Rhetoric to Reality: Obamacare Repeal and Medicare

Introduction: Selective Exposure Theory

There is a theory in psychology called “selective exposure theory.” As it relates to media consumption, it refers to the tendency to select media that confirms your own ideas while avoiding contrary information.

Finding a non-partisan, balanced perspective of the ACA repeal debacle is challenging, to say the least. If you have any suggestions for resources to better inform this research, please let us know!

Background: Media Flip

For years the media focused on all the disappointments of the Affordable Care Act (commonly referred to as ACA or Obamacare). Now that the ACA is in jeopardy, the press and the public are changing the tone of the conversation. The indecisiveness and friction within the federal government is fueling the fears of the public, the experts and the press. The prospect of a repeal with no replacement is almost universally abhorrent to healthcare experts.

The following is an attempt to provide clear, non-partisan and well-researched answers to key questions surrounding the ACA repeal.

Answers to Questions

Q: What is the status of the ACA Repeal?

A: This is a fairly simple question, but every day, sometimes every hour, something new is happening in D.C. As of February 1, 2017, there was been a stalling of action. Republicans are frustrated at the lack of progress. This week, the language Republicans are using has started to soften to “Repeal and REPAIR.” Sen. Lamar Alexander, R-Tenn, said the following:

“I think of it as a collapsing bridge. . . . You send in a rescue team and you go to work to repair it so that nobody else is hurt by it and you start to build a new bridge, and only when that new bridge is complete, people can drive safely across it, do you close the old bridge,” Alexander said.

“When it’s complete, we can close the old bridge, but in the meantime, we repair it. No one is talking about repealing anything until there is a concrete practical alternative to offer Americans in its place.”

Q: What is going to replace the ACA, if it is repealed?

A: There have been many proposals, of varying specificity. Senator Rand Paul has one that sounds interesting and thorough. There are many more out there.

UPDATE: The Chicago Tribune reported Friday that Republicans revealed four drafts of bills before a House health panel. “One would let insurers charge older customers higher rates. Another would replace the law’s unpopular individual mandate with a requirement that people maintain ‘continuous’ coverage if they want to avoid more expensive policies.”

Q: What is so bad about repealing the ACA without a replacement strategy?

A: Here is just a sampling of some portents of doom found in the top pages of a Google Search of the topic:

  • “ACA Repeal Would Be Devastating In Ky.”
  • “Repealing The Affordable Care Act Will Kill More Than 43,000 People…”
  • “ACA Repeal Could Cost Idaho $20M Per Year”
  • “Repealing The ACA Could Worsen The Opioid Epidemic”
  • “ACA Repeal Will Cost More Than A Million Jobs”
  • “ACA Repeal Puts Cancer Patients At Risk”
  • “Not Even Insurance Companies Want Obamacare Repealed”
  • “Most Doctors Who Voted For Trump Don’t Want Obamacare Repealed”

    Screenshot of my Google search

We were unable to find recent, positive forecasts for repeal, if there is no agreed-upon
replacement. If there are any, they are buried deeply in the Internet dungeons. All of the Medicare advocates I have seen are opposed to the repeal as long as there is no replacement. The AARP, a strong voice in the Medicare arena, opposes any cuts to Medicare, and is launching a massive campaign to protect Medicare rights.

 Q: What are the benefits of repealing the ACA, if there is a replacement?

A: The actual benefits of repealing ACA (assuming a good replacement) appear to be mostly financial. The repeal would save some Americans money (especially younger, healthier people). It would save the government (and tax payers) money. It would save insurance companies money (maybe). Right now 4 million people are choosing to pay the penalty rather than sign up for health care. Presumably, repealing ACA would let patients shop around for more personalized coverage and force insurance companies to be competitive with their pricing.

On his campaign site, Donald Trump stated that Obamacare has resulted in “runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.”

Theoretically, the ACA would be replaced by a better system that follows “free market principles” and give more power to the states to decide on how to handle Medicaid coverage. Trump’s position also implies that healthcare costs will go down by cracking down on illegal immigration and bringing jobs back to America.

These benefits are highly disputed.

Q: How would the repeal affect Medicare?

A: It depends on if it is replaced, and what replaces it. There are many different premonitions about how repeal of the ACA would affect folks on Medicare. The basic qualifications to receive Medicare will most likely not be changed right away. But newer perks, like free preventive screenings, may possibly be cut.

Other benefits may be cut that affect people on Medicare. CNN ran a piece about Trump supporters – coal miner families, in this case – who are worried Trump is betraying their trust. Trump promised to bring back mining jobs, but there are provisions in the Affordable Care Act that help them claim Black Lung Disease disability benefits (financial and medical), by shifting the burden of proof away from the victim. One retired coal miner with black lung said, “When they eliminate the Obamacare, they may just eliminate all of the black lung program. It may all be gone. Don’t matter how many years you got.”

Medicare recipients could also expect to other recent improvements disappear, such as the shrinking of that gap in drug coverage that we call “the doughnut hole.”

Conclusion

Nothing is set in stone yet. Congress is in disarray over the ACA repeal. If a good replacement is found for the ACA, then a large group of people may find themselves with better options. However, there is no such thing as “free money” or “free health care.” Any new plan will probably benefit some people at the expense of other people. Someone will feel robbed. The question is, who?

Present Medicare recipients are fairly safe, but Medicare may end up less attractive in the long run, unless a new plan takes special care with Medicare-related benefits.

It is fairly safe to say that Congress needs to get its act together and plan properly before forcing a repeal through. Their obviously erratic behavior is creating public fear to the point of mass hysteria. The worst-case-scenario headlines by the press are fueling this panic in the public.

We at Medicare World will continue to advocate for the Medicare community by bringing relevant news and information in an easily accessible format.

Other Sources

In addition to the citations within this article, here are some other websites with interesting or useful information.


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