En español | The looming presidential election is heating up the rhetoric on health care reform. But how much of it is true?
“The amount of misinformation about the Affordable Care Act [ACA] — including outright lies — is astonishing,” says Shana Alex Lavarreda, Ph.D., director of health insurance studies at the UCLA Center for Health Policy Research. “The point of the law is to make the health system better for each person, for less cost to society overall.”
But myths about the ACA abound. Some of the most persistent:
MYTH 1: The new law cuts Medicare drastically, so I won't be able to get quality health care.
The Affordable Care Act (ACA) in fact prohibits cuts to guaranteed Medicare benefits. There are provisions in the law to help curb the soaring costs of Medicare, but savings will come from reining in unreasonable payments to providers, taxing high-premium plans (beginning in the year 2018), cracking down on fraud and waste, and encouraging patient-centered, coordinated care, says Sara R. Collins, Ph.D., vice president of the Commonwealth Fund, a private research foundation focused on health care.
The ACA also covers preventive care designed to avert chronic conditions like heart disease and diabetes, which currently cost billions. Medicare beneficiaries get an annual wellness exam as well as numerous screenings and vaccines free of charge. The new system also improves coordination of care between doctors, nurses and other providers to prevent harmful and costly hospital readmissions.
Finally, the law closes the infamous Medicare Part D prescription drug "doughnut hole," in which Medicare beneficiaries paid full price for prescription drugs after exceeding a certain dollar limit each year. Now enrollees who reach the doughnut hole get large discounts, and by 2020, the hole will close.
MYTH 2: I've heard that Medicare Advantage plans will be cut or taken away.
The ACA does not eliminate Medicare Advantage plans, which are privately administered plans that provide benefits to about a quarter of Americans with Medicare. These plans were created to bring market efficiencies to Medicare, but they actually cost taxpayers 14 percent more per enrollee than the traditional Medicare program does. The ACA aims to bring costs back into line.
"The plans are still required to provide at least the same benefits as those available through traditional Medicare plans," says Stuart Guterman, vice president of the Commonwealth Fund. "And for the first time, the law ensures that plans that perform better will be paid better, so the care they provide should improve."
MYTH 3: I'll have to wait longer to see my doctor — or I won't be able to see my doctor at all.
"If your current plan allows you to see any physician in the plan, nothing will change," says UCLA's Lavarreda. Health plans are already building bigger networks in anticipation of new patients, so choices could be even greater.
Although the law doesn't specifically address wait times, many of its provisions are aimed at improving quality of care, including some that encourage more physicians to become primary care doctors.
MYTH 4: If I have Medicare, I will need to get more or different insurance.
Some people have confused the ACA's "individual mandate" with a requirement to obtain additional insurance on top of Medicare. "That's just not accurate," says Guterman. "Medicare beneficiaries will continue to have Medicare, and there's no requirement that they get additional coverage beyond what they already have."