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If Health Care Reform Unravels

Critics want to scuttle the new law. What happens if they succeed?

Steel chain held together with red string

— Pier/Getty Images

"You really can't pick and choose elements of this very complex package to preserve or to eliminate," Reischauer says. "It hangs together as a whole. Stripping out the individual mandate or the exchanges or the subsidies would leave a chaotic structure."

Gutting the law of measures designed to reduce the upward spiral of medical costs over time would also have a negative effect on the federal deficit, Social Security and Medicare. With those cost-saving measures in place, projected savings would shave $143 billion from the deficit by 2019, according to the nonpartisan Congressional Budget Office. Medicare's solvency would be extended by 12 years.

And because tax-free employer insurance premiums are expected to go down under the new law, leaving employees with more taxable earnings, the recent trustees' report predicted a somewhat rosier picture for Social Security's health over the next 75 years "than would occur in the absence of the legislation." But the reverse is true if the law is repealed, says AARP's Rother. "If costs are not restrained, then more of your income goes to health care and less to Social Security payroll taxes, and that hastens the financial exhaustion of Social Security pretty dramatically."

Democrats and Republicans can both cite public opinion polls to support their positions, because Americans are fairly equally divided for and against the law. "Of those with a view, half want to go ahead, implement the law and even strengthen it, and half don't," says Robert Blendon, a public opinion expert and a professor at Harvard University. "And currently the half that don't are likely to vote Republican."

These findings are muddied, though, by recent polls showing widespread misunderstanding of what the law actually says. More than a third of people 65 and older think it would allow a government panel to make decisions about end-of-life care — the "death panels" coined by Sarah Palin — and half think it would cut benefits to everyone on Medicare, according to a survey by the Kaiser Family Foundation. In fact, the law does neither.

"Right now, people are making a judgment about what they hear about the law," often gleaned from misinformation spread by its critics, says Drew Altman, the foundation's president. "But at some point the public judgment will be based on what tens of millions of people actually experience as a result of what's in the law."

In that context, though, the Democrats may not have time on their side. The law's main provisions, for better or worse, do not go into effect until 2014, long after the 2010 midterm elections, after the 2012 presidential election and after the lawsuits have begun working their way through the courts.

Patricia Barry is a senior editor of the AARP Bulletin who covers Medicare and health policy issues.

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