According to Medicare’s Office of the Actuary (that’s in the department of Health and Human Services) The Affordable Care Act (TACA aka Obamacare) may have serious side effects on American’s health and wallet (via AP).  But don’t forget, in order to be a winner with TACA, you have to think like a winner.  And have hope.

  • Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, “possibly jeopardizing access” to care for seniors

But here is where the thinking like a winner comes into play. Post TACA you might not have a hospital or other providers.  But it still counts as a win because you haven’t lost your Medicare coverage.  And Medicare has been expanded to others so that is another win.  See Win/Win.  (But just to be safe, hope you don’t live near that 15%.)

  • new voluntary long-term care insurance program created under the law faces “a very serious risk” of insolvency

So if you buy into TACA’s long-term care insurance you’ll have a card – expanded coverage (win), but a bankrupt insurance that can’t pay for the care.  That means no outgoing expenses which will keep costs down (win). See another Win/Win. (But just to be safe, hope it stays solvent.)

  • reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular alternative. Enrollment would plummet by about 50 percent. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.

If you had Medicare Advantage, but post TACA you have higher out-of-pocket costs the thing to do is remind yourself it is only money.  The important thing is you won’t lose care (win) and you still have a coverage (win). (And then hope the out-of-pocket cost magically disappear.)

  • cost-control measures in the bill — Medicare cuts, a tax on high-cost insurance and a commission to seek ongoing Medicare savings —couldhelp reduce the rate of cost increases beyond 2020. …During 2010-2019, however, these effects would be outweighed by the increased costs associated with the expansions of health insurance coverage”

In the short term we are screwed.  But it’s only 10 years. (win)  So close your eyes and think of happy things (win).  Bet you thought this one would be a toughie!  (Then just hope the “could” helps to reduce and not increase cost.)

  • [TACA] will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. … total health care spending during the decade is estimated to surpass $35 trillion.

The increase is actually less than 1 % (win) and it is only in the billions, not the trillions (win).  (So just hope everyones calculators were working properly when they were adding up all those billions and trillions.)

  • “… the longer-term viability of the Medicare … reductions is doubtful.”

Well, then you don’t have to worry about that 15% of hospitals and medical providers that would be jeapordized by the cuts (win), and if TACA costs sky-rocket like the Drug program, they’ll have to do a reform.(win)  (And you can hope we have a new and improved congress by then that actually knows how to reform.)

Now wasn’t it fun to think like a winner and have hope?

Still I wondered what the White House’s had to say about the  report.  As you might guess, despite coming from within the HHS this report  didn’t carry the White House seal of approval. In fact:

The report from Medicare’s Office of the Actuary carried a disclaimer saying it does not represent the official position of the Obama administration. White House officials have repeatedly complained that such analyses have been too pessimistic and lowball the law’s potential to achieve savings.

So what is the White Houses take? From the White House Blog:

“…the Actuary’s report is little changed from a previous report issued months ago by the same office…”

Then the WH blog offer up a piece from TIME Magazine on the same report which concedes that:

The health reform law will increase overall spending in the near future because more people will have insurance and therefore access to medical care. Those who are now going without care because of cost will, post-implementation of reform, seek care, insurance or Medicaid card in hand. Reductions in Medicare reimbursements to providers may cause some to limit the Medicare patients they accept; future cuts to Medicare reimbursements called for in the bill may never happen due to political pressure; the long-term care insurance program created by the law may be unsustainable.

What is not to love in all this up side.  So many millions more with card in hand able to seek care.  See we are that close to expanded care.  I mean card is almost the same as care – you only have to change one letter .  I do it all the time by accident when I’m typing.

And then the Time piece, that the White House blog quoted, quotes Ezra Klein:

In 2019, implementation of the Affordable Care Act will reduce the ranks of the uninsured by 34 million people and increase nation health expenditures by 1 percent.

One percent.

And that 1 percent is actually 1 percent and falling: When the legislation is fully implemented in 2016, the spending increase will be 2 percent. But cost controls kick in over those years and bring it down to 1 percent. Assuming the trend holds, the second decade will see national health expenditures fall below what spending would’ve been if the bill hadn’t passed. So that’s the bottom line of the report: We’re covering 34 million people and come 2019, spending is expected to be one percentage point — and falling — above what it would’ve been if we’d done nothing.

I like that math.  It’s the winning kind of math that gave us millions of  “jobs saved” that wouldn’t have been saved without the stimulus.  I particularly liked the falling 2 that is really a 1, after 10 years – if all goes well.  So, we ‘ll just call it a one.  It’s easier.  (So just hope that the extra 1% won’t kill your working family budget, along with unemployment and underemployment .  And also hopethat the 2% isn’t 3% or a 4%in 2014.  Cause they didn’t say, and that would be a bummer.  And, wow, this Klein guy is really hopeful.)

Then the Time piece goes back to their own reporting with:

The bottom line is that no one knows for sure if health reform will “bend the curve” of increasing medical spending. The law will experiment with cost controls that economists and health policy experts think could curb spending, but there’s little certainty and a lot of politics likely to interfere while reform is being implemented and tweaked.

Its a grand experiment and we all get to be a part of it – tweaks and all.  Aren’t we lucky.  We can keep thinking like winners and having hope for years to come.  Boy, life is good.

And that’s where the White House blog post ends.  So in the end their response all boils down to …

“…the Actuary’s report is little changed from a previous report issued months ago by the same office…”

That is their story and they are sticking to it.

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[Cross posted at No Quarter]

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