The controversial Affordable Care Act (aka ObamaCare) endures many attempts at repeal, along with masses of misinformation from those who'd benefit from its demise, financially or politically. Yet, it's the law, having passed both Congress and the Supreme Court.
While not perfect, it'll improve health care access. People on Medicare, Medicaid, or employer group plans do not have to shop in the new health Marketplace.
So, let's look at its impacts on seniors aged 65 and over, since most have focused on impacts for those under age 65.
* Closing the Medicare Part D Rx gap or "Donut hole". From 2010-2020, ACA’s reducing the amount seniors on Part D Medicare pay for prescriptions once they get in the gap. 6.6 million folks on Medicare have already saved over $7 billion via ACA. They're now paying 47.5 percent of the plan's gap costs for brand names and 78 percent of generic Rx costs in 2013, reducing to virtually nothing in 2020.
* Preventive Services. ACA increases use of preventive services, lowering health costs for all, with no co-pays to seniors. Included are annual wellness exams, heart, colon, prostate, mammography, diabetes, bone density, other screenings. Also covered are smoking cessation, alcohol misuse counseling, vaccinations. Additional diagnostic tests or treatments are subject to insurance co-pays.
* Extending Medicare Solvency. ObamaCare extends Medicare Solvency from 2016 to 2024. The term "solvency" means when Medicare will start to spend more money than it takes in. It does not mean the program would end then. ACA already raises Part A taxes on wages by 0.9 percent on earnings over $200,000 for individuals and $250,000 for couples; it also raises a 3.8 percent tax on non-wage income i.e., dividends, interest, rents etc. Removing the cap on Medicare taxes for wages over $113,700, would extend Medicare solvency for 75 years.
ObamaCare reduces Medicare spending growth from 6.8 percent now, to 5.5 percent annually, per the Kaiser Family Foundation, resulting in $716 billion in savings. This will not reduce benefits to seniors as misstated by some, but via over payments to hospitals, reducing hospital payments for seeing uninsureds, lower payments to medical equipment and home care, reducing subsidies to Medicare Advantage plans, the rest savings from waste, fraud and abuse.
* Reducing Medicare Advantage plan subsidies. "Advantage" plans (HMOs, PPOs etc) get around 14 percent federal subsidies that traditional Medicare Supplement plans do not. Yet they've not been very successful in driving down health costs; subsidies have averaged approximately $1,000 monthly for each member. ACA is supposed to cut subsidies to advantage plan but lobbyists and allies successfully delayed this for 2014. These plans threaten to privatize Medicare, costing seniors many more $billions for their health care later.
* ObamaCare includes the Elder Justice provisions requiring more disclosure from nursing homes, also making comparisons between them available for seniors and their families. There is also funding available for medical students to help fill future medical provider shortages.
Oregon Birthday Rule (non ACA law). The ACA eliminates pre-existing health conditions and underwriting questions only for those under age 65. Starting in 2013, State Insurance Department rules allow Oregonians on Medicare supplements to switch to the same or lesser plan without any health questions within +/-30 days of their birthday, to save premium. Medicare supplements with health questions are still available year round.
ObamaCare/ACA brings a number of changes to help seniors improve health coverage and lower health care costs. Check with health insurance agents, SHIBA volunteers, navigators from Cover Oregon, accountants, CMS Medicare, other sources for details and information. Despite the loads of misinformation, ObamaCare is what we have now, to make the best of. The various effects of Obama Care on those under age 65 will be addressed later.