by Ron Pollack
(Editor's Note: Ron Pollack is the executive director of Families USA, the national organization for health care consumers. Families USA advocates for universal, affordable, quality health care.)
At the end of March, the Supreme Court will review the constitutionality of the Affordable Care Act (the 2010 health care law), and the rhetoric has been flowing fast and furious. I happen to think the law is constitutional -- but I'm going to leave the legal analysis for another time and place. Instead, I want to focus on some facts: what the law does for older Americans and what might happen if those challenging the law get their way. The opponents of the law say the court should toss out the whole thing, even sections of the law that are already in effect and working. And that's where it gets very interesting for older Americans, especially for those who rely on Medicare.
Under the law, the infamous gap in the Medicare prescription drug benefit (known as the "doughnut hole") is gradually closing. In 2011, about 3.6 million Medicare beneficiaries with substantial prescription drug costs saved a total of $2.1 billion on drugs compared to what they would have paid without the law. The average Medicare beneficiary is on track to save almost $4,200 by 2021. But if the court strikes down the law, the doughnut hole will re-open. That will increase seniors' prescription drug costs, hitting people with high drug costs the hardest.
Medicare's preventive benefits are also better thanks to the law. Medicare now covers most preventive services without a deductible or coinsurance. This is part of the broader shift to use Medicare to help keep people well, not just cover care when they get sick. Potentially life-saving services, like mammograms, prostate cancer screenings, cholesterol testing, and now obesity counseling are covered free of charge. Without the law, Medicare's coverage for many of these services will be reduced and out-of-pocket costs will go up.
Thanks to the Affordable Care Act, Medicare's other out-of-pocket costs (premiums and coinsurance) are also lower than they would be otherwise. The law slows down the growth in payments to hospitals and other health care providers. It also encourages doctors and hospitals to work together better, to cut down on unnecessary tests and avoid unnecessary readmissions. These kinds of changes will save Medicare billions over the coming years, and those savings are passed on to seniors through smaller increases in premiums and coinsurance. Getting rid of the law will halt progress just as it gets started.
Beyond Medicare, many other improvements that matter to older Americans are at risk if the court strikes down the law. If you need long-term care through Medicaid, changes in the law make it easier to get help in your home, rather than having to move to a nursing home. And if you (or your loved one) someday do need care at a nursing home, the law helps make sure you're safe by expanding background checks for nursing home employees and making better information about nursing home quality available to everyone. All those protections will be gone if the court strikes down the law.
And of course, for those of us who don't have Medicare coverage yet, as well as for our children and grandchildren, the law provides a host of much-needed protections, like making health care coverage more affordable and prohibiting insurance companies from discriminating against people with pre-existing conditions. Those protections are very much in jeopardy at the Supreme Court.
There's no way to know what the Supreme Court will decide when it takes up the Affordable Care Act case. But one thing's for sure -- we all have a stake in the outcome.