Vice president Joe Biden: “President Obama has increased the benefits available to people on Medicare today by the action he took.”
During a Sept. 28 campaign stop in South Florida, Vice President Joe Biden played up new Medicare benefits under the Affordable Care Act while omitting mention that the ACA has features that may restrict seniors’ ability to access medical services under Medicare.
The Affordable Care Act does add some new Medicare benefits such as free preventive services (some conditions apply):
- Bone mass measurement
- Cervical cancer screening, including Pap smear tests and pelvic exams
- Cholesterol and other cardiovascular screenings
- Colorectal cancer screening (except for barium enemas)
- Diabetes screening
- Flu shot, pneumonia shot, and the hepatitis B shot
- HIV screening for people at increased risk or who ask for the test
- Medical nutrition therapy to help people manage diabetes or kidney disease
- Prostate cancer screening (except digital rectal examinations)
- See the full list of preventive services at Medicare.gov
The ACA also eases costs for prescription drugs, in part by addressing the “donut hole” in Medicare Part D.
And the downside?
Preventive medicine tends to increase costs overall. An individual certainly might save if a screening provides early detection of disease, but a 2008 article in The New England Journal of Medicine shows that most applications of preventive medicine increase costs. It doesn’t benefit seniors if the Medicare program runs out of money, so adding a free preventive care benefit adds a potential concern for Medicare beneficiaries.
The ACA also contains features that may end up limiting seniors’ access to Medicare services. Medicare savings achieved by cutting Medicare Advantage reimbursements will price the benefits of Medicare Advantage out of the reach of some seniors. As it happens, the senior population that signs up for Medicare Advantage is not as healthy as the general Medicare population. In addition, the Independent Payment Advisory Board received power through the ACA to cut physician reimbursements under Medicare. Such cuts automatically create pressure on doctors to provide fewer low-profit services. That, in turn, will start to limit the numbers of seniors who receive those services.
Does the ACA offer a net increase of services for Medicare beneficiaries? The future holds the answer to that question. Meanwhile, the claim from Biden suffers from some ambiguity. Did Biden simply mean to emphasize the new Medicare benefits available through the ACA? If so, his statement is true by that charitable interpretation. Careful parsing of Biden’s words easily allows it.
If Biden intended to say that Medicare beneficiaries receive a net benefit from the ACA, he’s simply giving his opinion. Fact checking such an opinion makes little sense, but we can at least point out the reasons for doubting Biden’s accuracy.
Analyzing the Rhetoric
Here’s the vice president in action via Politico video:
Transcript (starting at about 8:30 of the video; bold emphasis added):
Now, rather than tell you since their convention or even at their convention what their position on Medicare is, they’ve gone out of their way and spent tens of millions, I don’t know, maybe hundreds, I don’t know how much, millions of dollars on advertising telling you what they say our position on Medicare is. Ladies and gentlemen, they say we–folks like me who fought my entire life, public life, to preserve Medicare are somehow prepared to have raided it, and stolen it, and taken money from it in order to do other things.
Nothing could be further from the truth.
So as, there used to be that program some of you will remember, I said this to my staff and they looked at me like “What are you talking about?” But some of you remember that program with Walter Brennan when he was saying “Ain’t brag, ma’am, just fact.”
Not a single woman’s nodding her head. I know all you guys (unintelligible) but you know what I’m talking about.
Well, look, just look at the facts. Everyone knows, all of you in this room know, that President Obama has increased the benefits available to people on Medicare today by the action he took. You are now able to go and get a wellness exam if, guys, if you conclude you need a colonoscopy because of the feeling you have or you need a breast health examination or if you need you don’t have to pay copay for it.
If you’ve approached that and hit that donut hole, if you’re in that category, you’re saving, senior citizens are saving $700-$800 a month because of what the president did.
And the other thing that people may not know is that the action that the president took with regard to Medicare has made the system solvent, the trust fund solvent, through 2024. And ladies and gentlemen, next time one of your Republican friends says “This is what they did,” ask them the rhetorical question, I realize it’s an appeal to authority, one of the logical fallacies as we learned in graduate, undergraduate school, but ask them the question “If that’s true, why has the American Medical Association endorsed what the president did? Why has the American Hospital Association endorsed it? And why, why has AARP endorsed it?”
And ladies and gentlemen, as I said, our Republican opponents like to give a mistaken view of what we’re for and they won’t tell you–let me tell you what they’re for. And as they say, you know, this’ll be fact checked. Check it. First of all, if the plan they’re proposing were to come to fruition in January or February of 2013, immediately those folks in the donut hole would have to pay $800 more for their prescription drugs. Immediately, those co-pays would be back for wellness visits. Immediately, what would happen is, the solvency of the program would recede and be insolvent by 2016. In three years. And what they don’t tell you, what they really don’t want to talk about, is how they fundamentally change Medicare.
The Republican “plan they’re proposing” is apparently the plan to repeal the ACA. The consequences Biden cites regarding the cost of prescription drugs and co-pays for wellness visits match the benefits Biden claims are added by Mr. Obama through the ACA.
Biden leaves out a great deal in his description.
Biden’s key omission concerns the method the ACA uses to achieve savings. Cutting reimbursements, as noted, puts pressure on providers to limit providing less profitable services. Perhaps more importantly, the methods the ACA tries to use to save money may simply fail to work. Here’s how the actuarial office of the Centers for Medicaid and Medicare Services puts it:
(T)he long-range implications of the productivity adjustments mandated by the Affordable Care Act are very uncertain, but they could have serious consequences for the Medicare program if left unchanged. Likewise, the large reductions in Medicare payments rates to physicians would likely have serious implications for beneficiary access to care; utilization, intensity, and quality of services; and other factors.
Most of the problems the actuaries warn about occur after the projected insolvency of the Medicare trust fund in 2024. But the actuaries take special care to emphasize the uncertainty about the effects of the ACA. Nobody knows exactly what will happen. The Congressional Budget Office predicted that fewer seniors would sign up for Medicare Advantage. Later in his speech Biden claims that more seniors are signing up for Medicare Advantage. But the projections for savings to Medicare are partly built on the expectation that overall Medicare Advantage reimbursements will drop. Increased use of Medicare Advantage may increase overall costs even with lower reimbursement rates.
Rhetorically, Biden cherry-picks his data. He presents to his audience the facts favorable to the Obama/Biden ticket and obscures the ones more favorable to the Romney/Ryan ticket.
“Medicare Preventive Services.” HealthCare.gov. U.S. Department of Health and Human Services, n.d. Web. 7 Oct. 2012.
Cohen, Joshua T., Ph.D., Peter J. Neumann, Sc.D., and Milton C. Weinstein, Ph.D. “Does Preventive Care Save Money? Health Economics and the Presidential Candidates.” The New England Journal of Medicine. Massachusetts Medical Society, 14 Feb. 2008. Web. 7 Oct. 2012.
Robertson, Lori. “A Campaign Full of Mediscare.” FactCheck.org. The Annenberg Public Policy Center, 22 Aug. 2012. Web. 7 Oct. 2012.
“Projected Medicare Expenditures under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers” Centers for Medicare and Medicaid Services. Web. 7 Oct. 2012.
“Comparison of Projected Enrollment in Medicare Advantage Plans and Subsidies for Extra Benefits Not Covered by Medicare Under Current Law and Under the Patient Protection and Affordable Care Act” Congressional Budget Office letter to John Boehner. 24 July 2012. Web. 7 Oct. 2012.