of Representatives.
"In most cases, taxpayers will file their tax returns reporting their health insurance coverage, and-or making a payment, and there will be no need for further interactions with the IRS," Miller said. [Reuters, 9/11/12]
The New Republic: Idea That Obamacare Gives IRS Control Over Individuals' Health Care Is "Beyond Laughable." In a May 17 New Republic article, Jonathan Cohn called the idea that the Affordable Care Act would "meaningfully" expand the power of the IRS "beyond laughable." He highlighted the minor role that the agency would play in implementing the law and contrasted it with the agency's existing power:
[T]he notion that Obamacare meaningfully expands the power of the IRS, let alone that it will give its bureaucrats control over how people get medical care, is beyond laughable.
It's true that the IRS performs several of Obamacare's critical functions. Starting next year, the IRS will be distributing the tax credits that will make insurance affordable for millions of Americans. The IRS will also be responsible for enforcing the "personal responsibility requirement"--a.k.a., the individual mandate. To do that, it must figure out who has insurance, and then, under certain circumstances, impose a tax penalty on people who do not.
The medical privacy nightmare is a figment of the libertarian imagination. The IRS will never see an actual medical record, let alone meddle with decision-making by doctors and hospitals. The agency will deal entirely with financial matters--how much money you make and whether you have insurance.
[I]f you're worried about the IRS discriminating against individuals, selective application of a modest, non-enforceable tax penalty seems like a trivial matter given the other options the agency has at its disposal. After all, the IRS has the power to conduct audits, which can be brutal, and dial income tax penalties way up or down. [The New Republic, 5/17/13]
Richmond Times-Dispatch: Trusting Health Care Navigators Is Akin To Trusting The NSA. In his column for the Richmond Times-Dispatch, A. Barton Hinkle warned that health insurance navigators should not be trusted based solely on their federal government training and ignored laws set up to protect privacy:
Administration officials have insisted the law "maintains strict privacy controls to safeguard personal information." That sounds comforting. Then again, it sounded comforting when Director of National Intelligence James Clapper was asked whether the NSA collects "any type of data at all" on millions of Americans and replied "No, sir." We all know how true that statement was now. [The Richmond Times-Dispatch, 8/25/13]
FACT: Navigators Must Pass Federal Training Standards To Ensure Privacy Protection
The Hill: Navigators "Will Help People Make Sense Of Their Options Under Obamacare." The Hill described navigators as people who will be informed on the details of enrolling in insurance, but will not be agents of insurance companies:
The Health and Human Services Department on Friday finalized rules for the "navigators" who will help people make sense of their options under ObamaCare.
Traditional insurance agents cannot be certified as navigators, because navigators cannot be paid by a specific insurance company -- their charge is to help explain the system, not to sell a particular product.
"Navigators will be trained to play a vital role in fulfilling our commitment to help consumers learn about and apply for quality health insurance when open enrollment for consumers in the Marketplaces beginsOctober 1," said Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services. [The Hill, 7/12/13]
Virginia Code: Navigators Are Prohibited From Violating Privacy Requirements, Subject To State Government Oversight. Virginia law specifically prohibits navigators from violating "any unfair trade practice and privacy requirements." The law also requires the state to review any reports of violations to these requirements:
That the State Corporation Commission, through its review of complaints concerning activities of navigators pursuant to subsection C of § 38.2-3448, shall monitor the activities of navigators in the Commonwealth to determine whether and to what extent navigators operating in the Commonwealth have engaged in prohibited practices. The Commission shall report its findings to the Governor and the chairs of the Senate and House Commerce and Labor Committees annually onNovember 15, 2014, and November 15, 2015. [Health Benefit Exchange, Code of Virginia, Chapter 34 of Title 38.2, Article 7, accessed 9/27/13]
New York Post: "Obamacare Will Question Your Sex Life." According to a September 15 New York Post opinion piece by Betsy McCaughey, the ACA mandates doctors ask unrelated sexual history questions of patients with each doctors visit, and will turn doctors in "government agents":
'Are you sexually active? If so, with one partner, multiple partners or same-sex partners?"
Be ready to answer those questions and more the next time you go to the doctor, whether it's the dermatologist or the cardiologist and no matter if the questions are unrelated to why you're seeking medical help. And you can thank the Obama health law.
"This is nasty business," says New York cardiologist Dr. Adam Budzikowski. He called the sex questions "insensitive, stupid and very intrusive." He couldn't think of an occasion when a cardiologist would need such information -- but he knows he'll be pushed to ask for it.
The president's "reforms" aim to turn doctors into government agents, pressuring them financially to ask questions they consider inappropriate and unnecessary, and to violate their Hippocratic Oath to keep patients' records confidential. [New York Post, 9/15/13]
FACT: The ACA Does Not Require Doctors To Ask Unrelated Sexual History Questions
Asking About Sexual History Is Already Common Medical Practice And Not Mandated By The ACA. In responding to Betsy McCaughey's New York Post op-ed , Dr. Aaron Carroll refutes the claims that doctors will be forced to ask such questions as fabricated and misguided:
Evidently Ms. McCaughey knows some pretty crappy doctors, because if you consider it "inappropriate and unnecessary" to talk to your patients about their sex lives, then you really shouldn't be in the business. I agree that it's not necessary to ask these questions at every visit for every complaint. But seriously, a cardiologist is saying he can't imagine a single occasion when he might ask a patient about his sex life? Really? I'm speechless.
But it gets worse. Ms. McCaughey further misrepresents what the law does:
Embarrassing though it may be, you confide things to a doctor you wouldn't tell anyone else. But this is entirely different.
Doctors and hospitals who don't comply with the federal government's electronic-health-records requirements forgo incentive payments now; starting in 2015, they'll face financial penalties from Medicare and Medicaid. The Department of Health and Human Services has already paid out over $12.7 billion for these incentives.
There are federal EHR requirements. But those are part of the HITECH Act (which was part of ARRA), not Obamacare. What Obamacareintroduces is that insurance must now reimburse physicians for preventive services. These include things like STI counseling (which is why more docs may ask about sex). They also include lots of other stuff, especially for women and children. I'm fine with this, because these things work. They have evidence behind them. That's why they're in there. For years, we've paid for tons of things that don't work, while not paying for things that do. This tries to right that balance. [The Incidental Economist, 9/16/13]
Forbes: The ACA's Expansion Of Medicaid Will Push Doctors To Refuse Service To Patients Because Of Low Provider Reimbursements. According to a June 6 Forbes op-ed, doctors refuse to see patients covered under Medicaid because of low reimbursement rates, a practice that will grow with expanded Medicaid under the ACA:
Doctors are also becoming choosier about whom they'll see.
They've long limited the number of Medicaid patients they'll treat, thanks to the program's low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients.
Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.
These underpayments have grown worse over time, as cash-strapped states have tried to rein in spending on Medicaid. Ohio hasn't increased payments to doctors in three years; Kentucky hasn't raised them in two decades. Colorado, Nebraska, South Carolina, Arizona, Oregon, and Arizona all cut payments in 2011.
By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors. [Forbes, 6/10/13]
FACT: The Affordable Care Act Aims To Increase Medicaid Reimbursement Rates
Washington Post: The ACA Will Aim To Expand Access To Doctors By Increasing Medicaid Reimbursement Rates. According to a February 8 Washington Post blog post, the ACA will address doctors' concerns by increasing provider reimbursement rates:
The health-care law's big attempt at increasing Medicaid access takes on the exact same factor that we think inhibits access: Low reimbursement rates. The Affordable Care Act boosts Medicaid primary care reimbursement rates to match those paid by the Medicare program. Given that Medicaid rates tend to be really low, this works out to an average raise of 73 percent.
In the states that have been paying the lowest rates, the increase is even bigger.
Does that matter on the ground, to providers? It's hard to know from most of the Medicaid research, which was conducted before the Affordable Care Act expanded Medicaid. We do have one study though, from Michigan, which suggests that most doctors do feel like they can take on more Medicaid patients than they currently see. [The Washington Post, 2/8/13]
Civitas Institute: 30 Million People Will Remain Uninsured Under Obamacare. According to Civitas Review Online's September 11 post, 30 million people will be left without insurance after the Affordable Care Act (ACA) is fully implemented:
Meanwhile, the bad news keeps coming. Advocates of the health-care law say it was needed because millions of people couldn't get health insurance. Well, when ObamaCare goes fully into effect ... 30 million people will still lack health insurance. [Civitas Review Online, 9/11/13]
Heritage Foundation: Obamacare Spends $1 Trillion Dollars And Still Leaves 30 Million Uncovered. According to a July 25, 2012, post by the Heritage Foundation, the ACA is to blame for the 30 million predicted to be left uninsured after implementation of the ACA:
Although Obamacare spends more than $1 trillion to get people covered, CBO predicts it will still leave 30 million Americans uninsured, falling far short of what was promised. CBO's announcement said that Obamacare could cost less than originally projected--but the reason for the drop was that fewer people will be covered. [Heritage Foundation, 7/25/12]
FACT: GOP Obstructionism Is To Blame For Remaining Lack Of Coverage
The Week: The Uninsured Will Include Many Undocumented Workers Who Are Ineligible To Seek Benefits. A full reading of The Week's article linked to in Civitas's post reveals that a large number of the post-ACA uninsured will be undocumented workers who are barred from using the exchanges to buy insurance:
President Obama's signature health-care law is expected to extend coverage to 25 million uninsured people in the U.S. as all of its provisions are implemented over the next decade. But ObamaCare is far from universal -- the nonpartisan Congressional Budget Office estimates that 31 million people will still lack insurance by 2023.
Undocumented workers will make up a growing share of the uninsured, say Sarah Kliff and Lena H. Sun in a Monday article in The Washington Post, because they will be ineligible to buy insurance on new exchanges that are scheduled to go online next month and will extend coverage to 24 million people over the next decade, according to CBO estimates. [The Week, 9/9/13]
Washington Post: The Post-ACA Uninsured Will Be Undocumented Workers And Low-Income Individuals In States That Refuse To Expand Medicaid. The Washington Post explained the post-ACA uninsured will consist of undocumented workers or low-income citizens who live in states where Republican-led legislatures opted out of Medicaid expansion offered under the ACA:
The Affordable Care Act, the most sweeping health care program created in a half century, is expected to extend coverage to 25 million Americans over the next decade, according to the most recent government estimates. But that will still leave a projected 31 million people without insurance by 2023. Those left out include undocumented workers and poor people living in the 21 states, such as Virginia, that have so far declined to expand Medicaid under the statute, commonly called Obamacare. [The Washington Post, 9/8/13]
The Week: 11 Of 15 States With Highest Uninsured Populations Are Planning To Opt Out Of Medicaid Expansion. The Week article cited by Civitas went on to explain that GOP obstruction of Medicaid expansion would prevent 11 of 15 states with the highest uninsured populations from expanding Medicaid:
Republicans in red states, many of whom have bashed ObamaCare as a federal takeover of the health care system, have chipped away at the law by refusing to launch their own exchanges (in those cases, the federal government will simply do it for them). GOP-led state legislatures in 21 states have also declined to expand Medicaid under the law, potentially leaving out millions who were supposed to be brought under theObamaCare umbrella. Those states include 11 of the 15 states with the highest uninsured populations (in order, starting at the top: Texas, Florida, Georgia, North Carolina, Ohio, Pennsylvania, New Jersey, Michigan, Arizona, Virginia, Louisiana, South Carolina, Tennessee, Missouri, and Indiana). [The Week, 9/9/13]
The Washington Post: Republicans Have Fought Extending Benefits To Undocumented Workers And Legalized Immigrants. According to a Washington Post June 17 article, GOP members pushed to obstruct legalized residents from accessing health care, and supported plans that would require undocumented workers to purchase expensive private insurance:
So amidst an effort to pass a comprehensive immigration reform bill meant to help the Republican Party appeal to Hispanic voters, Republicans are making a point of demanding that legalized immigrants can't get Obamacare, and in some cases can't even get emergency care. They're also considering a crushingly punitive version of the individual mandate, in which undocumented immigrants need to purchase private health care on their own, without subsidies, or they can't even become legal residents. And they're refusing to agree to Obamacare's Medicaid expansion in some of the states where it would do Hispanics the most good. [The Washington Post, 6/17/13]