By Lisa Zamosky
In the days following the Supreme Court’s decision about the Affordable Care Act, readers submitted many questions about the law in an effort to understand how their health care will be directly impacted.
One question came up repeatedly and reflects a deep concern many people have about the possibility of limits being placed on their medical treatment. The question: Will a panel limit medical procedures for seniors?
The answer is a definitive no. But given the apparent widespread belief that the law intends to cut access to medical care for older Americans – presumably with the goal of saving money – a deeper look at the origin of this idea, and why aspects of law have led seniors to believe the government is out to reduce their medical care, seems warranted.
Talking About End-of-Life
An early version of the Affordable Care Act included a provision that would have reimbursed doctors who counseled their Medicare patients about end-of-life treatments.
Why reward doctors who discuss these issues with their patients? There are a few reasons.
First, billions of dollars are spent each year on aggressive medical procedures to treat people with terminal illness in the last days of life. In 2010, the Centers for Medicare and Medicaid Services estimate that 5% of the beneficiaries who die each year take up 30% of the annual Medicare budget. What’s more, studies have shown that the care delivered at the end of life usually provides no greater chance of survival.
Perhaps more importantly, patients who understand their treatment options have a tendency to choose those that are less invasive. Most people don’t realize, for example, that when kept alive on a breathing machine, they’re unable to talk to their loved ones.
The idea behind this provision, then, was to educate patients about their options so they could make an informed decision and take some control over how they spent the last days of their lives.
Due to controversy, this provision was ultimately removed and did not make its way into the final version of the bill.
Birth of the Panel
The second part of the law that has contributed to the belief that seniors’ health care will be limited by the Affordable Care Act is the creation of something called an Independent Payment Advisory Board (IPAB).
The goal of this 15-member board is to develop ways of reducing the growth of Medicare spending, such as cuts to provider reimbursement. Unless Congress acts to amend or block IPAB proposals with a two-thirds majority, they would go into force automatically.
Republicans have called the IPAB a “rationing board,” and “the real death panel” – a term that originated with Alaska Gov. Sarah Palin, who is opposed to the Affordable Care Act. The fear is that the board would both end up rationing medical care and override Congressional authority.
In fact, the law clearly prohibits the board from recommending actions that would “include any recommendation to ration care, raise revenues or Medicare beneficiary premiums, increase cost-sharing, restrict benefits, or alter eligibility,” according to a report out this March by the Congressional Research Service.
Here’s what we know for a fact does exist for Medicare beneficiaries as a result of the law so far.
Since 2010, more than 5 million seniors who entered the gap in Part D prescription drug coverage known as the “donut hole” have saved $3.7 million on prescription drugs.
More than 32 million Medicare beneficiaries have taken advantage of preventive medical services, such as annual wellness visits, cancer and other health screenings, with no annual deductibles, co-pays, or coinsurance.
The fact is that conversations about medical costs and how to reduce our out-of-control health care spending are controversial, but necessary, if we’re to preserve Medicare for today’s seniors and future generations. Reasonable people can reasonably disagree about how to best achieve this.
But death panels, well, they simply don’t exist.
Share your thoughts: What have you heard about the Affordable Care Act that scares you? Sound off in the comments section below.