Posted on 01 April 2010
By Mark Miller
I received several notes from people who opposed health care reform, but are beginning to change their minds. Then, of course, several people called me a liar, a socialist or worse. To coin a phrase: People, can we all get along?
Here’s a sampling of your questions, comments and rants on health care reform:
Q: I feel that you are not being honest with your readers when you make light of the serious cuts to Medicare that are coming. For example you don’t mention Medicare cuts to inpatient psychiatric hospitals coming in 2010. Neither do you mention the 2011 Medicare cuts to home health care. Nor do you speak of Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT scans, etc. coming in 2011. There will also be cuts in ambulance services, diagnostic labs and durable medical equipment in 2011. All these will dramatically affect seniors who have paid their dues all these years and shouldn’t have to be shortchanged like this. – B.B., via the Internet
A: Medicare is a huge, complicated program, and it is on rocky financial ground. The new law doesn’t cut the basic benefits of traditional Medicare and it contains some important new preventive care benefits.
At the same time, it’s true that the payment reforms you mention are taking place. Some are linked to the new health care law, but they are part of a larger movement to reform how health care is delivered and how it is paid for. Many of these changes pre-date the new health reform law. For example, the Medicare Prescription Drug Improvement and Modernization Act of 2003–a Republican-sponsored bill that was signed by President George Bush–established the bidding program for durable medical equipment. Many of these payment reforms also seek to reduce fraud, waste and abuse.
Q: I’m one of those people who has been opposed to the healthcare reform legislation recently passed and have to admit that the more I read, the less threatened I feel. I am 68 and currently enrolled in a Medicare Advantage program with which I’m quite pleased; having said that, this year my co-pays and deductibles have been raised–some by 20 percent, which is quite annoying.
Let me point out one aspect of a government bureaucracy’s involvement in my healthcare that leaves me suspicious and concerned (albeit perhaps irrationally). In your article, you mention doctors receiving incentives for joining “accountable care organizations.” I would love it if you could allay my concerns that a disconnected organization, manned by bureaucrats, will always operate strictly with the benefit of the patients as their main objective. Who will staff these organizations and who will proffer their objectives and guidelines? – J.G., via the Internet
A: It’s not mandatory for doctors to join ACOs under the new law, and the intent is to create a patient-centered program. This is an experiment; the law establishes some basic requirements for an organization to be considered an ACO, but details remain to be ironed out. The idea here is to prevent adverse health events that may occur because in the current system there is no incentive for follow-up care. The hope is that having better coordination of care will help people avoid incidents such as re-hospitalizations.
Q: It was my understanding that health insurance companies couldn’t turn away applicants for a pre-existing condition starting in 2014, except for children, which would take effect in six months. You wrote that it starts this year. Which is correct? – D.M., via the Internet
A: You are correct–only children will be protected this year (six months from the date the bill was signed). Everyone else will have to wait until 2014 for this important protection to kick in. In the meantime, people with pre-existing conditions can join the high risk pools that will be created by the federal government, starting this summer.
Q: I have a 19-year-old adopted son. I’m 67 and have a Medicare Advantage Plan. Does the new health care reform law allow for my son to be covered by my plan until he reaches age 26? Currently, his insurance ends September 30, 2010. – P.G., via the Internet
A: The new law allows parents with private insurance plans to keep their children on their plans until age 26. Medicare Advantage plans are private but they are subject to Medicare rules. So, your son is not eligible for coverage under your plan.